24680 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 411, 412, 413, and 489 

[CMS–1533–P] 

RIN 0938–AO70 

Medicare Program; Proposed Changes 

to the Hospital Inpatient Prospective 

Payment Systems and Fiscal Year 2008 

Rates 

AGENCY: Centers for Medicare and 

Medicaid Services (CMS), HHS. 

ACTION: Proposed rule. 

SUMMARY: We are proposing to revise the 

Medicare hospital inpatient prospective 

payment systems (IPPS) for operating 

and capital-related costs to implement 

changes arising from our continuing 

experience with these systems, and to 

implement certain provisions made by 

the Deficit Reduction Act of 2005 (Pub. 

L. 109–171), the Medicare 

Improvements and Extension Act under 

Division B, Title I of the Tax Relief and 

Health Care Act of 2006 (Pub. L. 109– 

432), and the Pandemic and All-Hazards 

Preparedness Act (Pub. L. 109–417). In 

addition, in the Addendum to this 

proposed rule, we describe the proposed 

changes to the amounts and factors used 

to determine the rates for Medicare 

hospital inpatient services for operating 

costs and capital-related costs. We also 

are setting forth proposed rate-ofincrease limits for certain hospitals and 

hospital units excluded from the IPPS 

that are paid in full or in part on a 

reasonable cost basis subject to these 

limits or that have a portion of a 

prospective payment system payment 

based on reasonable cost principles. 

These proposed changes would be 

applicable to discharges occurring on or 

after October 1, 2007. 

In this proposed rule, we discuss our 

proposals to further refine the diagnosisrelated group (DRG) system under the 

IPPS to better recognize severity of 

illness among patients—for FY 2008, we 

are proposing to adopt a Medicare 

Severity DRG (MS–DRG) classification 

system for the IPPS. We are also 

proposing to use the structure of the 

proposed MS–DRG system for the LTCH 

prospective payment system (referred to 

as MS–LTC–DRGs) for FY 2008. 

Among the other policy changes that 

we are proposing to make are changes 

related to: Limited revisions of the 

reclassification of cases to proposed 

MS–DRGs, the proposed relative 

weights for the proposed MS–LTC– 

DRGs; the wage data, including the 

occupational mix data, used to compute 

the wage index; applications for new 

technologies and medical services addon payments; payments to hospitals for 

the indirect costs of graduate medical 

education; submission of hospital 

quality data; provisions governing 

application of sanctions relating to the 

Emergency Medical Treatment and 

Labor Act of 1986 (EMTALA); 

provisions governing disclosure of 

physician ownership in hospitals and 

patient safety measures; and provisions 

relating to services furnished to 

beneficiaries in custody of penal 

authorities. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on June 12, 2007. 

ADDRESSES: In commenting, please refer 

to file code CMS–1533–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/eRulemaking. Click 

on the link ‘‘Submit electronic 

comments on CMS regulations with an 

open comment period’’. (Attachments 

should be in Microsoft Word, 

WordPerfect, or Excel; however, we 

prefer Microsoft Word.) 

2. By regular mail. You may mail 

written comments (one original and two 

copies) to the following address ONLY: 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–1533– 

P, P.O. Box 8011, Baltimore, MD 21244– 

1850. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments (one 

original and two copies) to the following 

address ONLY: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–1533–P, Mail Stop C4–26–05, 

7500 Security Boulevard, Baltimore, MD 

21244–1850. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786– 

7195 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201, or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal Government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submission of comments on 

paperwork requirements. You may 

submit comments on this document’s 

paperwork requirements by mailing 

your comments to the addresses 

provided at the end of the ‘‘Collection 

of Information Requirements’’ section in 

this document. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Marc Hartstein, (410) 786–4548, 

Operating Prospective Payment, 

Diagnosis-Related Groups (DRGs), 

Wage Index, New Medical Services 

and Technology Add-On Payments, 

and Hospital Geographic 

Reclassifications Issues 

Tzvi Hefter, (410) 786–4487, Capital 

Prospective Payment, Excluded 

Hospitals, Graduate Medical 

Education, Critical Access Hospitals, 

and Long-Term Care (LTC)–DRG 

Issues 

Siddhartha Mazumdar, (410) 786–6673, 

Rural Community Hospital 

Demonstration Issues 

Sheila Blackstock, (410) 786–3502, 

Quality Data for Annual Payment 

Update Issues 

Thomas Valuck, (410) 786–7479, 

Hospital Value-Based Purchasing 

Issues 

Jacqueline Proctor, (410) 786–8852, 

Disclosure of Physician Ownership in 

Hospitals and Patient Safety Measures 

Issues 

Fred Grabau, (410) 786–0206, Services 

to Beneficiaries in Custody of Penal 

Authorities Issues 

SUPPLEMENTARY INFORMATION: 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code CMS–1533–P 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24681 

and the specific ‘‘issue identifier’’ that 

precedes the section on which you 

choose to comment. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http://www.cms.hhs.gov/ 

eRulemaking. Click on the link 

‘‘Electronic Comments on CMS 

Regulations’’ on that Web site to view 

public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–800–743–3951. 

Electronic Access 

This Federal Register document is 

also available from the Federal Register 

online database through GPO Access, a 

service of the U.S. Government Printing 

Office. Free public access is available on 

a Wide Area Information Server (WAIS) 

through the Internet and via 

asynchronous dial-in. Internet users can 

access the database by using the World 

Wide Web; the Superintendent of 

Documents’ home page address is 

http://www.gpoaccess.gov/, by using 

local WAIS client software, or by telnet 

to swais.access.gpo.gov, then login as 

guest (no password required). Dial-in 

users should use communications 

software and modem to call (202) 512– 

1661; type swais, then login as guest (no 

password required). 

Acronyms 

AHA American Hospital Association 

AHIMA American Health Information 

Management Association 

AHRQ Agency for Health Care Research and 

Quality 

AMI Acute myocardial infarction 

AOA American Osteopathic Association 

APR DRG All Patient Refined Diagnosis 

Related Group System 

ASC Ambulatory surgical center 

ASP Average sales price 

AWP Average wholesale price 

BBA Balanced Budget Act of 1997, Pub. L. 

105–33 

BBRA Medicare, Medicaid, and SCHIP [State 

Children’s Health Insurance Program] 

Balanced Budget Refinement Act of 

1999, Pub. L. 106–113 

BIPA Medicare, Medicaid, and SCHIP [State 

Children’s Health Insurance Program] 

Benefits Improvement and Protection 

Act of 2000, Pub. L. 106–554 

BLS Bureau of Labor Statistics 

CAH Critical access hospital 

CART CMS Abstraction & Reporting Tool 

CBSAs Core-based statistical areas 

CC Complication or comorbidity 

CCR Cost-to-charge ratio 

CDAC Clinical Data Abstraction Center 

CIPI Capital input price index 

CPI Consumer price index 

CMI Case-mix index 

CMS Centers for Medicare & Medicaid 

Services 

CMSA Consolidated Metropolitan Statistical 

Area 

COBRA Consolidated Omnibus 

Reconciliation Act of 1985, Pub. L. 99– 

272 

CPI Consumer price index 

CY Calendar year 

DRA Deficit Reduction Act of 2005, Pub. L. 

109–171 

DRG Diagnosis-related group 

DSH Disproportionate share hospital 

ECI Employment cost index 

EMR Electronic medical record 

EMTALA Emergency Medical Treatment and 

Labor Act of 1986, Pub. L. 99–272 

FDA Food and Drug Administration 

FFY Federal fiscal year 

FIPS Federal information processing 

standards 

FQHC Federally qualified health center 

FTE Full-time equivalent 

FY Fiscal year 

GAAP Generally Accepted Accounting 

Principles 

GAF Geographic Adjustment Factor 

GME Graduate medical education 

HCAHPS Hospital Consumer Assessment of 

Healthcare Providers and Systems 

HCFA Health Care Financing Administration 

HCRIS Hospital Cost Report Information 

System 

HHA Home health agency 

HHS Department of Health and Human 

Services 

HIC Health insurance card 

HIPAA Health Insurance Portability and 

Accountability Act of 1996, Pub. L. 104– 

191 

HIPC Health Information Policy Council 

HIS Health information system 

HIT Health information technology 

HMO Health maintenance organization 

HSA Health savings account 

HSCRC Maryland Health Services Cost 

Review Commission 

HSRV Hospital-specific relative value 

HSRVcc Hospital-specific relative value cost 

center 

HQA Hospital Quality Alliance 

HQI Hospital Quality Initiative 

ICD–9–CM International Classification of 

Diseases, Ninth Revision, Clinical 

Modification 

ICD–10–PCS International Classification of 

Diseases, Tenth Edition, Procedure 

Coding System 

IHS Indian Health Service 

IME Indirect medical education 

IOM Institute of Medicine 

IPF Inpatient psychiatric facility 

IPPS Acute care hospital inpatient 

prospective payment system 

IRF Inpatient rehabilitation facility 

JCAHO Joint Commission on Accreditation of 

Healthcare Organizations 

LAMCs Large area metropolitan counties 

LTC–DRG Long-term care diagnosis-related 

group 

LTCH Long-term care hospital 

MAC Medicare Administrative Contractor 

MCC Major complication or comorbidity 

MCE Medicare Code Editor 

MCO Managed care organization 

MCV Major cardiovascular condition 

MDC Major diagnostic category 

MDH Medicare-dependent, small rural 

hospital 

MedPAC Medicare Payment Advisory 

Commission 

MedPAR Medicare Provider Analysis and 

Review File 

MEI Medicare Economic Index 

MGCRB Medicare Geographic Classification 

Review Board 

MIEA–TRHCA Medicare Improvements and 

Extension Act, Division B of the Tax 

Relief and Health Care Act of 2006, Pub. 

L. 109–432 

MMA Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003, Pub. L. 108–173 

MPN Medicare provider number 

MRHFP Medicare Rural Hospital Flexibility 

Program 

MSA Metropolitan Statistical Area 

NAICS North American Industrial 

Classification System 

NCD National coverage determination 

NCHS National Center for Health Statistics 

NCQA National Committee for Quality 

Assurance 

NCVHS National Committee on Vital and 

Health Statistics 

NECMA New England County Metropolitan 

Areas 

NQF National Quality Forum 

NTIS National Technical Information Service 

NVHRI National Voluntary Hospital 

Reporting Initiative 

OES Occupational employment statistics 

OIG Office of the Inspector General 

OMB Executive Office of Management and 

Budget 

O.R. Operating room 

OSCAR Online Survey Certification and 

Reporting (System) 

PRM Provider Reimbursement Manual 

PPI Producer price index 

PMSAs Primary metropolitan statistical areas 

PPS Prospective payment system 

PRA Per resident amount 

ProPAC Prospective Payment Assessment 

Commission 

PRRB Provider Reimbursement Review Board 

PS&R Provider Statistical and 

Reimbursement (System) 

QIG Quality Improvement Group, CMS 

QIO Quality Improvement Organization 

RHC Rural health clinic 

RHQDAPU Reporting hospital quality data 

for annual payment update 

RNHCI Religious nonmedical health care 

institution 

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RRC Rural referral center 

RUCAs Rural-urban commuting area codes 

RY Rate year 

SAF Standard Analytic File 

SCH Sole community hospital 

SFY State fiscal year 

SIC Standard Industrial Classification 

SNF Skilled nursing facility 

SOCs Standard occupational classifications 

SOM State Operations Manual 

SSA Social Security Administration 

SSI Supplemental Security Income 

TEFRA Tax Equity and Fiscal Responsibility 

Act of 1982, Pub. L. 97–248 

UHDDS Uniform hospital discharge data set 

VBP Value-based purchasing 

Table of Contents 

I. Background 

A. Summary 

1. Acute Care Hospital Inpatient 

Prospective Payment System (IPPS) 

2. Hospitals and Hospital Units Excluded 

From the IPPS 

a. Inpatient Rehabilitation Facilities (IRFs) 

b. Long-Term Care Hospitals (LTCHs) 

c. Inpatient Psychiatric Facilities (IPFs) 

3. Critical Access Hospitals (CAHs) 

4. Payments for Graduate Medical 

Education (GME) 

B. Provisions of the Deficit Reduction Act 

of 2005 (DRA) 

C. Provisions of the Medicare 

Improvements and Extension Act Under 

Division B of the Tax Relief and Health 

Care Act of 2006 

D. Provisions of the Pandemic and AllHazards Preparedness Act 

E. Major Contents of this Proposed Rule 

1. Proposed DRG Reclassifications and 

Recalibrations of Relative Weights 

2. Proposed Changes to the Hospital Wage 

Index 

3. Other Decisions and Proposed Changes 

to the IPPS for Operating Costs and GME 

Costs 

4. Proposed Changes to the IPPS for 

Capital-Related Costs 

5. Proposed Changes to the Payment Rate 

for Excluded Hospitals and Hospital 

Units: Rate-of-Increase Percentages 

6. Services Furnished to Beneficiaries in 

Custody of Penal Authorities 

7. Determining Proposed Prospective 

Payment Operating and Capital Rates 

and Rate-of-Increase Limits 

8. Impact Analysis 

9. Recommendation of Update Factors for 

Operating Cost Rates of Payment for 

Inpatient Hospital Services 

10. Discussion of Medicare Payment 

Advisory Commission Recommendations 

II. Proposed Changes to DRG Classifications 

and Relative Weights 

A. Background 

B. DRG Reclassifications 

1. General 

2. Yearly Review for Making DRG Changes 

C. MedPAC Recommendations for 

Revisions to the IPPS DRG System 

D. Refinement of DRGs Based on Severity 

of Illness 

1. Evaluation of Alternative SeverityAdjusted DRG Systems 

a. Overview of Alternative DRG 

Classification Systems 

b. Comparative Performance in Explaining 

Variation in Resource Use 

c. Payment Accuracy and Case-Mix Impact 

d. Issues for Future Consideration 

2. Development of Proposed Medicare 

Severity DRGs (MS–DRGs) 

a. Comprehensive Review of the CC List 

b. Chronic Diagnosis Codes 

c. Acute Diagnosis Codes 

d. Prior Research on Subdivisions of CCs 

Into Multiple Categories 

e. Proposed Medicare Severity DRGs (MS– 

DRGs) 

3. Dividing Proposed MS–DRGs on the 

Basis of the CCs and MCCs 

4. Conclusion 

5. Impact of the Proposed MS–DRGs 

6. Changes to Case-Mix Index (CMI) from 

the Proposed MS–DRGs 

7. Effect of the Proposed MS–DRGs on the 

Outlier Threshold 

8. Effect of the Proposed MS–DRGs on the 

Postacute Care Transfer Policy 

E. Refinement of the Relative Weight 

Calculation 

1. Summary of RTI’s Report on Charge 

Compression 

2. RTI Recommendations 

a. Short-Term Recommendations 

b. Medium-Term Recommendations 

c. Long-Term Recommendations 

F. Hospital-Acquired Conditions, Including 

Infections 

1. General 

2. Legislative Requirements 

3. Public Input 

4. Collaborative Effort 

5. Criteria for Selection of the HospitalAcquired Conditions 

6. Proposed Selection of Hospital-Acquired 

Conditions 

7. Other Issues 

G. Proposed Changes to the Specific DRG 

Classifications 

1. Pre-MDC: Intestinal Transplantations 

2. MDC 1 (Diseases and Disorders of the 

Nervous System) 

a. Implantable Neurostimulators 

b. Intracranial Stents 

3. MDC 3 (Diseases and Disorders of the 

Ear, Nose, Mouth, and Throat)—Cochler 

Implants 

4. MDC 8 (Diseases and Disorders of the 

Musculoskeletal System and Connective 

Tissue) 

a. Hip and Knee Replacements 

b. Spinal Fusions 

c. Spinal Disc Devices 

d. Other Spinal DRGs 

5. MDC 17 (Myeloproliferative Diseases 

and Disorders, Poorly Differentiated 

Neoplasm): Endoscopic Procedures 

6. Medicare Code Editor (MCE) Changes 

a. Non-Covered Procedure Edit: Code 00.62 

(Percutaneous Angioplasty or 

Atherectomy of Intracranial Vessel(s)) 

b. Non-Specific Principal Diagnosis Edit 7 

and Non-Specific O.R. Procedures Edit 

10 

c. Limited Coverage Edit 17 

7. Surgical Hierarchies 

8. CC Exclusion List Proposed for FY 2008 

a. Background 

b. Proposed CC Exclusions List for FY 2008 

9. Review of Procedure Codes in CMS 

DRGs 468, 476, and 477 

a. Moving Procedure Codes From CMS 

DRG 468 (Proposed MS–DRGs 981 

Through 983) or CMS DRG 477 

(Proposed MS–DRGs 987 Through 989) 

to MDCs 

b. Reassignment of Procedures Among 

CMS DRGs 468, 476, and 477 (Proposed 

MS–DRG 981 Through 983, 984 Through 

986, and 987 Through 989) 

c. Adding Diagnosis or Procedure Codes to 

MDCs 

10. Changes to the ICD–9–CM Coding 

System 

11. Other Issues 

a. Seizures and Headaches 

b. Devices That Are Replaced Without Cost 

or Where Credit for a Replaced Device Is 

Furnished to the Hospital 

H. Recalibration of DRG Weights 

I. Proposed MS–LTC–DRG 

Reclassifications and Relative Weights 

for LTCHs for FY 2008 

1. Background 

2. Proposed Changes in the LTC–DRG 

Classifications 

a. Background 

b. Patient Classifications Into DRGs 

3. Development of the Proposed FY 2008 

MS–LTC–DRG Relative Weights 

a. General Overview of Development of the 

Proposed MS–LTC–DRG Relative 

Weights 

b. Data 

c. Hospital-Specific Relative Value 

Methodology 

d. Proposed Treatment of Severity Levels 

in Developing Relative Weights 

e. Proposed Low-Volume MS–LTC–DRGs 

4. Steps for Determining the Proposed FY 

2008 MS–LTC–DRG Relative Weights 

J. Proposed Add-On Payments for New 

Services and Technologies 

1. Background 

2. Public Input Before Publication of a 

Notice of Proposed Rulemaking on AddOn Payments 

3. FY 2008 Status of Technologies 

Approved for FY 2007 Add-On Payments 

a. Endovascular Graft Repair of the 

Thoracic Aorta 

b. Restore[reg] Rechargeable Implantable 

Neurostimulators 

c. X STOP Interspinous Process 

Decompression System 

4. FY 2008 Application for New 

Technology Add-On Payments 

5. Technical Correction 

III. Proposed Changes to the Hospital Wage 

Index 

A. Background 

B. Core-Based Statistical Areas for the 

Hospital Wage Index 

C. Proposed Occupational Mix Adjustment 

to the Proposed FY 2008 Wage Index 

1. Development of Data for the Proposed 

FY 2008 Occupational Mix Adjustment 

2. Timeline for the Collection, Review, and 

Correction of the Occupational Mix Data 

3. Calculation of the Proposed 

Occupational Mix Adjustment for FY 

2008 

4. Proposed 2007–2008 Occupational Mix 

Survey for the FY 2010 Wage Index 

D. Worksheet S–3 Wage Data for the 

Proposed FY 2008 Wage Index 

1. Included Categories of Costs 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24683 

2. Contract Labor for Indirect Patient Care 

Services 

3. Excluded Categories of Costs 

4. Use of Wage Index Data by Providers 

Other Than Acute Care Hospitals Under 

the IPPS 

E. Verification of Worksheet S–3 Wage 

Data 

F. Wage Index for Multicampus Hospitals 

G. Computation of the Proposed FY 2008 

Unadjusted Wage Index 

1. Method for Computing the Proposed FY 

2008 Unadjusted Wage Index 

2. Expiration of the Imputed Floor 

3. CAHs Reverting Back to IPPS Hospitals 

and Raising the Rural Floor 

4. Application of Rural Floor Budget 

Neutrality 

H. Analysis and Implementation of the 

Proposed Occupational Mix Adjustment 

and the Proposed FY 2008 Occupational 

Mix Adjusted Wage Index 

I. Revisions to the Proposed Wage Index 

Based on Hospital Redesignations 

1. General 

2. Effects of Reclassification/Redesignation 

3. FY 2008 MGCRB Reclassifications 

4. Hospitals That Applied for 

Reclassification Effective in FY 2008 and 

Reinstating Reclassifications in FY 2008 

5. Clarification of Policy on Reinstating 

Reclassifications 

6. ‘‘Fallback’’ Reclassifications 

7. Geographic Reclassification Issues for 

Multicampus Hospitals 

8. Redesignations of Hospitals under 

Section 1886(d)(8)(B) of the Act 

9. Reclassifications Under Section 

1886(d)(8)(B) of the Act 

10. New England Deemed Counties 

11. Reclassifications under Section 508 of 

Pub. L. 108–173 

12. Other Issues 

J. Proposed FY 2008 Wage Index 

Adjustment Based on Commuting 

Patterns of Hospital Employees 

K. Process for Requests for Wage Index 

Data Corrections 

L. Labor-Related Share for the Proposed 

Wage Index for FY 2008 

M. Wage Index Study Required Under Pub. 

L. 109–432 

N. Proxy for the Hospital Market Basket 

IV. Other Decisions and Proposed Changes to 

the IPPS for Operating Costs and GME 

Costs 

A. Reporting of Hospital Quality Data for 

Annual Hospital Payment Update 

1. Background 

2. FY 2008 Quality Measures 

3. New Quality Measures and Data 

Submission Requirements for FY 2009 

and Subsequent Years 

a. Proposed New Quality Measures for FY 

2009 and Subsequent Years 

b. Data Submission 

4. Retiring or Modifying RHQDAPU 

Program Quality Measures 

5. Procedures for the RHQDAPU Program 

for FY 2008 and FY 2009 

a. Procedures for Participating in the 

RHQDAPU Program 

b. Chart Validation Requirements 

c. Data Validation and Attestation 

d. Public Display 

e. Reconsideration and Appeal Procedures 

f. RHQDAPU Program Withdrawal 

Requirements 

6. Electronic Medical Records 

7. New Hospitals 

B. Development of the Medicare Hospital 

Value-Based Purchasing Plan 

C. Rural Referral Centers (RRCs) 

1. Proposed Annual Update of RRC Status 

Criteria 

a. Case-Mix Index 

b. Discharges 

2. Acquired Rural Status of RRCs 

D. Indirect Medical Education (IME) 

Adjustment 

1. Background 

2. IME Adjustment Factor for FY 2008 

3. Time Spent by Residents on Vacation or 

Sick Leave and in Orientation 

a. Background 

b. Vacation and Sick Leave Time 

c. Orientation Activities 

d. Proposed Regulation Changes 

E. Hospital Emergency Services Under 

EMTALA 

1. Background 

2. Recent Legislation Affecting EMTALA 

Implementation 

a. Secretary’s Authority to Waive 

Requirements During National 

Emergencies 

b. Provisions of the Pandemic and AllHazards Preparedness Act 

c. Proposed Revisions to the EMTALA 

Regulations 

F. Disclosure of Physician Ownership in 

Hospitals and Patient Safety Measures 

1. Disclosure of Physician Ownership in 

Hospitals 

2. Patient Safety Measures 

G. Rural Community Hospital 

Demonstration Program 

V. Proposed Changes to the IPPS for CapitalRelated Costs 

A. Background 

B. Proposed Policy Change 

VI. Proposed Changes for Hospitals and 

Hospital Units Excluded From the IPPS 

A. Payments to Existing and New Excluded 

Hospitals and Hospital Units 

B. Separate PPS for IRFs 

C. Separate PPS for LTCHs 

D. Separate PPS for IPFs 

E. Determining Proposed LTCH Cost-toCharge Ratios (CCRs) Under the LTCH 

PPS 

VII. Services Furnished to Beneficiaries in 

Custody of Penal Authorities 

VIII. MedPAC Recommendations 

IX. Other Required Information 

A. Requests for Data From the Public 

B. Collection of Information Requirements 

C. Response to Public Comments 

Regulation Text 

Addendum—Proposed Schedule of 

Standardized Amounts, Update Factors, and 

Rate-of-Increase Percentages Effective With 

Cost Reporting Periods Beginning On or 

After October 1, 2007 

I. Summary and Background 

II. Proposed Changes to the Prospective 

Payment Rates for Hospital Inpatient 

Operating Costs for FY 2008 

A. Calculation of the Proposed Adjusted 

Standardized Amount 

1. Standardization of Base-Year Costs or 

Target Amounts 

2. Computing the Proposed Average 

Standardized Amount 

3. Updating the Proposed Average 

Standardized Amount 

4. Other Adjustments to the Average 

Standardized Amount 

a. Proposed Recalibration of DRG Weights 

and Updated Wage Index—Budget 

Neutrality Adjustment 

b. Reclassified Hospitals—Budget 

Neutrality Adjustment 

c. Case-Mix Budget Neutrality Adjustment 

d. Outliers 

e. Proposed Rural Community Hospital 

Demonstration Program Adjustment 

(Section 410A of Pub. L. 108–173) 

5. Proposed FY 2008 Standardized Amount 

B. Proposed Adjustments for Area Wage 

Levels and Cost-of-Living 

1. Proposed Adjustment for Area Wage 

Levels 

2. Proposed Adjustment for Cost-of-Living 

in Alaska and Hawaii 

C. Proposed DRG Relative Weights 

D. Calculation of the Proposed Prospective 

Payment Rates for FY 2008 

1. Federal Rate 

2. Hospital-Specific Rate (Applicable Only 

to SCHs and MDHs) 

a. Calculation of Hospital-Specific Rate 

b. Updating the FY 1982, FY 1987, FY 

1996, and FY 2002 Hospital-Specific 

Rates for FY 2008 

3. General Formula for Calculation of 

Proposed Prospective Payment Rates for 

Hospitals Located in Puerto Rico 

Beginning On or After October 1, 2007 

and Before October 1, 2008 

a. Puerto Rico Rate 

b. National Rate 

III. Proposed Changes to Payment Rates for 

Acute Care Hospital Inpatient CapitalRelated Costs for FY 2008 

A. Determination of Proposed Federal 

Hospital Inpatient Capital-Related 

Prospective Payment Rate Update 

1. Projected Capital Standard Federal Rate 

Update 

a. Description of the Update Framework 

b. Comparison of CMS and MedPAC 

Update Recommendation 

2. Proposed Outlier Payment Adjustment 

Factor 

3. Proposed Budget Neutrality Adjustment 

Factor for Changes in DRG 

Classifications and Weights and the GAF 

4. Proposed Exceptions Payment 

Adjustment Factor 

5. Proposed Capital Standard Federal Rate 

for FY 2008 

6. Proposed Special Capital Rate for Puerto 

Rico Hospitals 

B. Calculation of the Proposed Inpatient 

Capital-Related Prospective Payments for 

FY 2008 

C. Capital Input Price Index 

1. Background 

2. Forecast of the CIPI for FY 2008 

IV. Proposed Changes to Payment Rates for 

Excluded Hospitals and Hospital Units: 

Rate-of-Increase Percentages 

A. Payments to Existing Excluded 

Hospitals and Units 

B. New Excluded Hospitals and Units 

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V. Tables 

Table 1A—National Adjusted Operating 

Standardized Amounts, Labor/Nonlabor 

(69.7 Percent Labor Share/30.3 Percent 

Nonlabor Share If Wage Index Is Greater 

Than 1) 

Table 1B—National Adjusted Operating 

Standardized Amounts, Labor/Nonlabor 

(62 Percent Labor Share/38 Percent 

Nonlabor Share If Wage Index Is Less 

Than or Equal to 1) 

Table 1C—Adjusted Operating 

Standardized Amounts for Puerto Rico, 

Labor/Nonlabor 

Table 1D—Capital Standard Federal 

Payment Rate 

Table 2—Hospital Case-Mix Indexes for 

Discharges Occurring in Federal Fiscal 

Year 2006; Hospital Wage Indexes for 

Federal Fiscal Year 2008; Hospital 

Average Hourly Wages for Federal Fiscal 

Years 2006 (2002 Wage Data), 2007 (2003 

Wage Data), and 2008 (2004 Wage Data); 

and 3-Year Average of Hospital Average 

Hourly Wages 

Table 3A—FY 2008 and 3-Year Average 

Hourly Wage for Urban Areas by CBSA 

Table 3B—FY 2008 and 3-Year Average 

Hourly Wage for Rural Areas by CBSA 

Table 4A—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Urban Areas by CBSA—FY 2008 

Table 4B—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Rural Areas by CBSA—FY 2008 

Table 4C—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Hospitals That Are Reclassified by 

CBSA—FY 2008 

Table 4F—Puerto Rico Wage Index and 

Capital Geographic Adjustment Factor 

(GAF) by CBSA—FY 2008 

Table 4J—Out-Migration Wage 

Adjustment—FY 2008 

Table 5—List of Proposed Medicare 

Severity Diagnosis-Related Groups (MS– 

DRGs), Relative Weighting Factors, and 

Geometric and Arithmetic Mean Length 

of Stay 

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—Additions to the CC Exclusion 

List (Available only through the Internet 

on the CMS Web site at: http:// 

www.cms.hhs.gov/AcuteInpatientPPS/) 

Table 6H—Deletions from the CC 

Exclusion List (Available only through 

the Internet on the CMS Web site at: 

http://www.cms.hhs.gov/ 

AcuteInpatientPPS/) 

Table 6I—Complete List of Complication 

and Comorbidity (CC) Exclusions 

(Available only through the Internet on 

the CMS Web site at: http:// 

www.cms.hhs.gov/AcuteInpatientPPS/) 

Table 6J—Major Complication and 

Comorbidity (MCC) List 

Table 6K—Complications and Comorbidity 

(CC) List 

Table 7A—Medicare Prospective Payment 

System Selected Percentile Lengths of 

Stay: FY 2006 MedPAR Update— 

December 2006 GROUPER V24.0 CMS– 

DRGs 

Table 7B—Medicare Prospective Payment 

System Selected Percentile Lengths of 

Stay: FY 2006 MedPAR Update— 

December 2006 GROUPER V25.0 CMS 

DRGs 

Table 8A—Proposed Statewide Average 

Operating Cost-to-Charge Ratios—March 

2007 

Table 8B—Proposed Statewide Average 

Capital Cost-to-Charge Ratios—March 

2007 

Table 8C—Proposed Statewide Average 

Total Cost-to-Charge Ratios for LTCHs— 

March 2007 

Table 9A—Hospital Reclassifications and 

Redesignations—FY 2008 

Table 9C—Hospitals Redesignated as Rural 

under Section 1886(d)(8)(E) of the Act— 

FY 2008 

Table 10—Geometric Mean Plus the Lesser 

of .75 of the National Adjusted Operating 

Standardized Payment Amount 

(Increased to Reflect the Difference 

Between Costs and Charges) or .75 of 

One Standard Deviation of Mean Charges 

by Proposed Medicare Severity 

Diagnosis-Related Groups (MS–DRGs)— 

March 2007 

Table 11—Proposed FY 2008 MS–LTC– 

DRGs, Relative Weights, Geometric 

Average Length of Stay, and 5/6ths of the 

Geometric Average Length of Stay 

Appendix A—Regulatory Impact Analysis 

I. Overall Impact 

II. Objectives 

III. Limitations on Our Analysis 

IV. Hospitals Included In and Excluded From 

the IPPS 

V. Effects on Excluded Hospitals and 

Hospital Units 

VI. Quantitative Effects of the Proposed 

Policy Changes Under the IPPS for 

Operating Costs 

A. Basis and Methodology of Estimates 

B. Analysis of Table I 

C. Effects of the Proposed Changes to the 

DRG Reclassifications and Relative CostBased Weights (Column 2) 

D. Effects of Proposed Wage Index Changes 

(Column 3) 

E. Combined Effects of Proposed DRG and 

Wage Index Changes (Column 4) 

F. Effects of the Expiration of the 3-Year 

Provision Allowing Urban Hospitals 

That Were Converted to Rural as a Result 

of the FY 2005 Labor Market Area 

Changes to Maintain the Wage Index of 

the Urban Labor Market Area in Which 

They Were Formerly Located (Column 5) 

G. Effects of MGCRB Reclassifications 

(Column 6) 

H. Effects of the Adjustment to the 

Application of the Rural Floor (Column 

7) 

I. Effects of Expiration of the Imputed 

Rural Floor (Column 8) 

J. Effects of the Expiration of Section 508 

of Pub. L. 108–173 (Column 9) 

K. Effects of the Proposed Wage Index 

Adjustment for Out-Migration (Column 

10) 

L. Effects of All Proposed Changes With 

CMI Adjustment Prior to Assumed 

Growth (Column 11) 

M. Effects of All Proposed Changes With 

CMI Adjustment and Assumed Growth 

(Column 12) 

N. Effects of Proposed Policy on Payment 

Adjustment for Low-Volume Hospitals 

O. Impact Analysis of Table II 

VII. Effects of Other Proposed Policy Changes 

A. Effects of Proposed Policy on HospitalAcquired Conditions, Including 

Infections 

B. Effects of Proposed MS–LTC–DRG 

Reclassifications and Relative Weights 

for LTCHs 

C. Effects of Proposed New Technology 

Add-On Payments 

D. Effects of Requirements for Hospital 

Reporting of Quality Data for Annual 

Hospital Payment Update 

E. Effects of Proposed Policy on 

Cancellation of Classification of 

Acquired Rural Status and Rural Referral 

Centers 

F. Effects of Proposed Policy Change on 

Payment for Indirect Graduate Medical 

Education 

G. Effects of Proposed Policy Changes 

Relating to Emergency Services Under 

EMTALA 

H. Effects of Proposed Policy on Disclosure 

of Physician Ownership in Hospitals and 

Patient Safety Measures 

I. Effects of Implementation of Rural 

Community Hospital Demonstration 

Program 

J. Effects of Proposed Policy Changes on 

Services Furnished to Beneficiaries in 

Custody of Penal Authorities 

VIII. Effects of Proposed Changes in the 

Capital IPPS 

A. General Considerations 

B. Results 

IX. Alternatives Considered 

X. Overall Conclusion 

XI. Accounting Statement 

XII. Executive Order 12866 

Appendix B—Recommendation of Update 

Factors for Operating Cost Rates of Payment 

for Inpatient Hospital Services 

I. Background 

II. Inpatient Hospital Update for FY 2008 

III. Secretary’s Recommendation 

IV. MedPAC Recommendation for Assessing 

Payment Adequacy and Updating 

Payments in Traditional Medicare 

I. Background 

A. Summary 

1. Acute Care Hospital Inpatient 

Prospective Payment System (IPPS) 

Section 1886(d) of the Social Security 

Act (the Act) sets forth a system of 

payment for the operating costs of acute 

care hospital inpatient stays under 

Medicare Part A (Hospital Insurance) 

based on prospectively set rates. Section 

1886(g) of the Act requires the Secretary 

to pay for the capital-related costs of 

hospital inpatient stays under a 

prospective payment system (PPS). 

Under these PPSs, Medicare payment 

for hospital inpatient operating and 

capital-related costs is made at 

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predetermined, specific rates for each 

hospital discharge. Discharges are 

classified according to a list of 

diagnosis-related groups (DRGs). 

The base payment rate is comprised of 

a standardized amount that is divided 

into a labor-related share and a 

nonlabor-related share. The laborrelated share is adjusted by the wage 

index applicable to the area where the 

hospital is located; and if the hospital is 

located in Alaska or Hawaii, the 

nonlabor-related share is adjusted by a 

cost-of-living adjustment factor. This 

base payment rate is multiplied by the 

DRG relative weight. 

If the hospital treats a high percentage 

of low-income patients, it receives a 

percentage add-on payment applied to 

the DRG-adjusted base payment rate. 

This add-on payment, known as the 

disproportionate share hospital (DSH) 

adjustment, provides for a percentage 

increase in Medicare payments to 

hospitals that qualify under either of 

two statutory formulas designed to 

identify hospitals that serve a 

disproportionate share of low-income 

patients. For qualifying hospitals, the 

amount of this adjustment may vary 

based on the outcome of the statutory 

calculations. 

If the hospital is an approved teaching 

hospital, it receives a percentage add-on 

payment for each case paid under the 

IPPS, known as the indirect medical 

education (IME) adjustment. This 

percentage varies, depending on the 

ratio of residents to beds. 

Additional payments may be made for 

cases that involve new technologies or 

medical services that have been 

approved for special add-on payments. 

To qualify, a new technology or medical 

service must demonstrate that it is a 

substantial clinical improvement over 

technologies or services otherwise 

available, and that, absent an add-on 

payment, it would be inadequately paid 

under the regular DRG payment. 

The costs incurred by the hospital for 

a case are evaluated to determine 

whether the hospital is eligible for an 

additional payment as an outlier case. 

This additional payment is designed to 

protect the hospital from large financial 

losses due to unusually expensive cases. 

Any outlier payment due is added to the 

DRG-adjusted base payment rate, plus 

any DSH, IME, and new technology or 

medical service add-on adjustments. 

Although payments to most hospitals 

under the IPPS are made on the basis of 

the standardized amounts, some 

categories of hospitals are paid the 

higher of a hospital-specific rate based 

on their costs in a base year (the higher 

of FY 1982, FY 1987, FY 1996, or FY 

2002) or the IPPS rate based on the 

standardized amount. For example, sole 

community hospitals (SCHs) are the sole 

source of care in their areas, and 

Medicare-dependent, small rural 

hospitals (MDHs) are a major source of 

care for Medicare beneficiaries in their 

areas. Both of these categories of 

hospitals are afforded this special 

payment protection in order to maintain 

access to services for beneficiaries. 

(Until FY 2007, an MDH has received 

the IPPS rate plus 50 percent of the 

difference between the IPPS rate and its 

hospital-specific rate if the hospitalspecific rate is higher than the IPPS rate. 

In addition, an MDH does not have the 

option of using FY 1996 as the base year 

for its hospital-specific rate. As 

discussed below, for discharges 

occurring on or after October 1, 2007, 

but before October 1, 2011, an MDH will 

receive the IPPS rate plus 75 percent of 

the difference between the IPPS rate and 

its hospital-specific rate, if the hospitalspecific rate is higher than the IPPS 

rate.) 

Section 1886(g) of the Act requires the 

Secretary to pay for the capital-related 

costs of inpatient hospital services ‘‘in 

accordance with a prospective payment 

system established by the Secretary.’’ 

The basic methodology for determining 

capital prospective payments is set forth 

in our regulations at 42 CFR 412.308 

and 412.312. Under the capital IPPS, 

payments are adjusted by the same DRG 

for the case as they are under the 

operating IPPS. Capital IPPS payments 

are also adjusted for IME and DSH, 

similar to the adjustments made under 

the operating IPPS. In addition, 

hospitals may receive outlier payments 

for those cases that have unusually high 

costs. 

The existing regulations governing 

payments to hospitals under the IPPS 

are located in 42 CFR part 412, subparts 

A through M. 

2. Hospitals and Hospital Units 

Excluded From the IPPS 

Under section 1886(d)(1)(B) of the 

Act, as amended, certain specialty 

hospitals and hospital units are 

excluded from the IPPS. These hospitals 

and units are: rehabilitation hospitals 

and units; long-term care hospitals 

(LTCHs); psychiatric hospitals and 

units; children’s hospitals; and cancer 

hospitals. Religious nonmedical health 

care institutions (RNHCIs) are also 

excluded from the IPPS. Various 

sections of the Balanced Budget Act of 

1997 (Pub. L. 105–33), the Medicare, 

Medicaid and SCHIP [State Children’s 

Health Insurance Program] Balanced 

Budget Refinement Act of 1999 (Pub. L. 

106–113), and the Medicare, Medicaid, 

and SCHIP Benefits Improvement and 

Protection Act of 2000 (Pub. L. 106–554) 

provide for the implementation of PPSs 

for rehabilitation hospitals and units 

(referred to as inpatient rehabilitation 

facilities (IRFs)), LTCHs, and psychiatric 

hospitals and units (referred to as 

inpatient psychiatric facilities (IPFs)), as 

discussed below. Children’s hospitals, 

cancer hospitals, and RNHCIs continue 

to be paid solely under a reasonable 

cost-based system. 

The existing regulations governing 

payments to excluded hospitals and 

hospital units are located in 42 CFR 

parts 412 and 413. 

a. Inpatient Rehabilitation Facilities 

(IRFs) 

Under section 1886(j) of the Act, as 

amended, rehabilitation hospitals and 

units (IRFs) have been transitioned from 

payment based on a blend of reasonable 

cost reimbursement subject to a 

hospital-specific annual limit under 

section 1886(b) of the Act and the 

adjusted facility Federal prospective 

payment rate for cost reporting periods 

beginning on or after January 1, 2002 

through September 30, 2002, to payment 

at 100 percent of the Federal rate 

effective for cost reporting periods 

beginning on or after October 1, 2002. 

IRFs subject to the blend were also 

permitted to elect payment based on 100 

percent of the Federal rate. The existing 

regulations governing payments under 

the IRF PPS are located in 42 CFR part 

412, subpart P. 

b. Long-Term Care Hospitals (LTCHs) 

Under the authority of sections 123(a) 

and (c) of Pub. L. 106–113 and section 

307(b)(1) of Pub. L. 106–554, the LTCH 

PPS was effective for a LTCH’s first cost 

reporting period beginning on or after 

October 1, 2002. LTCHs that do not 

meet the definition of ‘‘new’’ under §

412.23(e)(4) are paid, during a 5-year 

transition period, a LTCH prospective 

payment that is comprised of an 

increasing proportion of the LTCH 

Federal rate and a decreasing proportion 

based on reasonable cost principles. 

Those LTCHs that did not meet the 

definition of ‘‘new’’ could elect to be 

paid based on 100 percent of the Federal 

prospective payment rate instead of a 

blended payment in any year during the 

5-year transition. For cost reporting 

periods beginning on or after October 1, 

2006, all LTCHs are paid 100 percent of 

the Federal rate. The existing 

regulations governing payment under 

the LTCH PPS are located in 42 CFR 

part 412, subpart O. 

c. Inpatient Psychiatric Facilities (IPFs) 

Under the authority of sections 124(a) 

and (c) of Pub. L. 106–113, inpatient 

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24686 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

psychiatric facilities (IPFs) (formerly 

psychiatric hospitals and psychiatric 

units of acute care hospitals) are paid 

under the IPF PPS. Under the IPF PPS, 

some IPFs are transitioning from being 

paid for inpatient hospital services 

based on a blend of reasonable costbased payment and a Federal per diem 

payment rate, effective for cost reporting 

periods beginning on or after January 1, 

2005. For cost reporting periods 

beginning on or after January 1, 2008, all 

IPFs will be paid 100 percent of the 

Federal per diem payment amount. The 

existing regulations governing payment 

under the IPF PPS are located in 42 CFR 

412, subpart N. 

3. Critical Access Hospitals (CAHs) 

Under sections 1814, 1820, and 

1834(g) of the Act, payments are made 

to critical access hospitals (CAHs) (that 

is, rural hospitals or facilities that meet 

certain statutory requirements) for 

inpatient and outpatient services based 

on 101 percent of reasonable cost. 

Reasonable cost is determined under the 

provisions of section 1861(v)(1)(A) of 

the Act and existing regulations under 

42 CFR parts 413 and 415. 

4. Payments for Graduate Medical 

Education (GME) 

Under section 1886(a)(4) of the Act, 

costs of approved educational activities 

are excluded from the operating costs of 

inpatient hospital services. Hospitals 

with approved graduate medical 

education (GME) programs are paid for 

the direct costs of GME in accordance 

with section 1886(h) of the Act; the 

amount of payment for direct GME costs 

for a cost reporting period is based on 

the hospital’s number of residents in 

that period and the hospital’s costs per 

resident in a base year. The existing 

regulations governing payments to the 

various types of hospitals are located in 

42 CFR part 413. 

B. Provisions of the Deficit Reduction 

Act of 2005 (DRA) 

The Deficit Reduction Act of 2005 

(DRA), Pub. L. 109–171, made a number 

of changes to the Act relating to 

prospective payments to hospitals and 

other providers for inpatient services. 

This proposed rule would implement 

amendments made by (1) section 

5001(a), which, effective for FY 2007 

and subsequent years, expands the 

requirements for hospital quality data 

reporting; and (2) section 5001(c), which 

requires the Secretary to select, by 

October 1, 2007, at least two hospitalacquired conditions that meet certain 

specified criteria that will be subject to 

a quality adjustment in DRG payments 

during FY 2008. 

In this proposed rule, we also discuss 

our development of a plan to 

implement, beginning with FY 2009, a 

value-based purchasing plan for section 

1886(d) hospitals, in accordance with 

the requirements of section 5001(b) of 

Pub. L. 109–171. 

C. Provisions of the Medicare 

Improvements and Extension Act Under 

Division B of the Tax Relief and Health 

Care Act of 2006 

In this proposed rule, we discuss the 

provisions of section 106(b)(1) of the 

Medicare Improvements and Extensions 

Act under Division B, Title I of the Tax 

Relief and Health Care Act of 2006 

(MIEA–TRHCA), Pub. L. 109–432, 

which requires MedPAC to submit to 

Congress, not later than June 30, 2007, 

a report on the Medicare wage index 

classification system applied under the 

Medicare Prospective Payment System. 

Section 106(b) of the MIEA–TRHCA 

requires the report to include any 

alternatives that MedPAC recommends 

to the method to compute the wage 

index under section 1886(d)(3)(E) of the 

Act. 

In addition, we discuss the provisions 

of section 106(b)(2) of the MIEA– 

TRHCA, which instructs the Secretary 

of Health and Human Services, taking 

into account MedPAC’s 

recommendations on the Medicare wage 

index classification system, to include 

in the FY 2009 IPPS proposed rule one 

or more proposals to revise the wage 

index adjustment applied under section 

1886(d)(3)(E) of the Act for purposes of 

the IPPS. 

We note that we published a notice in 

the Federal Register on March 23, 2007 

(72 FR 13799) that addressed the 

provisions of section 106(a) of the 

MIEA–TRHCA relating to the extension 

of geographic reclassifications of 

hospitals under section 508 of Pub. L. 

108–173 (that expired on March 31, 

2007) through September 30, 2007. 

D. Provisions of the Pandemic and AllHazards Preparedness Act 

On December 19, 2006, Congress 

enacted the Pandemic and All-Hazards 

Preparedness Act, Pub. L. 109–417. 

Section 302(b) of Pub. L. 109–417 makes 

two specific changes that affect 

EMTALA implementation in emergency 

areas during an emergency period. 

Specifically section 302(b)(1)(A) of Pub. 

L. 109–417 amended section 

1135(b)(3)(B) of the Act to state that 

sanctions may be waived for the 

direction or relocation of an individual 

for screening where, in the case of a 

public health emergency that involves a 

pandemic infections disease, that 

direction or relocation occurs pursuant 

to a State pandemic preparedness plan. 

In addition, sections 302(b)(1)(B) and 

(b)(1)(C) of Pub. L. 109–417 amended 

section 1135(b)(3)(B) of the Act to state 

that, if a public health emergency 

involves a pandemic infectious disease 

(such as pandemic influenza), the 

duration of a waiver or modification 

under section 1135(b)(3) of the Act 

(relating to EMTALA) shall be 

determined in accordance with section 

1135(e) of the Act as that subsection 

applies to public health emergencies. 

In this proposed rule, we are 

proposing to make changes to the 

EMTALA regulations to conform them 

to the sanction waiver provisions of 

section 302(b) of Pub. L. 109–417. 

E. Major Contents of This Proposed Rule 

In this proposed rule, we are setting 

forth proposed changes to the Medicare 

IPPS for operating costs and for capitalrelated costs in FY 2008. We also are 

setting forth proposed changes relating 

to payments for IME costs and payments 

to certain hospitals and units that 

continue to be excluded from the IPPS 

and paid on a reasonable cost basis. The 

changes being proposed would be 

effective for discharges occurring on or 

after October 1, 2007, unless otherwise 

noted. 

The following is a summary of the 

major changes that we are proposing to 

make: 

1. Proposed DRG Reclassifications and 

Recalibrations of Relative Weights 

We are proposing to adopt a Medicare 

Severity DRG (MS–DRG) classification 

system for the IPPS to better recognize 

severity of illness. We present the 

methodology we used to establish the 

proposed MS–DRGs and discuss our 

efforts to further analyze alternative 

severity-adjusted DRG systems and to 

refine the relative weight calculations 

for DRGs. 

We present a proposed listing and 

discussion of hospital-acquired 

conditions, including infections, which 

we have evaluated and are considering 

for selection to be subject to the 

statutorily required quality adjustment 

in DRG payments for FY 2008. 

We are proposing limited annual 

revisions to the DRG classification 

system in the following areas: intestinal 

transplants, neurostimulators, 

intracranial stents, cochlear implants, 

knee and hip replacements, spinal 

fusions and spinal disc devices, and 

endoscopic procedures. 

We are presenting our reevaluation of 

certain FY 2007 applicants for add-on 

payments for high-cost new medical 

services and technologies, and our 

analysis of the FY 2008 applicant 

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(including public input, as directed by 

Pub. L. 108–173, obtained in a town hall 

meeting). We are proposing the annual update 

of the long-term care diagnosis-related 

group (LTC–DRG) classifications and 

relative weights for use under the LTCH 

PPS for FY 2008. We are proposing that 

the LTC–DRGs would be revised to 

mirror the proposed MS–DRGs for the 

IPPS. 

2. Proposed Changes to the Hospital 

Wage Index 

In section III. of the preamble to this 

proposed rule, we are proposing 

revisions to the wage index and the 

annual update of the wage data. Specific 

issues addressed include the following: <bullet≤ The FY 2008 wage index 

update, using wage data from cost 

reporting periods that began during FY 

2004. 

<bullet≤ Analysis and 

implementation of the proposed FY 

2008 occupational mix adjustment to 

the wage index. <bullet≤ Proposed changes relating to 

expiration of the imputed floor for the 

wage index and application of budget 

neutrality for the rural floor. <bullet≤ Proposed changes in 

determining the wage index for 

multicampus hospitals. <bullet≤ The proposed revisions to 

the wage index based on hospital 

redesignations and reclassifications, 

including reclassifications for 

multicampus hospitals. <bullet≤ The proposed adjustment to 

the wage index for FY 2008 based on 

commuting patterns of hospital 

employees who reside in a county and 

work in a different area with a higher 

wage index. <bullet≤ The timetable for reviewing 

and verifying the wage data that will be 

in effect for the proposed FY 2008 wage 

index. 

<bullet≤ The labor-related share for 

the FY 2008 wage index, including the 

labor-related share for Puerto Rico. 

3. Other Decisions and Proposed 

Changes to the IPPS for Operating Costs 

and GME Costs 

In section IV. of the preamble to this 

proposed rule, we discuss a number of 

provisions of the regulations in 42 CFR 

Parts 412, 413, and 489, including the 

following: <bullet≤ The reporting of hospital 

quality data as a condition for receiving 

the full annual payment update 

increase. 

<bullet≤ Development of the Medicare 

value-based purchasing plan and 

scheduled ‘‘listening sessions.’’ <bullet≤ The proposed updated 

national and regional case-mix values 

and discharges for purposes of 

determining RRC status and a proposed 

policy change relating to the acquired 

rural status of RRCs. 

<bullet≤ The statutorily-required IME 

adjustment factor for FY 2008 and a 

proposed policy change relating to 

determining counts of residents on 

vacation or sick leave and in orientation 

for IME and direct GME purposes. 

<bullet≤ Proposed changes relating to 

waiver of sanctions for requirements for 

emergency services for hospitals under 

EMTALA during national emergency. 

<bullet≤ Proposed policy changes 

relating to disclosure to patients of 

physician ownership of hospitals and 

patient safety measures. 

<bullet≤ Discussion of the fourth year 

of implementation of the Rural 

Community Hospital Demonstration 

Program. 

4. Proposed Changes to the IPPS for 

Capital-Related Costs 

In section V. of the preamble to this 

proposed rule, we discuss the payment 

policy requirements for capital-related 

costs and capital payments to hospitals 

and propose changes relating to 

adjustments to the Federal capital rate 

to address continuous large positive 

margins. 

5. Proposed Changes to the Payment 

Rates for Excluded Hospitals and 

Hospital Units: Rate-of-Increase 

Percentages 

In section VI. of the preamble to this 

proposed rule, we discuss payments to 

excluded hospitals and hospital units, 

and proposed changes for determining 

LTCH CCRs under the LTCH PPS. 

6. Services Furnished to Beneficiaries in 

Custody of Penal Authorities 

In section VII. of the preamble to this 

proposed rule, we clarify when 

individuals are considered to be in 

‘‘custody’’ for purposes of Medicare 

payment for services furnished to 

beneficiaries who are under penal 

authorities. 

7. Determining Proposed Prospective 

Payment Operating and Capital Rates 

and Rate-of-Increase Limits 

In the Addendum to this proposed 

rule, we set forth proposed changes to 

the amounts and factors for determining 

the FY 2008 prospective payment rates 

for operating costs and capital-related 

costs. We also establish the proposed 

threshold amounts for outlier cases. In 

addition, we address the proposed 

update factors for determining the rateof-increase limits for cost reporting 

periods beginning in FY 2008 for 

hospitals and hospital units excluded 

from the PPS. 

8. Impact Analysis 

In Appendix A of this proposed rule, 

we set forth an analysis of the impact 

that the proposed changes would have 

on affected hospitals. 

9. Recommendation of Update Factors 

for Operating Cost Rates of Payment for 

Inpatient Hospital Services 

In Appendix B of this proposed rule, 

as required by sections 1886(e)(4) and 

(e)(5) of the Act, we provided our 

recommendations of the appropriate 

percentage changes for FY 2008 for the 

following: <bullet≤ A single average 

standardized amount for all areas for 

hospital inpatient services paid under 

the IPPS for operating costs (and 

hospital-specific rates applicable to 

SCHs and MDHs). 

<bullet≤ Target rate-of-increase limits 

to the allowable operating costs of 

hospital inpatient services furnished by 

hospitals and hospital units excluded 

from the IPPS. 

10. Discussion of Medicare Payment 

Advisory Commission 

Recommendations 

Under section 1805(b) of the Act, 

MedPAC is required to submit a report 

to Congress, no later than March 1 of 

each year, in which MedPAC reviews 

and makes recommendations on 

Medicare payment policies. MedPAC’s 

March 2007 recommendation 

concerning hospital inpatient payment 

policies addressed the update factor for 

inpatient hospital operating costs and 

capital-related costs under the IPPS and 

for hospitals and distinct part hospital 

units excluded from the IPPS. This 

recommendation is addressed in 

Appendix B of this proposed rule. For 

further information relating specifically 

to the MedPAC March 2007 reports or 

to obtain a copy of the reports, contact 

MedPAC at (202) 220–3700 or visit 

MedPAC’s Web site at: http:// 

www.medpac.gov. 

II. Proposed Changes to DRG 

Classifications and Relative Weights 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRG Reclassifications’’ at the 

beginning of your comment.) 

A. Background 

Section 1886(d) of the Act specifies 

that the Secretary shall establish a 

classification system (referred to as 

DRGs) for inpatient discharges and 

adjust payments under the IPPS based 

on appropriate weighting factors 

assigned to each DRG. Therefore, under 

the IPPS, we pay for inpatient hospital 

services on a rate per discharge basis 

that varies according to the DRG to 

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Report to the Congress, Physician-Owned Specialty 

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which a beneficiary’s stay is assigned. 

The formula used to calculate payment 

for a specific case multiplies an 

individual hospital’s payment rate per 

case by the weight of the DRG to which 

the case is assigned. Each DRG weight 

represents the average resources 

required to care for cases in that 

particular DRG, relative to the average 

resources used to treat cases in all 

DRGs. 

Congress recognized that it would be 

necessary to recalculate the DRG 

relative weights periodically to account 

for changes in resource consumption. 

Accordingly, section 1886(d)(4)(C) of 

the Act requires that the Secretary 

adjust the DRG classifications and 

relative weights at least annually. These 

adjustments are made to reflect changes 

in treatment patterns, technology, and 

any other factors that may change the 

relative use of hospital resources. 

B. DRG Reclassifications 

1. General 

As discussed in the preamble to the 

FY 2007 IPPS final rule (71 FR 47881 

through 47971), we are focusing our 

efforts in FY 2008 on making significant 

reforms to the IPPS consistent with the 

recommendations made by MedPAC in 

its ‘‘Report to the Congress, PhysicianOwned Specialty Hospitals’’ in March 

2005. MedPAC recommended that the 

Secretary refine the entire DRG system 

by taking into account severity of illness 

and applying hospital-specific relative 

value (HSRV) weights to DRGs.1 We 

began this reform process by adopting 

cost-based weights over a 3-year 

transition period beginning in FY 2007 

and making interim changes to the DRG 

system for FY 2007 by creating 20 new 

CMS DRGs and modifying 32 others 

across 13 different clinical areas 

involving nearly 1.7 million cases. As 

described below in more detail, these 

refinements are intermediate steps 

towards comprehensive reform of both 

the relative weights and the DRG system 

that is occurring as we undertake further 

study. 

Currently, cases are classified into 

CMS DRGs for payment under the IPPS 

based on the principal diagnosis, up to 

eight additional diagnoses, and up to six 

procedures performed during the stay. 

In a small number of DRGs, 

classification is also based on the age, 

sex, and discharge status of the patient. 

The diagnosis and procedure 

information is reported by the hospital 

using codes from the International 

Classification of Diseases, Ninth 

Revision, Clinical Modification (ICD–9– 

CM). 

The process of forming the DRGs was 

begun by dividing all possible principal 

diagnoses into mutually exclusive 

principal diagnosis areas, referred to as 

Major Diagnostic Categories (MDCs). 

The MDCs were formed by physician 

panels as the first step toward ensuring 

that the DRGs would be clinically 

coherent. The diagnoses in each MDC 

correspond to a single organ system or 

etiology and, in general, are associated 

with a particular medical specialty. 

Thus, in order to maintain the 

requirement of clinical coherence, no 

final DRG could contain patients in 

different MDCs. Most MDCs are based 

on a particular organ system of the 

body. For example, MDC 6 is Diseases 

and Disorders of the Digestive System. 

This approach is used because clinical 

care is generally organized in 

accordance with the organ system 

affected. However, some MDCs are not 

constructed on this basis because they 

involve multiple organ systems (for 

example, MDC 22 (Burns)). For FY 2007, 

cases are assigned to one of 538 DRGs 

in 25 MDCs. The table below lists the 25 

MDCs. 

MAJOR DIAGNOSTIC CATEGORIES (MDCS) 

1 ...... Diseases and Disorders of the Nervous System. 

2 ...... Diseases and Disorders of the Eye. 

3 ...... Diseases and Disorders of the Ear, Nose, Mouth, and Throat. 

4 ...... Diseases and Disorders of the Respiratory System. 

5 ...... Diseases and Disorders of the Circulatory System. 

6 ...... Diseases and Disorders of the Digestive System. 

7 ...... Diseases and Disorders of the Hepatobiliary System and Pancreas. 

8 ...... Diseases and Disorders of the Musculoskeletal System and Connective Tissue. 

9 ...... Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast. 

10 .... Endocrine, Nutritional and Metabolic Diseases and Disorders. 

11 .... Diseases and Disorders of the Kidney and Urinary Tract. 

12 .... Diseases and Disorders of the Male Reproductive System. 

13 .... Diseases and Disorders of the Female Reproductive System. 

14 .... Pregnancy, Childbirth, and the Puerperium. 

15 .... Newborns and Other Neonates with Conditions Originating in the Perinatal Period. 

16 .... Diseases and Disorders of the Blood and Blood Forming Organs and Immunological Disorders. 

17 .... Myeloproliferative Diseases and Disorders and Poorly Differentiated Neoplasms. 

18 .... Infectious and Parasitic Diseases (Systemic or Unspecified Sites). 

19 .... Mental Diseases and Disorders. 

20 .... Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders. 

21 .... Injuries, Poisonings, and Toxic Effects of Drugs. 

22 .... Burns. 

23 .... Factors Influencing Health Status and Other Contacts with Health Services. 

24 .... Multiple Significant Trauma. 

25 .... Human Immunodeficiency Virus Infections. 

In general, cases are assigned to an 

MDC based on the patient’s principal 

diagnosis before assignment to a DRG. 

However, for FY 2007, there are 9 DRGs 

to which cases are directly assigned on 

the basis of ICD–9–CM procedure codes. 

These DRGs are for heart transplant or 

implant of heart assist systems, liver 

and/or intestinal transplants, bone 

marrow transplants, lung transplants, 

simultaneous pancreas/kidney 

transplants, pancreas transplants, and 

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for tracheostomies. Cases are assigned to 

these DRGs before they are classified to 

an MDC. The table below lists the nine 

current pre-MDCs. 

PRE-MAJOR DIAGNOSTIC CATEGORIES (PRE-MDCS) 

DRG 103 Heart Transplant or Implant of Heart Assist System. 

DRG 480 Liver Transplant and/or Intestinal Transplant. 

DRG 481 Bone Marrow Transplant. 

DRG 482 Tracheostomy for Face, Mouth, and Neck Diagnoses. 

DRG 495 Lung Transplant. 

DRG 512 Simultaneous Pancreas/Kidney Transplant. 

DRG 513 Pancreas Transplant. 

DRG 541 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except for Face, Mouth, and Neck Diagnosis 

with Major O.R. 

DRG 542 Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except for Face, Mouth, and Neck Diagnosis without 

Major O.R. 

Once the MDCs were defined, each 

MDC was evaluated to identify those 

additional patient characteristics that 

would have a consistent effect on the 

consumption of hospital resources. 

Because the presence of a surgical 

procedure that required the use of the 

operating room would have a significant 

effect on the type of hospital resources 

used by a patient, most MDCs were 

initially divided into surgical DRGs and 

medical DRGs. Surgical DRGs are based 

on a hierarchy that orders operating 

room (O.R.) procedures or groups of 

O.R. procedures by resource intensity. 

Medical DRGs generally are 

differentiated on the basis of diagnosis 

and age (0 to 17 years of age or greater 

than 17 years of age). Some surgical and 

medical DRGs are further differentiated 

based on the presence or absence of a 

complication or comorbidity (CC). 

Generally, nonsurgical procedures 

and minor surgical procedures that are 

not usually performed in an operating 

room are not treated as O.R. procedures. 

However, there are a few non-O.R. 

procedures that do affect DRG 

assignment for certain principal 

diagnoses. An example is extracorporeal 

shock wave lithotripsy for patients with 

a principal diagnosis of urinary stones. 

Once the medical and surgical classes 

for an MDC were formed, each diagnosis 

class was evaluated to determine if 

complications, comorbidities, or the 

patient’s age would consistently affect 

the consumption of hospital resources. 

Physician panels classified each 

diagnosis code based on whether the 

diagnosis, when present as a secondary 

condition, would be considered a 

substantial CC. A substantial CC was 

defined as a condition which, because 

of its presence with a specific principal 

diagnosis, would cause an increase in 

the length of stay by at least one day in 

at least 75 percent of the patients. Each 

medical and surgical class within an 

MDC was tested to determine if the 

presence of any substantial CC would 

consistently affect the consumption of 

hospital resources. 

A patient’s diagnosis, procedure, 

discharge status, and demographic 

information is entered into the Medicare 

claims processing systems and subjected 

to a series of automated screens called 

the Medicare Code Editor (MCE). The 

MCE screens are designed to identify 

cases that require further review before 

classification into a DRG. 

After patient information is screened 

through the MCE and any further 

development of the claim is conducted, 

the cases are classified into the 

appropriate DRG by the Medicare 

GROUPER software program. The 

GROUPER program was developed as a 

means of classifying each case into a 

DRG on the basis of the diagnosis and 

procedure codes and, for a limited 

number of DRGs, demographic 

information (that is, sex, age, and 

discharge status). 

After cases are screened through the 

MCE and assigned to a DRG by the 

GROUPER, the PRICER software 

calculates a base DRG payment. The 

PRICER calculates the payment for each 

case covered by the IPPS based on the 

DRG relative weight and additional 

factors associated with each hospital, 

such as IME and DSH adjustments. 

These additional factors increase the 

payment amount to hospitals above the 

base DRG payment. 

The records for all Medicare hospital 

inpatient discharges are maintained in 

the Medicare Provider Analysis and 

Review (MedPAR) file. The data in this 

file are used to evaluate possible DRG 

classification changes and to recalibrate 

the DRG weights. However, in the FY 

2000 IPPS final rule (64 FR 41500), we 

discussed a process for considering nonMedPAR data in the recalibration 

process. In order for us to consider 

using particular non-MedPAR data, we 

must have sufficient time to evaluate 

and test the data. The time necessary to 

do so depends upon the nature and 

quality of the non-MedPAR data 

submitted. Generally, however, a 

significant sample of the non-MedPAR 

data should be submitted by midOctober for consideration in 

conjunction with the next year’s 

proposed rule. This date allows us time 

to test the data and make a preliminary 

assessment as to the feasibility of using 

the data. Subsequently, a complete 

database should be submitted by early 

December for consideration in 

conjunction with the next year’s 

proposed rule. 

In this IPPS proposed rule for FY 

2008, we are proposing to adopt 

significant changes to the current DRGs. 

As described in detail below, we are 

proposing significant improvement in 

the DRG system to recognize severity of 

illness and resource usage by proposing 

to adopt Medicare Severity DRGs (MS– 

DRGs). The changes we are proposing in 

this proposed rule would be reflected in 

the FY 2008 GROUPER, Version 25.0, 

and would be effective for discharges 

occurring on or after October 1, 2007. 

Unless otherwise noted in this proposed 

rule, our DRG analysis is based on data 

from the December 2006 update of the 

FY 2006 MedPAR file, which contains 

hospital bills received through 

December 31, 2006, for discharges 

occurring in FY 2006. 

2. Yearly Review for Making DRG 

Changes 

Many of the changes to the DRG 

classifications we make annually are the 

result of specific issues brought to our 

attention by interested parties. We 

encourage individuals with concerns 

about DRG classifications to bring those 

concerns to our attention in a timely 

manner so they can be carefully 

considered for possible inclusion in the 

annual proposed rule and, if included, 

may be subjected to public review and 

comment. Therefore, similar to the 

timetable for interested parties to submit 

non-MedPAR data for consideration in 

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the DRG recalibration process, concerns 

about DRG classification issues should 

be brought to our attention no later than 

early December in order to be 

considered and possibly included in the 

next annual proposed rule updating the 

IPPS. 

The actual process of forming the 

DRGs was, and will likely continue to 

be, highly iterative, involving a 

combination of statistical results from 

test data combined with clinical 

judgment. We describe in detail below 

the process we used to develop the 

proposed MS–DRGs. In addition, in 

deciding whether to make further 

modification to the proposed MS–DRGs 

for particular circumstances brought to 

our attention, we would consider 

whether the resource consumption and 

clinical characteristics of the patients 

with a given set of conditions are 

significantly different than the 

remaining patients in the proposed MS– 

DRG. We would evaluate patient care 

costs using average charges and lengths 

of stay as proxies for costs and rely on 

the judgment of our medical officers to 

decide whether patients are clinically 

distinct or similar to other patients in 

the MS–DRG. In evaluating resource 

costs, we would consider both the 

absolute and percentage differences in 

average charges between the cases we 

would select for review and the 

remainder of cases in the MS–DRG. We 

also would consider variation in charges 

within these groups; that is, whether 

observed average differences were 

consistent across patients or attributable 

to cases that were extreme in terms of 

charges or length of stay, or both. 

Further, we also would consider the 

number of patients who will have a 

given set of characteristics and generally 

would prefer not to create a new DRG 

unless it would include a substantial 

number of cases. 

C. MedPAC Recommendations for 

Revisions to the IPPS DRG System 

In the FY 2006 and FY 2007 IPPS 

final rules, we discussed a number of 

recommendations made by MedPAC 

regarding revisions to the DRG system 

used under the IPPS (70 FR 47473 

through 47482 and 71 FR 47881 through 

47939). 

In Recommendations 1–3 in the 2005 

Report to Congress on Physician-Owned 

Specialty Hospitals, MedPAC 

recommended that CMS: 

<bullet≤ Refine the current DRGs to 

more fully capture differences in 

severity of illness among patients. <bullet≤ Base the DRG relative 

weights on the estimated cost of 

providing care. <bullet≤ Base the weights on the 

national average of the hospital-specific 

relative values (HSRVs) for each DRG 

(using hospital-specific costs to derive 

the HSRVs). 

<bullet≤ Adjust the DRG relative 

weights to account for differences in the 

prevalence of high-cost outlier cases. <bullet≤ Implement the case-mix 

measurement and outlier policies over a 

transitional period. As we noted in the FY 2006 IPPS final 

rule, we had insufficient time to 

complete a thorough evaluation of these 

recommendations for full 

implementation in FY 2006. However, 

we did adopt severity-weighted cardiac 

DRGs in FY 2006 to address public 

comments on this issue and the specific 

concerns of MedPAC regarding cardiac 

surgery DRGs. We also indicated that we 

planned to further consider all of 

MedPAC’s recommendations and 

thoroughly analyze options and their 

impacts on the various types of 

hospitals in the FY 2007 IPPS proposed 

rule. 

For FY 2007, we began this process. 

In the FY 2007 IPPS proposed rule, we 

proposed to adopt Consolidated 

Severity DRGs (CS DRGs) for FY 2008 (if 

not earlier). However, based on public 

comments received on the FY 2007 IPPS 

proposed rule, we decided not to adopt 

the CS DRGs. Rather, we decided to 

make interim changes to the existing 

DRGs for FY 2007 by creating 20 new 

DRGs involving 13 different clinical 

areas that would significantly improve 

the CMS DRG system’s recognition of 

severity of illness. We also modified 32 

DRGs to better capture differences in 

severity. The new and revised DRGs 

were selected from 40 existing CMS 

DRGs that contain 1,666,476 cases and 

represent a number of body systems. In 

creating these 20 new DRGs, we deleted 

8 and modified 32 existing DRGs. We 

indicated that these interim steps for FY 

2007 were being taken as a prelude to 

more comprehensive changes to better 

account for severity in the DRG system 

by FY 2008. In the FY 2007 IPPS final 

rule, we indicated our intent to pursue 

further DRG reform through two 

initiatives. First, we announced that we 

were in the process of engaging a 

contractor to assist us with evaluating 

alternative DRG systems that were 

raised as potential alternatives to the CS 

DRGs in the public comments. Second, 

we indicated our intent to review over 

13,000 ICD–9–CM diagnosis codes as 

part of making further refinements to 

the current CMS DRGs to better 

recognize severity of illness based on 

the work that CMS (then HCFA) did in 

the mid-1990’s to adopt severity DRGs. 

We describe in detail below the progress 

we have made on these two initiatives, 

our proposed actions for FY 2008, and 

our plans for continued analysis of 

reform of the DRG system for FY 2009. 

We note that revising the DRGs to better 

recognize severity of illness has 

implications for the outlier threshold, 

the application of the postacute care 

transfer policy, the measurement of real 

case-mix versus apparent case-mix, and 

the IME and the DSH adjustments. We 

discuss these implications in more 

detail in the following sections. 

In the FY 2007 IPPS proposed rule, 

we discussed MedPAC’s 

recommendations to move to a costbased HSRV weighting methodology 

beginning with the FY 2007 IPPS 

proposed rule. Although we proposed to 

adopt HSRV weights for FY 2007, we 

decided not to adopt the proposed 

methodology in the final rule after 

considering the public comments. 

Instead, in the FY 2007 IPPS final rule, 

we adopted a cost-based weighting 

methodology without the hospitalspecific portion of the methodology. 

The cost weights are being adopted over 

a 3-year transition period in 1/3 

increments between FY 2007 and FY 

2009. In addition, in the FY 2007 IPPS 

final rule, we indicated our intent to 

further study the hospital-specific 

methodology as well as other issues 

brought to our attention with respect to 

the cost weights. There was significant 

concern in the public comments that we 

account for charge compression or the 

practice of applying a higher charge 

markup over costs to lower cost than 

higher cost items and services, if we are 

to develop relative weights based on 

cost. Further, public commenters 

expressed concern about potential 

inconsistencies between how costs and 

charges are reported on the Medicare 

cost reports and charges on the 

Medicare claims. In the FY 2007 IPPS 

final rule, we used costs and charges 

from the cost report to determine 

departmental level cost-to-charge ratios 

(CCRs) to apply to charges on the 

Medicare claims to determine the cost 

weights. The commenters were 

concerned about potential distortions to 

the cost weights that would result from 

inconsistent reporting between the cost 

reports and the Medicare claims. After 

publication of the FY 2007 IPPS final 

rule, we entered into a contract with RTI 

International to study both charge 

compression and to what extent our 

methodology for calculating DRG 

relative weights is affected by 

inconsistencies between how hospitals 

report costs and charges on the cost 

report and how hospitals report charges 

on individual claims. Further, as part of 

its study of alternative DRG systems, the 

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RAND Corporation is analyzing the 

HSRV cost-weighting methodology. As we present below, we believe that 

revisions to the DRG system to better 

recognize severity of illness and changes 

to the relative weights based on costs 

rather than charges are improving the 

accuracy of the payment rates in the 

IPPS. We agree with MedPAC that these 

refinements should be pursued. 

Although we continue to caution that 

any system that groups cases will 

always present some opportunities for 

providers to specialize in cases they 

believe to have higher margins, we 

believe that the changes we have 

adopted and the continuing reforms we 

are proposing to adopt for FY 2008 will 

improve payment accuracy and reduce 

financial incentives to create specialty 

hospitals. 

D. Refinement of DRGs Based on 

Severity of Illness 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRG Reform and Proposed 

MS–DRGs’’ at the beginning of your 

comment.) 

For purposes of the following 

discussions, the term ‘‘CMS DRGs’’ 

means the DRG system we currently use 

under the IPPS; the term ‘‘MedicareSeverity DRGs (MS–DRGs)’’ means the 

revisions that we are proposing to make 

to the current CMS DRGs to better 

recognize severity of illness and 

resource use based on case complexity. 

Although we have found the terms 

‘‘CMS DRGs’’ and ‘‘MS–DRGs’’ useful to 

distinguish the current DRG system 

from the DRGs that we are proposing to 

adopt for FY 2008, we are interested in 

public comments on how to best refer to 

both the current DRGs and the proposed 

DRGs to avoid confusion and improve 

clarity. 

1. Evaluation of Alternative SeverityAdjusted DRG Systems 

In the FY 2007 IPPS final rule, we 

stated our intent to engage a contractor 

to assist us with an evaluation of 

alternative DRG systems that may better 

recognize severity than the current CMS 

DRGs. We noted it was possible that 

some of the alternative systems would 

better recognize severity of illness and 

are based on the current CMS DRGs. We 

further stated that if we were to develop 

a clinical severity concept using the 

current CMS DRGs as the starting point, 

it was possible that several of the issues 

raised by commenters (in response to 

the CS DRGs, which, in the FY 2007 

IPPS proposed rule, we proposed to 

adopt for FY 2008 or earlier) would no 

longer be a concern. We noted that if we 

were to propose adoption of severity 

DRGs for FY 2008, we would consider 

the issues raised by commenters on last 

year’s proposed rule as we continued to 

make further refinements to account for 

complexity as well as severity to better 

reflect relative resource use. We stated 

that we believed it was likely that at 

least one of several alternative severityadjusted DRG systems suggested for 

review (or potentially a system we 

would develop ourselves) would be 

suitable to achieve our goal of 

improving payment accuracy beginning 

in FY 2008. 

On September 1, 2006, we awarded a 

contract to the RAND Corporation to 

perform an evaluation of alternative 

severity-adjusted DRG classification 

systems. RAND is evaluating several 

alternative DRG systems based on how 

well they are suited to classifying and 

making payments for inpatient hospital 

services provided to Medicare patients. 

Each system is being assessed on its 

ability to differentiate among severity of 

illness. A final report is due on or before 

September 1, 2007. RAND’s draft interim report focused 

on the following criteria: <bullet≤ Severity-adjusted DRG 

classification systems: —How well does 

each classification system explain 

variation in resource use? —How would 

the classification system affect a 

hospital’s patient mix? —Are the 

groupings manageable, administratively 

feasible and understandable? 

<bullet≤ Payment accuracy—What are 

the payment implications of selected 

models? 

In response to our request, several 

vendors of DRG systems submitted their 

products for evaluation. The following 

products are currently being evaluated 

by RAND: 

3M/Health Information Systems (HIS) 

<bullet≤ CMS DRGs modified for AP– 

DRG Logic (CMS + AP–DRGs) <bullet≤ Consolidated SeverityAdjusted DRGs (CS DRGs) 

Health Systems Consultants (HSC) 

<bullet≤ Refined DRGs (HSC–DRGs) 

HSS/Ingenix 

<bullet≤ All-Payer Severity DRGs 

with Medicare modifications (MM– 

APS–DRGs) 

Solucient 

<bullet≤ Solucient Refined DRGs 

(Sol–DRGs) 

Vendors submitted their commercial 

(off-the-shelf) software to RAND in late 

September 2006. The five systems were 

compared to the CMS DRGs that were in 

effect as of October 1, 2006 (FY 2007). 

RAND assigned FY 2004 and FY 2005 

Medicare discharges from acute care 

hospitals to the FY 2007 CMS DRGs and 

to each of the alternative severityadjusted DRG systems. RAND’s initial 

analysis provided an overview of each 

alternative DRG classification system, 

their comparative performance in 

explaining variation in resource use, 

differences in DRG grouping logic, and 

case-mix change. 

A Technical Expert Panel comprised 

of individuals representing academic 

institutions, hospital associations, and 

MedPAC was formed in October 2006. 

The members received the preliminary 

draft report of RAND’s alternative 

severity-adjusted DRG systems 

evaluation in early January 2007. The 

panel met with RAND and CMS on 

January 18, 2007, to discuss the 

preliminary draft report and to provide 

additional comments. RAND 

incorporated items raised by the panel 

into its preliminary draft report and 

submitted a revised interim report to 

CMS in mid-March 2007. CMS posted 

RAND’s interim report on the CMS Web 

site in late March 2007. Interested 

individuals can view RAND’s interim 

report on the CMS Web site at: http:// 

www.cms.hhs.gov/Reports/downloads/ 

Wynn0307.pdf. 

At this time, RAND has not completed 

its final evaluation. RAND’s interim 

report reflects its preliminary evaluation 

of the alternative DRG systems using the 

criteria described above. In the project’s 

second phase, RAND will continue to 

evaluate alternative DRG systems as 

well as to compare performance using 

HSRVs. As RAND has not completed its 

evaluation of alternative DRG systems, 

we are not ready at this time to propose 

use of one of the alternative DRG 

systems being evaluated for Medicare in 

FY 2008. Further, even if RAND had 

completed its evaluation, we would 

need to explore whether any transition 

issues would need to be resolved before 

we are ready to propose adopting an 

alternative DRG system. Among other 

issues, we would need to evaluate the 

legal and contractual issues associated 

with adopting a proprietary DRG 

product. Although vendors for four of 

the five systems have indicated a 

willingness to make their products 

available in the public domain, we 

believe it is likely there would need to 

be some discussion as to whether there 

would be any limitations (such as the 

source code as well as the DRG logic) on 

the availability of the DRG systems to 

hospitals or competing vendors. 

Further, we would need to resolve 

contractual issues for updates and 

maintenance of an alternative DRG 

system and consider how they interact 

with our current ongoing contract to 

maintain the CMS DRGs. There may be 

further system conversion issues that we 

have not yet considered. The RAND 

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contract will be complete by September 

1, 2007. Once RAND completes its 

work, we believe we will be in a better 

position to evaluate whether it would be 

appropriate to propose to adopt one of 

the five alternative DRG systems for 

purposes of the IPPS. 

As discussed later in this proposed 

rule, we are proposing to adopt MS– 

DRGs beginning with FY 2008. The MS– 

DRGs are the result of modifications to 

the CMS DRGs to better account for 

severity. While we are proposing to 

implement the MS–DRGs on October 1, 

2007, we believe the MS–DRGs should 

be evaluated by RAND. We have 

instructed RAND to evaluate the 

proposed MS–DRGs using the same 

criteria that it is applying to the other 

DRG systems. As described below, we 

believe the proposed MS–DRGs 

represent a substantial improvement in 

the recognition of severity of illness and 

resource consumption. For this reason, 

we are proposing to adopt MS–DRGs for 

FY 2008. 

As stated earlier, a final report is 

expected from RAND by September 1, 

2007. This report will include further 

analysis of the five alternative DRG 

systems and the additional evaluation of 

the MS–DRGs. We look forward to 

reviewing RAND’s final report that will 

provide a comprehensive evaluation of 

each severity DRG system that has been 

examined. We anticipate that after this 

process is completed, we will have the 

necessary information to decide our 

next steps in the reform of the IPPS. 

Meanwhile, we are proposing to adopt 

the MS–DRGs for FY 2008 and are 

providing the following update on 

RAND’s progress in evaluating 

alternative DRG systems. 

We invite public comment regarding 

RAND’s preliminary analysis of each 

vendor-supplied alternative severityadjusted DRG system described below. 

a. Overview of Alternative DRG 

Classification Systems 

Analysis of how each of the five 

severity-adjusted DRG systems performs 

began by using the current CMS DRGs 

as a baseline. Two of the five systems 

(CS DRGs and MM–APS–DRGs) are 

derivatives of all-patient severityadjusted DRG systems that have been 

modified by their developers for the 

Medicare population and two of the 

systems (HSC–DRGs and Sol–DRGs) are 

all-patient systems that incorporate 

severity levels into the CMS DRGs. The 

CMS–AP–DRGs are a combination of 

CMS DRGs and a modification for the 

Medicare population of the major CC 

severity groupings used in the AP–DRG 

system. (The AP–DRG system was 

developed by 3M/HIS specifically for 

the State of New York to capture the 

non-Medicare population.) 

Table A below shows how each of the 

five alternative severity-adjusted 

systems classifies patients into base 

DRGs and their corresponding severity 

levels. 

TABLE A.—LOGIC OF CMS AND ALTERNATIVE DRG SYSTEMS

Classification element CMS DRG CMS+AP–DRG HSC–DRG Sol–-DRG MM–APS–DRG Con–APR–DRG 

Number of MDCs .............. 25 ...................... 25 ...................... 25 ...................... 25 ...................... 25 ...................... 25 

Number of Pre-MDC base 

DRGs.

9 ........................ 9 ........................ 9 ........................ 9 ........................ 9 ........................ 7 

Number of base DRGs ..... 379 .................... 379 .................... 215 ADRGs ....... 248 ADRGs ....... 361 .................... 379 

Total number of Pre-MDC 

DRGs.

9 ........................ 9 ........................ 30 ...................... 27 ...................... 27 ...................... 9 

Total number of DRGs ..... 538 .................... 602 .................... 1,274 ................. 1,261 ................. 915 .................... 859 

Number of CC (severity) 

subclasses.

2 ........................ 3 ........................ 3 (medical) or 4 

(surgical).

3 (medical) or 4 

(surgical).

3 ........................ 4 

CC subclasses .................. With CC without 

CC for selected base 

DRGs.

Without CC With 

CC for selected base 

DRGs and 

With MCC 

across DRGs 

within MDC.

No CC, Class C 

CC, Class B 

CC, Class A 

CC (surgical 

only).

Minor/no substantial CCs, 

moderate CCs, 

MCCs, catastrophic CCs 

(surgical only).

Without CC, with 

CC with MCC 

with some collapsing at 

base DRG 

level.

Minor, moderate, 

major, severe 

with some collapsing at 

DRG level. 

Multiple CCs recognized .. No ...................... No ...................... No ...................... No ...................... Yes (in computation of weights.Yes. 

CC assignment specific to 

base DRG.

Mostly no ........... Mostly no ........... Mostly no ........... Mostly no ........... No ...................... Yes. 

Logic of CC subdivision .... Presence/absence.Presence/absence.Presence/absence.Presence/absence.Presence/absence.18-step process. 

Logic of MDC assignment Principal diagnosis.Principal diagnosis.Principal diagnosis.Principal diagnosis.Principal diagnosis.Principal diagnosis with rerouting. 

Death used in DRG assignment.Yes (in selected 

DRGs).

Yes (in selected 

DRGs).

Yes (includes 

‘‘early death’’ 

DRGs).

Yes (includes 

‘‘early death’’ 

DRGs).

Yes (in selected 

DRGs).

No. 

Complications of care are 

CCs.

Yes .................... Yes .................... Yes .................... Yes .................... Yes, when recognized as a 

CC No, when 

CC represents 

‘‘poor medical 

care’’.

Few. 

RAND’s preliminary evaluation of the 

logic for each system demonstrated the 

following: 

<bullet≤ Four systems add severity 

levels to the base CMS DRGs; the CS 

DRGs add severity levels to base APR– 

DRGs, which are comparable but not 

identical to the base CMS DRGs. Both 

the CS DRGs and MM–APS–DRGs 

collapse some base DRGs with low 

Medicare volume. 

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<bullet≤ The HSC–DRGs and the Sol– 

DRGs use uniform severity levels for 

each base DRG (three for medical and 

four for surgical). The general structure 

of the MM–APS–DRG logic includes 

three severity levels for each base DRG, 

but some severity levels for the same 

base DRG are consolidated to address 

Medicare low-volume DRGs and 

monotonicity issues. Monotonicity is 

when the average costs for a severity 

group consistently rise as the severity 

level of the group increases. For 

example, in a monotonic system, if 

within a base DRG there are three 

severity groups and level 1 severity is 

less than level 2 severity and level 2 

severity is less than level 3 severity, the 

average costs for a level 3 case would be 

greater than the average costs for a level 

2 case, which would be greater than the 

average costs for a level 1 case. The 

general structure of the CS DRGs 

includes four severity levels for each 

base DRG. However, severity level 

consolidations occur to address 

Medicare low-volume DRGs and 

monotonicity. The CS DRGs consolidate 

both adjacent severity levels for the 

same base DRG and the same severity 

level across multiple base DRGs 

(especially for severity level 4). 

<bullet≤ Under the CMS+AP–DRGs 

and MM–APS–DRGs, each diagnosis is 

assigned a uniform CC-severity level 

across all base DRGs (other than CCs on 

the exclusion list for specific principal 

diagnoses). The remaining systems 

assign diagnoses to CC-severity level 

classifications by groups of DRGs. 

<bullet≤ Under the grouping logic 

used by all systems other than the CS 

DRGs, each discharge is assigned to the 

highest severity level of any secondary 

diagnosis. The CS DRGs adjust the 

initial severity level assignment based 

on other factors, including the presence 

of additional CCs. None of the other 

systems adjust the severity level 

classification for additional factors or 

CCs. However, the MM–APS–DRG 

system handles additional CCs through 

an enhanced relative weight. 

<bullet≤ The HSC–DRGs and the Sol– 

DRGs have a medical ‘‘early death’’ DRG 

within each MDC. 

<bullet≤ The CS DRGs do not use 

death in the grouping logic. In addition, 

most complications of care do not affect 

the DRG assignment. 

b. Comparative Performance in 

Explaining Variation in Resource Use 

In evaluating the comparative 

performance of each alternative DRG 

system, RAND used MedPAR data from 

FY 2004 and FY 2005. RAND excluded 

data from CAHs, Indian Health Service 

(IHS) hospitals, and hospitals that have 

all-inclusive rate charging practices. 

Consistent with CMS practice, RAND 

did not exclude data from Maryland 

hospitals, which operate under an IPPS 

waiver. Records that failed edits for data 

consistency or that had missing 

variables that were needed to determine 

standardized costs were also excluded. 

RAND reported that evaluation of 

each alternative severity-adjusted DRG 

system is a complex process due to 

differences in how each of the severity 

levels are applied, the number of 

severity-adjusted DRGs in each system, 

and the average number of discharges 

assigned to each DRG. In addition, the 

manner in which the DRGs for patients 

0–17 years of age are assigned in the 

severity-adjusted systems affects the 

number of low-volume DRGs using 

Medicare discharges. 

Low-volume, severity-adjusted DRGs 

can affect the relative performance of a 

classification system. However, the 

percentage of Medicare discharges 

assigned to these DRGs is small— 

approximately 0.7 percent in the HSC– 

DRG and Sol–DRG systems compared to 

0.1 percent in the CMS DRGs. 

In determining how much withinDRG variation exists for each alternative 

severity-adjusted DRG system, RAND 

calculated the mean standardized cost, 

standard deviation, and coefficient of 

variation for each DRG among the 

systems. The coefficient of variation 

(CV) is the standard deviation divided 

by the mean. The CV allowed RAND to 

compare the variation of populations 

that contain significantly different mean 

values. Preliminary results of the 

comparison demonstrate that all five 

severity-adjusted systems reduce the 

amount of variation within DRGs. The 

HSC–DRGs and Sol–DRGs have a 

slightly higher proportion of patients 

assigned to DRGs with a CV<76 percent 

but also have a higher proportion of 

patients assigned to DRGs with a 

CV≤=100 percent. The CS DRGs had a 

slightly lower percentage of patients 

assigned to DRGs with a CV<76 percent 

than the other severity-adjusted 

systems. The MM–APS–DRGs, CS 

DRGs, and CMS+AP–DRGs all have 

fewer than 2 percent of patients 

assigned to DRGs with a CV≤=100 

percent. 

RAND utilized a general linear 

regression model to evaluate how well 

each severity-adjusted DRG system 

explains variation in costs per case. The 

initial results demonstrate that all five 

severity-adjusted DRG systems predict 

cost better than the CMS DRGs. The CS 

DRGs have higher adjusted R2 values 

(explanatory power) than the other 

severity-adjusted systems in nearly 

every MDC. In general, the adjusted R2

value for the CS DRGs is 0.4458, a 13- 

percent improvement over the adjusted 

R2 value for the CMS DRGs. The HSC– 

DRGs demonstrate an 11-percent 

improvement, while the adjusted R2

values for the MM–APS–DRGs and Sol– 

DRGs are 10.0 percent and 9.7 percent 

higher respectively, than the CMS DRG 

R2 value. The CMS+AP–DRGs show the 

smallest improvement, nearly 8 percent. 

Another aspect of RAND’s evaluation 

was to identify the validity of each 

alternative DRG system as a 

measurement for resource costs. For a 

base DRG, the severity levels should be 

monotonic; that is, the mean cost per 

discharge should increase 

simultaneously with an increase in the 

severity level. A distinction between 

patient groups and varying treatment 

costs should be accomplished by the 

severity levels. RAND studied the 

percentage differences and absolute 

differences in cost between the severity 

levels within the base DRGs for each 

system under evaluation. For the two 

systems (CMS+AP–DRGs and CS DRGs) 

that include several base DRGs, RAND 

assigned those discharges to the lower 

severity level base DRG. Following that 

methodology, RAND was able to 

calculate how much more costly the 

discharges assigned to the consolidated 

or lower severity levels were than the 

discharges in the base DRG assigned to 

the next higher severity level. 

Preliminary results demonstrate that, 

overall, monotonicity is not a factor 

across the alternative DRG systems. 

There are only a small percentage of 

discharges that are assigned to 

nonmonotonic DRGs. When a DRG is 

nonmonotonic, the mean cost in the 

higher severity level is less than the 

mean cost in the lower severity level. 

Using the data from severity of illness 

levels 1 through 3 (except for the MM– 

APS–DRGs, which do not have a 

severity of illness level 3), RAND 

calculated the discharge-weighted mean 

cost difference between severity levels 

and the mean ratio of the cost per 

discharge for the higher severity level to 

the adjacent lower severity level. The 

greatest cost discrimination was present 

in the higher severity levels versus the 

lower severity levels across all the 

systems. The mean cost difference 

between severity of illness level 1 and 

severity of illness level 0 was reported 

to be less than $2,000 for all the 

severity-adjusted systems. The CMS+AP 

DRGs have the least amount of cost 

discrimination between severity levels 

($2,117), while the MM–APS–DRG 

system has the highest mean cost 

difference ($2,385). The remaining 

systems demonstrated equivalent 

percentage cost differences between the 

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severity levels as shown in Table B 

below. 

BILLING CODE 4120–01–P 

BILLING CODE 4120–01–C 

In examining whether each of the 

alternative DRG systems provided 

stability in the relative weights from 

year to year, RAND compared the 

relative weights derived from the 

MedPAR data in FY 2004 to the relative 

weights data from FY 2005. RAND’s 

preliminary results demonstrate that 

generally, across all the systems, only a 

small percentage of DRGs had greater 

than a 5 percent change in relative 

weights. The HSC–DRGs and Sol–DRGs 

had a higher proportion of DRGs with a 

greater than 5 percent change in relative 

weights than the other systems. Fewer 

than 10 percent of the DRGs in the 

remaining systems had relative weight 

changes greater than 10 percent. In 

addition to differences in the number of 

DRGs and the methodology of assigning 

the severity levels, RAND noted 

additional factors that may affect the 

comparative performance of each 

alternative severity-adjusted DRG 

system. For further details and 

discussion, we encourage readers to 

view RAND’s full interim report on the 

CMS Web site at: http:// 

www.cms.hhs.gov/Reports/downloads/ 

Wynn0307.pdf. 

c. Payment Accuracy and Case-Mix 

Impact 

Similar to how CMS established the 

relative weights in the FY 2007 IPPS 

final rule, RAND used standardized 

costs as determined by the national CCR 

and the FY 2005 MedPAR data to 

construct relative weights for each of the 

DRG systems being evaluated. RAND 

analyzed the effect of variations in the 


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explanatory power on the distribution of 

Medicare payments for each system 

under evaluation. The preliminary 

findings indicate payment accuracy is 

improved by each severity-adjusted 

system by redistributing payment from 

lower-cost discharges to higher-cost 

discharges. However, the total payment 

redistribution across systems differs and 

reflects the payment impact of improved 

explanatory power. Although these 

findings are estimates, the percent of 

total payment redistributed was the 

least under the CMS+AP–DRGs (7.1 

percent) and the most under the CS 

DRGs (11.9 percent). 

Table C shows changes in case-mix 

index (CMI) by hospital category across 

alternative severity-adjusted DRG 

systems. Preliminary results 

demonstrate that under the severityadjusted systems, urban hospitals have 

a higher average CMI than under the 

CMS DRGs, and rural hospitals have a 

lower CMI. The analysis suggests that 

any system adopted to better recognize 

severity of illness with a budget 

neutrality constraint will result in 

payment redistribution that can be 

expected to benefit urban hospitals at 

the expense of rural hospitals. This 

impact occurs because patients treated 

in urban hospitals are generally more 

severely ill than patients in rural 

hospitals and the CMS DRGs are not 

currently recognizing the full extent of 

these differences. For purposes of the 

study, RAND assumed no behavioral 

changes in coding practice or the types 

of patients treated. 

The shift in case-mix (CMI) is greatest 

with the CS DRGs. The CMI for rural 

hospitals is 2.4 percent lower than 

under the CMS DRGs. The CMI for large 

urban (hospitals located in CBSAs with 

greater than 1 million population) and 

other urban hospitals is 0.6 percent and 

0.1 percent higher, respectively, for the 

CS DRGs. The CMI generally increases 

for larger hospitals and decreases for 

smaller hospitals. Under the CMS+AP– 

DRG, HSC–DRG, and Sol–DRG systems, 

greater than 70 percent of hospitals 

would experience less than a 2.5 

percent change in their CMI. Under the 

MM–APS–DRG and Con–APR–DRG 

systems, 65 and 45 percent of hospitals, 

respectively, would experience less than 

a 2.5 percent change. The percentage of 

hospitals experiencing less than a 5 

percent change is significant across all 

of the CMS–based DRG systems. 

Teaching hospitals commonly treat a 

higher number of complex cases. 

However, depending on the severityadjusted DRG system being analyzed, 

the impact will vary. In the CMS+AP– 

DRG, HSC–DRG, and MM–APS–DRG 

systems, facilities with large teaching 

programs (100 or more residents) 

demonstrated a larger increase than 

those facilities with smaller teaching 

programs. Under the Sol–DRG system, 

facilities with large teaching programs 

would experience a 0.1 percent 

increase, while facilities with the 

smaller teaching programs would 

experience a 0.2 percent increase. The 

CS DRGs showed similar results for 

hospitals with large teaching programs, 

but hospitals with the smaller teaching 

programs would experience an increase 

of 0.7 percent, relative to the CMS 

DRGs. RAND found that CMI would 

decline for nonteaching hospitals from 

severity adjusted DRGs, from a 0.2 

percent decrease under the HSC–DRGs 

and Sol–DRGs compared to a 0.5 

percent decrease under the CS DRGs. 

TABLE C.—CMI CHANGE IN ALTERNATIVE DRG SYSTEMS RELATIVE TO THE CMS DRG CMI 

N 

hospitals 

N 

discharges 

CMS 

DRG 

CMI 

Percentage change from CMS–DRG–CMI 

CMS + 

AP–DRG 

HSC– 

DRG Sol–DRG 

MM– 

APS– 

DRG 

Con– 

APR– 

DRG 

ALL ........................................................... 3,890 12,165,763 1.00 0.0 0.0 0.0 0.0 0.0 

By Geographic Location: 

Large urban areas (pop≤1 million) ... 1,485 5,715,356 1.02 0.5 0.4 0.3 0.6 0.6 

Other urban areas (pop<1 million) ... 1,186 4,578,447 1.04 -0.2 -0.2 -0.1 -0.2 0.1 

Rural hospitals .................................. 1,219 1,871,960 0.84 -1.3 -0.9 -1.0 -1.4 -2.4 

Bed Size (Urban): 

0–99 beds ......................................... 685 611,139 0.91 -1.0 -1.1 -1.1 -1.3 -1.6 

100–199 beds ................................... 875 2,346,922 0.93 0.0 0.1 0.0 0.1 0.0 

200–299 beds ................................... 511 2,446,737 1.00 0.1 0.2 0.3 0.3 0.6 

300–499 beds ................................... 433 2,965,216 1.08 0.3 0.3 0.3 0.4 0.8 

500 or more beds ............................. 167 1,923,789 1.17 0.6 0.3 0.2 0.4 0.4 

Bed Size (Rural): 

0–49 beds ......................................... 543 330,242 0.73 -2.5 -2.1 -2.2 -2.7 -5.0 

50–99 beds ....................................... 398 595,599 0.80 -1.4 -1.0 -1.1 -1.6 -2.7 

100–149 beds ................................... 160 415,367 0.85 -1.1 -0.7 -0.8 -1.2 -2.0 

150–199 beds ................................... 69 260,910 0.91 -0.8 -0.6 -0.7 -0.8 -1.5 

200 or more beds ............................. 49 269,842 0.99 -0.6 -0.1 -0.1 -0.6 -0.5 

Urban by Region: 

New England .................................... 129 541,471 0.99 0.1 -0.2 -0.5 -0.5 -0.6 

Middle Atlantic .................................. 370 1,621,488 1.00 0.0 -0.4 -0.5 -0.3 -1.5 

South Atlantic .................................... 432 2,208,336 1.04 0.5 0.7 0.7 0.7 1.4 

East North Central ............................ 410 1,856,164 1.03 0.6 0.7 0.6 0.8 1.5 

East South Central ........................... 168 696,943 1.06 -0.2 -0.2 -0.2 -0.2 -0.3 

West North Central ........................... 164 657,322 1.08 -0.3 -0.3 0.0 -0.3 0.3 

West South Central .......................... 369 1,115,411 1.05 0.1 0.0 0.1 0.3 0.5 

Mountain ........................................... 153 465,093 1.08 0.4 0.2 0.5 0.4 1.0 

Pacific ............................................... 423 1,016,135 1.03 0.0 -0.2 -0.1 -0.1 0.2 

Puerto Rico ....................................... 53 115,440 0.87 -1.1 -1.4 -0.1 -1.2 -5.1 

Rural by Region: 

New England .................................... 34 49,842 0.90 -0.6 -0.6 -0.5 -1.1 -0.6 

Middle Atlantic .................................. 68 139,639 0.85 -1.1 -0.7 -0.7 -1.3 -1.5 

South Atlantic .................................... 191 409,116 0.82 -0.8 -0.4 -0.5 -0.9 -1.8 

East North Central ............................ 163 290,069 0.87 -1.1 -0.7 -0.9 -1.3 -1.8 

East South Central ........................... 201 328,326 0.82 -1.5 -0.9 -1.1 -1.4 -3.2 

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TABLE C.—CMI CHANGE IN ALTERNATIVE DRG SYSTEMS RELATIVE TO THE CMS DRG CMI—Continued 

% N 

hospitals 

N 

discharges 

CMS 

DRG 

CMI 

Percentage change from CMS–DRG–CMI 

CMS + 

AP–DRG 

HSC– 

DRG Sol–DRG 

MM– 

APS– 

DRG 

Con– 

APR– 

DRG 

West North Central ........................... 184 240,449 0.87 -1.6 -1.2 -1.1 -1.8 -2.5 

West South Central .......................... 227 266,419 0.80 -2.1 -1.8 -1.9 -2.0 -4.3 

Mountain ........................................... 91 80,219 0.85 -1.2 -1.0 -0.4 -1.3 -1.2 

Pacific ............................................... 60 67,881 0.86 -0.9 -1.0 -1.1 -1.4 -1.6 

Teaching Status: 

Non-teaching ..................................... 2,791 6,115,193 0.92 -0.4 -0.2 -0.2 -0.4 -0.5 

Fewer than 100 Residents ............... 853 4,061,451 1.04 0.1 0.2 0.2 0.2 0.7 

100 or more Residents ..................... 246 1,989,119 1.16 0.8 0.3 0.1 0.5 0.0 

Urban DSH: 

Non-DSH ........................................... 778 2,574,640 1.02 -0.1 0.0 0.1 -0.2 0.5 

100 or more beds ............................. 1,541 7,378,095 1.05 0.3 0.2 0.2 0.4 0.4 

Less than 100 beds .......................... 352 341,068 0.82 -0.9 -0.8 -1.0 -1.1 -2.0 

Rural DSH: 

Non-DSH ........................................... 238 300,747 0.87 -1.4 -1.0 -0.9 -1.7 -1.9 

SCH .................................................. 402 599,823 0.83 -1.3 -1.0 -1.0 -1.4 -2.4 

RRC .................................................. 132 466,395 0.92 -0.8 -0.3 -0.5 -0.7 -1.4 

Other Rural: 

100 or more beds ............................. 60 135,146 0.80 -0.9 -0.8 -1.2 -1.3 -2.0 

Less than 100 beds .......................... 387 369,849 0.74 -2.1 -1.6 -1.7 -2.2 -4.3 

Urban teaching and DSH: 

Both teaching and DSH .................... 829 4,705,476 1.09 0.5 0.3 0.3 0.5 0.5 

Teaching and no DSH ...................... 204 1,108,092 1.06 0.0 0.1 0.0 -0.1 0.4 

No teaching and DSH ....................... 1,064 3,013,687 0.95 -0.1 0.1 0.0 0.1 0.1 

No teaching and no DSH ................. 574 1,466,548 1.00 -0.2 -0.1 0.1 -0.3 0.5 

Rural Hospital Types: 

RRC .................................................. 145 519,808 0.92 -0.8 -0.4 -0.5 -0.7 -1.4 

SCH .................................................. 423 457,119 0.79 -1.6 -1.2 -1.2 -1.7 -3.0 

MDH .................................................. 180 164,453 0.75 -2.1 -1.7 -1.7 -2.3 -4.1 

SCH and RRC .................................. 76 266,027 0.92 -0.9 -0.7 -0.7 -1.1 -1.3 

MDH and RRC .................................. 8 19,746 0.85 -1.4 -0.6 -0.8 -1.6 -1.9 

Other Rural ....................................... 387 444,807 0.77 -1.6 -1.2 -1.4 -1.8 -3.3 

RAND also noted that changes in 

coding patterns or behaviors could 

improve payments with each severity 

adjusted DRG system. Increases in CMI 

after adopting the system could be the 

result of improved coding rather than 

increases in actual patient severity. 

Although the State of Maryland’s 

experience using the APR–DRG system 

is an indicator, coding behaviors are 

expected to vary under alternative 

systems according to RAND. Therefore, 

the risk of case-mix growth due to 

improved documentation and coding 

exists with any system. However, RAND 

advises that the amount of risk can be 

assessed based on the logic of the DRG 

system and result in anticipated changes 

in coding behavior. RAND found that 

the CMS+AP–DRG system may have the 

lowest risk of case-mix increase, while 

the CS DRGs present the greatest risk. 

The remaining systems under 

evaluation demonstrated equivalent 

risk, based on the DRG logic and other 

features specific to each system. 

In section II.D.2.c. of the preamble of 

this proposed rule, the CMI impact 

under the proposed MS–DRGs using the 

State of Maryland’s experience and data 

is described in detail. RAND’s final 

report will include a comparison of the 

CMI impact under the proposed MS– 

DRG system with the CMI impact of the 

other alternative severity-adjusted DRG 

systems. 

d. Other Issues for Consideration 

RAND was asked to examine whether 

each of the alternative severity-adjusted 

DRG systems under evaluation appear to 

contain logic that is manageable, 

administratively feasible, and 

understandable. Although its evaluation 

is not yet complete, RAND’s preliminary 

results describe the extent to which 

those features are present in the 

grouping logic of each system. A brief 

summary of these findings and other 

discussion points follow. For more 

complete details of the grouping logic 

for each system evaluated, we encourage 

readers to review RAND’s interim report 

at the following Web site: http:// 

www.cms.hhs.gov/Reports/downloads/ 

Wynn0307.pdf. 

To increase and promote 

understanding of a DRG classification 

system, the grouping logic should 

include a uniform structure. With the 

exception of the CS DRGs, RAND found 

that there is uniformity in the 

hierarchical structure for assigning 

discharges to MDCs, DRGs, and severity 

levels for each system evaluated. The CS 

DRGs utilize a complex rerouting logic 

and severity of illness level assignment. 

However, the result is a higher 

explanatory power that accounts for 

limitations in the current system. 

Therefore, due to the complexities 

associated with that system, it may not 

easily be understood. However, if the 

results yield clinically coherent groups 

of patients with comparable costs, 

RAND concluded that the system may 

be worth exploring further. The HSC– 

DRG and Sol–DRG grouping logic uses 

a standard number of severity levels for 

each base DRG, although the result is an 

increase in the number of low-volume 

DRGs. The standard severity level 

structure provides increased 

understanding, although as mentioned 

previously, low-volume, severityadjusted DRGs can affect the relative 

performance of a classification system. 

The MM–APS–DRGs and CS DRGs use 

standard DRG severity levels. However, 

the method of collapsing DRGs varies 

due to the modifications made for 

Medicare use. By only collapsing DRGs 

to determine relative weights, RAND 

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notes it is possible to preserve the 

underlying DRG structure, which 

perhaps would lead to a more 

understandable system. 

As stated earlier, there are also several 

transition issues that require attention 

when evaluating alternative severityadjusted DRG systems. In determining 

how manageable, administratively 

feasible, and understandable the 

systems being evaluated are, 

consideration should be given to how 

they crosswalk or map to the current 

CMS DRGs. Because four of the systems 

under evaluation are based on the 

underlying CMS DRG grouping logic to 

establish their base DRGs (CMS+AP– 

DRGs, HSC–DRGs, Sol–DRGs, and MM– 

APS–DRGs), the CMS DRGs are able to 

crosswalk smoothly to these severityadjusted DRGs. Conversely, 

crosswalking in reverse or backward 

mapping from the CMS+AP DRGs to the 

CMS DRGs is problematic due to the 

discharges in one severity level of the 

CMS+AP–DRG system compared to 

several base CMS DRGs. As expected, 

the CS DRGs do not crosswalk easily to 

the CMS DRGs due to the complex 

grouping logic. The MM–APS–DRGs 

pose unique complications as well due 

to the large number (over 1,000) of 

DRGs. 

System updates are another important 

factor that may have serious 

implications. All of the DRG systems 

RAND evaluated were reported to make 

annual updates to reflect ICD–9–CM 

coding changes. However, the CC 

severity level assignments for each 

system have not routinely been 

reviewed and revised. The review of the 

CC exclusion list and severity level 

assignments should be reviewed where 

appropriate to reflect current patterns of 

care, according to RAND. 

Accessibility to each of the severityadjusted DRG system’s logic and 

software is also a concern. Each system 

RAND analyzed is currently maintained 

as a proprietary product. In general, all 

of the vendors indicated a willingness to 

place their product in the public 

domain, under certain terms. As such, 

we believe it is likely there would need 

to be discussion as to whether there 

would be any limitations (such as the 

source code as well as the DRG logic) on 

the availability of the DRG systems to 

hospitals or competing vendors. The 

intent of each vendor to provide public 

access to its grouper logic and software 

is described in further detail in RAND’s 

interim report. 

The RAND contract will be complete 

by September 1, 2007. The final report 

will include evaluation of the proposed 

MS–DRGs, with further analysis of the 

five alternative severity-adjusted DRG 

classification systems. RAND will also 

study various approaches to estimating 

costs and developing relative weights, 

as well as the payment impacts of 

alternative methodologies. Again, we 

invite public comment on RAND’s 

preliminary analysis of the alternative 

severity-adjusted DRG systems. The 

interim report can be viewed on the 

CMS Web site at: http:// 

www.cms.hhs.gov/Reports/downloads/ 

Wynn0307.pdf. 

2. Development of Proposed Medicare 

Severity DRGs (MS–DRGs) 

As discussed previously, we are 

committed to continuing our efforts of 

making refinements to the current CMS 

DRGs to better recognize severity of 

illness. In the FY 2007 final rule, we 

stated that we had begun a 

comprehensive review of over 13,000 

diagnosis codes to determine which 

codes should be classified as CCs when 

present as a secondary diagnosis. We 

stated that we would also build on the 

severity DRG work we performed in the 

mid-1990’s. We received a number of 

public comments on last year’s 

proposed rule that supported the 

refinement of the current CMS DRGs so 

that they better capture severity. 

We also committed to performing a 

more broad based analysis of the entire 

DRG system to better recognize severity 

of illness. As a result of this broad based 

analysis, we developed the proposed 

MS–DRGs. The proposed MS–DRGs 

represent a comprehensive approach to 

applying a severity of illness 

stratification for Medicare patients 

throughout the DRGs. As discussed in 

section II.D.5. of the preamble of this 

proposed rule, the proposed MS–DRGs 

maintain the significant advancements 

in identifying medical technology made 

to the DRGs in past years. At the same 

time, they greatly improve our ability to 

identify groups of patients with varying 

levels of severity using secondary 

diagnoses. Further, they improve our 

ability to assign patients to different 

DRG severity levels based on resource 

use that is independent of the patient’s 

secondary diagnosis—referred to in this 

discussion as ‘‘complexity.’’ We are 

proposing to adopt the MS–DRGs for FY 

2008 and submit the system to RAND as 

part of its evaluation of alternative DRG 

systems. We encourage comments on 

both our proposed methodology as well 

as on the resulting proposed DRG 

structure. 

a. Comprehensive Review of the CC List 

Our efforts to better recognize severity 

of illness began with a comprehensive 

review of the CC list. Currently, 115 

DRGs are split based on the presence or 

absence of a CC. For these DRGs, the 

presence of a CC assigns the discharge 

to a higher weighted DRG. The list of 

diagnoses designated as a CC was 

initially created at Yale University in 

1980–1981 as part of the project to 

develop an ICD–9–CM version of the 

DRGs. The researchers at Yale 

University developed the ICD–9–CM 

DRGs using national hospital data with 

diagnoses and procedures coded in 

ICD–9–CM from the second half of 1979. 

Because hospitals only began reporting 

ICD–9–CM codes in 1979, discharge 

abstracts at that time were much less 

likely to fully report all secondary 

diagnoses. As a result, the Yale 

University researchers developed a 

liberal definition of a CC as any 

secondary diagnosis that ‘‘would cause 

an increase in length of stay by at least 

1 day in at least 75 percent of the 

patients.’’ Because of the likely 

underreporting of secondary diagnoses 

in the 1979 data, the Yale University 

researchers also used age as a surrogate 

for identifying patients with a CC. The 

original version of the ICD–9–CM DRGs 

assigned patients to a CC DRG if they 

had a secondary diagnosis on the CC list 

or if the patient was 70 years or older. 

With the implementation of the IPPS 

in FY 1984, the coding of secondary 

diagnoses by hospitals dramatically 

improved. During the first 4 years of the 

IPPS, the CC definition included the age 

70 criterion. With the improved coding 

and reporting of diagnoses associated 

with the implementation of the IPPS, 

the use of age as a surrogate for CCs was 

no longer necessary. Thus, beginning in 

FY 1988, the age 70 criterion was 

removed from the CC definition and a 

CC DRG was defined exclusively by the 

presence of a secondary diagnosis on 

the CC list. 

Except for new diagnosis codes that 

were added to ICD–9–CM after FY 1984 

(for example, HIV), the CC list of 

diagnoses currently used in the CMS 

DRGs is virtually identical to the CC list 

created at Yale University. However, 

there have been dramatic changes not 

only in the accuracy and completeness 

of the coding of secondary diagnoses but 

also in the characteristics of patients 

admitted to hospitals and the practice 

patterns within hospitals as well. 

Since the implementation of the IPPS, 

Medicare average length of stay has 

dropped dramatically from 9.8 days in 

1983 to 5.7 days in 2005. The economic 

incentives inherent in DRGs motivated 

a change in practice patterns to 

discharge patients earlier from the 

hospital. These changes were facilitated 

by the increased availability of 

postacute care services, such as nursing 

homes and home health services, which 

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allowed problems previously requiring 

continued hospitalization to be 

effectively treated outside the acute care 

hospital. Furthermore, there has also 

been a dramatic shift to outpatient 

surgery that avoids costly inpatient 

stays. Many surgical procedures 

formerly performed in the hospital are 

now routinely performed on an 

outpatient basis. As a result, patients 

admitted to the hospital today are on 

average more likely to have a CC than 

when the IPPS was implemented. The 

net effect of better coding of secondary 

diagnoses, reductions in hospital length 

of stay, increased availability of 

postacute care services, and the shift to 

outpatient care is that most patients 

(nearly 80 percent) admitted to a 

hospital now have a CC. As a result of 

the changes that have occurred during 

the 22 years since the implementation of 

the IPPS, the CC list as currently 

defined has lost much of its power to 

discriminate hospital resource use. 

Currently, 115 CMS DRGs have a CC 

subdivision. Up until FY 2002, the 

number of DRGs with a CC subdivision 

remained essentially unchanged from 

the original FY 1984 version of the 

DRGs. As a means of improving the 

payment accuracy of the DRGs, 

beginning with the FY 2002 DRG 

update, each base CMS DRG without a 

CC subdivision was evaluated to 

determine if a CC subdivision was 

warranted. Over the past five DRG 

updates, only seven base CMS DRGs 

have had a CC subdivision added. The 

primary constraint preventing a 

significant increase in the number of 

base CMS DRGs with a CC subdivision 

is the low number of patients that 

would be assigned to the non-CC group. 

Thus, the expansion of the number of 

CMS DRGs subdivided based on a CC is 

constrained because the vast majority of 

patients would be assigned to the CC 

group and few patients would be 

assigned to the non-CC group. To 

remedy these problems, we reviewed 

each of the 13,549 secondary diagnosis 

codes to evaluate their assignment as a 

CC or non-CC using statistical 

information from the Medicare claims 

data and applying medical judgment 

based on current clinical practice. We 

refer to this list in this section as the 

‘‘revised CC list.’’ 

The need for a revised CC list 

prompted a reexamination of the 

secondary diagnoses that qualify as a 

CC. Our intent was to better distinguish 

cases that are likely to result in 

increased hospital resource use based 

on secondary diagnosis. Using a 

combination of mathematical data and 

the judgment of our medical officers, we 

included the condition on the CC list if 

it could demonstrate that its presence 

would lead to substantially increased 

hospital resource use. Diagnoses may require increased 

hospital resource use because of a need 

for such services as: 

<bullet≤ Intensive monitoring (for 

example, an intensive care unit (ICU) 

stay). <bullet≤ Expensive and technically 

complex services (for example, heart 

transplant). <bullet≤ Extensive care requiring a 

greater number of caregivers (for 

example, nursing care for a 

quadriplegic). There are 3,326 diagnosis 

codes on the current CC list. Our 2006 

review of the CC list reduced the 

number of diagnosis codes on the CC 

list to 2,583. Based on the current CC 

list, 77.6 percent of patients have at 

least one CC present. Based on the 

revised CC list from our 2007 review, 

the percent of patients having at least 

one CC present would be reduced to 

41.24 percent. 

b. Chronic Diagnosis Codes 

The 1979 data used in the original 

formation of the CC list often did not 

have the manifestations of a chronic 

disease fully coded. As a result, the CC 

list included many chronic diseases 

with a broad range of manifestations. 

Such chronic illness diagnoses usually 

do not cause a significant increase in 

hospital resource use unless there is an 

acute exacerbation present or there is a 

significant deterioration in the 

underlying chronic condition. 

Therefore, in the revised CC list, we 

removed chronic diseases without a 

significant acute manifestation. 

Recognition of the impact of the chronic 

disease is accomplished by separately 

coding the acute manifestation. For 

example, the mitral valve disease codes 

(codes 396.0 through 396.9) are assigned 

to the current CC list. However, unless 

the mitral valve abnormalities are 

associated with other diagnoses 

indicating acute deterioration, such as 

acute congestive heart failure, acute 

pulmonary edema, or respiratory failure, 

they would not be expected to 

significantly increase hospital resource 

use. Therefore, the revised CC list did 

not include the mitral valve codes. 

Recognition of the contribution of mitral 

valve disease to the complexity of 

hospital care would be accomplished by 

separately coding those diseases on the 

CC list that are associated with an acute 

exacerbation or deterioration of the 

mitral valve disease. 

The revised CC list applied the 

criterion that chronic diagnoses having 

a broad range of manifestations are not 

assigned to the CC list as long as there 

are codes available that allow the acute 

manifestations of the disease to be 

coded separately. For some diseases, 

there are ICD–9–CM codes that 

explicitly include a specification of the 

acute exacerbation of the underlying 

disease. For example, for congestive 

heart failure, the following codes 

specify an acute exacerbation of the 

congestive heart failure: 

<bullet≤ 428.21, Acute systolic heart 

failure 

<bullet≤ 428.41, Acute systolic and 

diastolic heart failure 

<bullet≤ 428.43, Acute on chronic 

systolic heart failure 

<bullet≤ 428.31, Acute diastolic heart 

failure 

<bullet≤ 428.33, Acute on chronic 

diastolic heart failure 

These congestive heart failure codes 

are included on the revised CC List. 

However, the following congestive heart 

failure codes do not indicate an acute 

exacerbation and are not included in the 

revised CC list: 

<bullet≤ 428.0, Congestive heart failure 

not otherwise specified 

<bullet≤ 428.1, Left heart failure 

<bullet≤ 428.20, Systolic heart failure 

not otherwise specified 

<bullet≤ 428.22, Chronic systolic heart 

failure 

<bullet≤ 428.32, Chronic diastolic heart 

failure 

<bullet≤ 428.40, Systolic and diastolic 

heart failure 

<bullet≤ 428.9, Heart failure not 

otherwise specified 

As a result of this approach, most 

chronic diseases were not assigned to 

the revised CC list. In general, a 

significant acute manifestation of the 

chronic disease must be present and 

coded for the patient to be assigned a 

CC. We made exceptions for diagnosis 

codes that indicate a chronic disease in 

which the underlying illness has 

reached an advanced stage or is 

associated with systemic physiologic 

decompensation and debility. The 

presence of such advanced chronic 

diseases, even in the absence of a 

separately coded acute manifestation, 

significantly adds to the treatment 

complexity of the patient. Thus, the 

presence of the advanced chronic 

disease inherently makes the reason for 

admission more difficult to treat. For 

example, under the revised CC list, stage 

IV, V, or end-stage chronic renal failure 

(codes 585.4 through 585.6) are 

designated as a CC, but stage I through 

III chronic renal failure (codes 585.1 

through 585.3) are not. For obesity, a 

body mass index over 35 (codes V85.35 

through V85.4) is a CC, but a body mass 

index between 19 and 35 is not. Endstage renal failure and extreme obesity 

are examples of chronic diseases for 

which the advanced stage of the disease 

is clearly specified. 

However, for most major chronic 

diseases, the stage of the disease is not 

clearly specified in the code. These 

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codes were evaluated based on the 

consistency and intensity of the 

physiologic decompensation and 

debility associated with the chronic 

disease. For example, quadriplegia 

(codes 344.00 through 344.09) requires 

extensive care with a substantial 

increase in nursing services and more 

intensive monitoring. Therefore, 

quadriplegia is considered a CC in the 

revised CC list. 

c. Acute Diagnosis Codes 

Examples of acute diseases included 

on the revised CC list included acute 

myocardial infarction (AMI), 

cerebrovascular accident (CVA) or 

stroke, acute respiratory failure, acute 

renal failure, pneumonia and 

septicemia. These six diseases are 

representative of the types of illnesses 

we included on the revised CC list. 

Other acute diseases were designated as 

a CC if their impact on hospital resource 

use would be expected to be comparable 

to these representative acute diseases. 

For example, acute endocarditis was 

included on the CC list but urinary tract 

infection was not. 

The revised CC list is essentially 

comprised of significant acute disease, 

acute exacerbations of significant 

chronic diseases, advanced or end stage 

chronic diseases and chronic diseases 

associated with extensive debility. 

Compared to the existing CC list, the 

revised CC list requires a secondary 

diagnosis to have a consistently greater 

impact on hospital resource. 

The following Table D compares the 

current CC list and the revised CC list. 

There are 3,326 diagnosis codes on the 

current CC list. The CC revisions reduce 

the number of diagnosis codes on the 

CC list to 2,583. Based on the current CC 

list, 77.6 percent of patients have at 

least one CC present, using FY 2006 

MedPAR data. Based on the revised CC 

list, the percent of patients having at 

least one CC present is reduced to 40.34 

percent. The revised CC list increases 

the difference in average charges 

between patients with and without a CC 

by 56 percent ($15,236 versus $9,743). 

TABLE D.—COMPARISON OF CURRENT CC LIST AND REVISED CC LIST

Current CC list Revised CC list 

Codes designated as a CC ................................................................................................................................. 3,326 2,583 

Percent of patients with one or more CCs .......................................................................................................... 77 .66 40 .34 

Percent of patients with no CC ........................................................................................................................... 22 .34 59 .66 

Average charge of patients with one or more CCs ............................................................................................. $24,538 $31,451 

Average charge of patients with no CCs ............................................................................................................ $14,795 $16,215 

The analysis above suggests that 

merely reviewing and updating the CC 

list can lead to significant 

improvements in the ability of the CMS 

DRGs to recognize severity of illness. 

Although we could potentially adopt 

this one change to better recognize 

severity of illness in the CMS DRGs, we 

have undertaken additional analyses 

that further refine secondary diagnoses 

into MCCs, CCs and non-CCs as 

described below. 

d. Prior Research on Subdivision of CCs 

into Multiple Categories 

(1) Refined DRGs 

During the mid-1980s, CMS (then 

HCFA) funded a project at Yale 

University to revise the use of CCs in 

the CMS DRGs. The Yale University 

project mapped all secondary diagnoses 

that were considered a CC in the CMS 

DRGs into 136 secondary diagnosis 

groups, each of which was assigned a 

CC complexity level. For surgical 

patients, each of the 136 secondary 

diagnosis groups was assigned to 1 of 4 

CC complexity levels (non-CC, moderate 

CC, MCC, and catastrophic CC). For 

medical patients, each of the 136 

secondary diagnosis groups was 

assigned to 1 of 3 CC complexity levels 

(non-CC, moderate/MCC, and 

catastrophic CC). All age subdivisions 

and CC subdivisions in the DRGs were 

eliminated and replaced by the four CC 

subgroups for surgical patients, or the 

three CC subgroups for medical patients. 

The Yale University project did not 

reevaluate the categorization of 

secondary diagnosis as a CC versus a 

non-CC. Only the diagnoses on the 

standard CC list were used to create the 

moderate, major, and catastrophic 

subgroups. All secondary diagnoses in a 

secondary diagnosis group were 

assigned the same level, and a patient 

was assigned to the subgroup 

corresponding to the highest level 

secondary diagnosis. The number of 

secondary diagnoses had no effect on 

the subgroup assigned to the patient 

(that is, multiple secondary diagnoses at 

one level did not cause a patient to be 

assigned to a higher subgroup). The 

DRG system developed by the Yale 

University project demonstrated that a 

subdivision of the CCs into multiple 

subclasses would improve the 

predictability of hospital costs. 

(2) 1994 Severity DRGs 

We also examined the work we 

performed in the mid-1990’s to revise 

the CMS DRGs to better capture 

severity. In 1993, we reevaluated the use 

of CCs within the CMS DRGs. The 

reevaluation excluded the CMS DRGs 

associated with pregnancy, newborn, 

and pediatric patients (MDCs 14 and 15 

and DRGs defined based on age 0–17). 

The major CC list from the AP–DRGs 

that are used for Medicaid payment by 

New York and other States was used to 

identify an initial list of MCCs. Using 

Medicare data, we reevaluated the 

categorization of each secondary 

diagnosis as a non-CC, CC, or an MCC. 

The end result was that 111 diagnoses 

that were non-CCs in the standard CMS 

DRGs were made a CC, 220 diagnoses 

that were a CC were made a non-CC, 

and 395 CCs were considered an MCC. 

All CC splits in the CMS DRGs were 

eliminated, and an additional 24 DRGs 

were merged together. The resulting 

base CMS DRGs were then subdivided 

into three, two, or no subgroups based 

on an analysis of Medicare data. The 

result was 84 DRGs with no subgroups, 

124 DRGs with two subgroups, and 85 

DRGs with three subgroups. An 

additional 63 pregnancy, newborn, and 

pediatric DRGs not evaluated resulted in 

a total of 652 DRGs. 

A patient was assigned to the CC 

subgroup corresponding to the highest 

level secondary diagnosis. Multiple 

secondary diagnoses at one level did not 

cause a patient to be assigned to a 

higher subgroup. The categorization of a 

diagnosis as non-CC, CC, or MCC was 

uniform across the CMS DRGs, and 

there were no modifications for specific 

DRGs. As part of the FY 1995 IPPS 

proposed rule, we made a complete file 

of the revised DRG descriptions 

available to the public. However, we 

never adopted the revised DRGs (55 FR 

27756). 

e. Proposed Medicare Severity DRGs 

(MS–DRGs) 

We had several options in developing 

a refinement to the current CMS DRGs 

to better recognize increased resource 

use due to severity of illness. One 

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24700 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

option would involve simply taking the 

work performed in 1994 and then 

updating it with all the code changes 

that have taken place since then. We 

were reluctant to do this because of 

changes in medical practices as well as 

the substantial change in ICD–9–CM 

codes since that time. Another option 

would be to build on current CMS DRGs 

which include a number of 

advancements that better identify 

medical practices and technologies. 

Many commenters on the FY 2007 IPPS 

proposed rule urged us to take the latter 

approach because they believed the 

current base CMS DRGs clearly 

differentiate between the complexities 

of varying surgical procedures and 

medical devices. Therefore, we chose 

the option of developing a new severity 

DRG system based on the current CMS 

DRGs. 

The development of the 1994 Severity 

DRGs involved three steps: 

<bullet≤ Consolidation of existing 

DRGs into base DRGs. 

<bullet≤ Categorization of each 

diagnosis as an MCC, CC, or non-CC. 

<bullet≤ Subdivision of each base 

DRG into subclasses based on CCs. 

We reviewed and revised each of the 

three steps and applied them to our 

current CMS DRGs to develop DRGs that 

better identify severity of illness among 

Medicare patients. We refer to this 

proposed system as the Medicare 

Severity DRGs (MS–DRGs). The purpose 

of the proposed MS–DRGs is to more 

accurately stratify groups of Medicare 

patients with varying levels of severity. 

(1) Consolidation of Existing CMS DRGs 

Into Proposed Base MS–DRGs 

The first step in our process was the 

consolidation of existing CMS DRGs 

into new proposed base MS–DRGs. We 

combined together the 115 pairs of CMS 

DRGs that are subdivided based on the 

presence of a CC. We further 

consolidated the CMS DRGs that are 

split on the basis of a major 

cardiovascular condition, AMI with and 

without major complication (CMS DRGs 

121 and 122), and cardiac 

catheterization with and without 

complex diagnoses (CMS DRGs 124 and 

125). We also consolidated the three 

pairs of burn CMS DRGs that were 

defined based on the presence of a CC 

or a significant trauma (CMS DRGs 506 

and 507; 508 and 509; and 510 and 511). 

Next, we consolidated the 43 pediatric 

CMS DRGs that are defined based on age 

less than or equal to 17. These pediatric 

CMS DRGs contain a very low volume 

of Medicare patients. As shown in Table 

10 of the FY 2007 IPPS final rule (71 FR 

48318), only two of these pediatric CMS 

DRGs contained more than 100 patients 

(CMS DRGs 298 and 333). Seventeen of 

these pediatric DRGs had no patients 

(CMS DRGs 30, 33, 41, 48, 54, 58, 137, 

252, 255, 282, 330, 340, 343, 393, 405, 

446, and 448). As we have stated 

frequently, our primary focus in 

maintaining the CMS DRGs is to serve 

the Medicare population. We do not 

have the data or the expertise to 

maintain the DRGs in clinical areas that 

are not relevant to the Medicare 

population. We continue to encourage 

users of the CMS DRGs (or MS–DRGs if 

adopted) to make relevant adaptations if 

they are being used for a non-Medicare 

patient population. 

In addition to the pediatric CMS 

DRGs defined by the age of the patient, 

there are a number of CMS DRGs that 

relate primarily to the pediatric or adult 

population that have very low volume 

in the Medicare population, such as 

male sterilization, tubal interruptions, 

circumcisions, tonsillectomies, and 

myringotomies. These CMS DRGs were 

consolidated into the most clinically 

similar proposed MS–DRG. 

Over the past two decades, the site of 

service for some elective procedures 

such as carpal tunnel release, cataract 

extraction, and laparoscopy has shifted 

from the inpatient to the outpatient 

setting, resulting in the CMS DRGs 

associated with these procedures having 

very low volume. These CMS DRGs 

were also consolidated into the most 

clinically similar proposed MS–DRG. In 

addition, there were some clinically 

related CMS DRGs that had significant 

Medicare patient volume but had no 

significant difference in resource use. 

For example, thyroid (CMS DRG 290) 

and parathyroid (CMS DRG 289) 

procedures were virtually identical in 

terms of hospital resource use and were, 

therefore, consolidated. In total, 34 of 

these CMS DRGs were consolidated. 

The DRG consolidations are 

summarized in Table E below. 

Four pairs of proposed MS–DRGs (223 

and 224; 228 and 229; 323 and 324; and 

551 and 552) were defined based on the 

presence of a CC or some other 

condition. For example, proposed MS– 

DRG 323 is defined based on the 

presence of a CC or the performance of 

extracorporeal shock wave lithotripsy. 

For these proposed MS–DRGs, the CC 

condition was removed and the pair of 

DRGs remains separate but defined 

based only on the other condition (that 

is, proposed MS–DRG 323 became 

urinary stones with extracorporeal 

shock wave lithotripsy). As was done in 

the 1994 severity DRG work, we did not 

consolidate any of the CMS DRGs for 

maternity or newborn cases. 

Before proceeding further, we made 

one additional change to a base DRG 

assignment after completing these 

consolidations. We assigned cranialfacial bone procedures to a proposed 

new base DRG (Cranial/Facial Bone 

Procedures). These cases were 

previously assigned to DRGs 52 and 55 

through 63. 

Table E below shows how DRGs in 

the CMS DRGs (Version 24.0) were 

consolidated into proposed new base 

MS–DRGs. We refer readers to section 

II.D.2. of the preamble of this proposed 

rule for a detailed discussion of CCs and 

MCCs under the proposed MS–DRGs. 

TABLE E.—DRG CONSOLIDATION

CMS-DRG 

Version 24.0 DRG description 

Proposed 

2008 MSDRG Proposed new base MS-DRGs description 

6 .....................

7,8 ..................

Carpal Tunnel Release ....................................................

Peripheral & Cranial Nerve & Other Nervous System 

Procedure.

40 

41 

42 

Peripheral & Cranial Nerve & Other Nervous System 

Procedure with MCC, with CC, and without CC/MCC. 

36 ...................

38 ...................

39 ...................

42 ...................

Retinal Procedures ...........................................................

Primary Iris Procedures ...................................................

Lens Procedures with or without Vitrectomy ...................

Intraocular Procedures Except Retina, Iris & Lens .........

116 

117 

Intraocular Procedures with and without CC/MCC. 

43 ...................

46,47,48 .........

Hyphema ..........................................................................

Other Disorders of the Eye ..............................................

124 

125 

Other Disorders of the Eye with and without MCC. 

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TABLE E.—DRG CONSOLIDATION—Continued 

CMS-DRG 

Version 24.0 DRG description 

Proposed 

2008 MSDRG Proposed new base MS-DRGs description 

50 ...................

51 ...................

Sialoadenectomy ..............................................................

Salivary Gland Procedures Except Sialoadenectomy .....

139 Salivary Gland Procedures. 

52 ...................

55 ...................

Cleft Lip & Palate Repair .................................................

Miscellaneous Ear, Nose, Mouth & Throat Procedures ..

133 

134 

Other Ear, Nose, Mouth & Throat O.R. Procedures with 

and without CC/MCC. 

56 ...................

57,58 ..............

59,60 ..............

61,62 ..............

63 ...................

Rhinoplasty .......................................................................

Tonsillectomy & Adenoidectomy Procedure, Except 

Tonsillectomy &/or Adenoidectomy Only.

Tonsillectomy &/or Adenoidectomy Only .........................

Myringotomy with Tube Insertion .....................................

Other Ear, Nose, Mouth & Throat O.R. Procedures .......

131 

132 

New DRG—Cranial/Facial Bone Procedures with and 

without CC/MCC. 

67 ...................

68,69,70 .........

71 ...................

Epiglottitis .........................................................................

Otitis Media & Upper Respiratory Infection .....................

Laryngotracheitis ..............................................................

152 

153 

Otitis Media & Upper Respiratory Infection with and 

without MCC. 

72 ...................

73,74 ..............

Nasal, Trauma & Deformity .............................................

Other Ear, Nose, Mouth & Throat Diagnoses .................

154 

155 

156 

Other Ear, Nose, Mouth & Throat Diagnoses with MCC, 

with CC, without CC/MCC. 

185,186 ..........

187 .................

Dental & Oral Diseases Except Extractions & Restorations.

Dental Extractions & Restorations ...................................

157 

158 

159 

Dental & Oral Diseases with MCC, with CC, without CC/ 

MCC. 

199 .................

200 .................

Hepatobiliary Diagnostic Procedure for Malignancy ........

Hepatobiliary Diagnostic Procedure for Non-Malignancy 

420 

421 

422 

Hepatobiliary Diagnostic Procedures with MCC, with 

CC, without CC/MCC. 

244,245 ..........

246 .................

Bone diseases & Specific Arthropathies ..........................

Non-Specific Arthropathies ..............................................

553 

554 

Bone Diseases & Arthropathies with and without MCC. 

259,260 ..........

261 .................

262 .................

Subtotal Mastectomy for Malignancy * ............................

Breast Procedures for Non-Malignancy Except Biopsy & 

Local Excision.

Breast Biopsy & Local Excision for Non-Malignancy ......

584 

585 

Breast Biopsy, Local Excision & Other Breast Procedures with and without CC/MCC. 

267 .................

268 .................

269,270 ..........

Perianal & Pilonidal Procedures ......................................

Skin, Subcutaneous Tissue & Breast Plastic Procedures 

Other Skin, Subcutaneous Tissue & Breast Procedure ..

579 

580 

581 

Other Skin, Subcutaneous Tissue & Breast Procedures 

with MCC, with CC, without CC/MCC. 

289 .................

290 .................

291 .................

Parathyroid Procedures ...................................................

Thyroid Procedures ..........................................................

Thyroglossal Procedures .................................................

625 

626 

627 

Thyroid, Parathyroid & Thyroglossal Procedures with 

MCC, with CC, without CC/MCC. 

294 .................

295 .................

Diabetes ≤ 35 ...................................................................

Diabetes < 35 ...................................................................

637 

638 

639 

Diabetes with MCC, with CC, without CC/MCC. 

338 .................

339,340 ..........

Testes Procedures for Malignancy ..................................

Testes Procedures, Non-Malignancy ...............................

711 

712 

Testes Procedures with and without CC/MCC. 

342,343 .......... Circumcision ..................................................................... ................ Procedure 64.0 changed to non-O.R. Cases with only 

this procedure will go to medical DRGs. 

351 .................

352 .................

Sterilization, Male .............................................................

Other Male Reproductive System Diagnoses ..................

729 

730 

Other Male Reproductive System Diagnoses with and 

without CC/MCC. 

361 .................

362 .................

363 .................

364 .................

Laparoscopy & Incisional Tubal Interruption ...................

Endoscopic Tubal Interruption .........................................

D&C, Conization & Radio-Implant, for Malignancy ..........

D&C, Conization Except for Malignancy ..........................

History of Malignancy with Endoscopy ............................

744 

745 

D&C, Conization, Laparascopy & Tubal Interruption with 

and without CC/MCC. 

411 .................

412 .................

413,414 ..........

History of Malignancy without Endoscopy .......................

Other Myeloproliferative Disease or Poorly Differentiated 

Neoplasm Diagnosis.

843 

844 

845 

Other Myeloproliferative Disease or Poorly Differentiated 

Neoplasm Diagnosis with MCC, with CC, without CC/ 

MCC. 

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TABLE E.—DRG CONSOLIDATION—Continued 

CMS-DRG 

Version 24.0 DRG description 

Proposed 

2008 MSDRG Proposed new base MS-DRGs description 

465 .................

466 .................

Aftercare with History of Malignancy as Secondary Diagnosis.

Aftercare without History of Malignancy as Secondary 

Diagnosis.

949 

950 

Aftercare with and without CC/MCC. 

*Codes 85.22 and 85.23 in CMS DRGs 259 and 260 were moved to proposed MS-DRG 582 and 583. 

As summarized in the Table F, the 

consolidation resulted in the formation 

of 335 proposed base MS–DRGs. 

TABLE F.—CONSOLIDATION OF CURRENT CMS DRGS INTO PROPOSED

MS–DRGS

Number 

Current CMS DRGs ...................... 538 

Elimination of CC subgroups ........ -114 

Elimination of MCC subgroups ..... -7 

Elimination of CC complexity subgroups ....................................... -5 

Elimination of age 0–17 subgroups ....................................... -43 

Consolidation due to volume or 

resource similarity ..................... -34 

New DRG ..................................... +1 

Revised Base DRGs .................... 311 

Newborn, maternity and error 

DRGs ........................................ +24 

Base DRGs for severity subdivision ............................................ 335 

The end result of the consolidation of 

the CMS DRGs in the proposed MS– 

DRGs was similar to the consolidation 

performed in the 1994 severity DRGs. 

The 1994 DRG consolidations resulted 

in 356 base DRGs plus 2 error DRGs. 

The number of the 1994 base DRGs is 

different because new CMS DRGs have 

been added since 1994, the 43 age 0–17 

pediatric CMS DRGs were not 

consolidated, and some of the volume 

shifts to outpatient care had not yet 

occurred in 1994. In the 1994 severity 

DRGs, 24 DRGs were consolidated due 

to volume or resource similarity. 

Sixteen of these 1994 DRG 

consolidations are included in the 34 

consolidations done in the 2007 

consolidations. However, due to 

concerns expressed by our physician 

consultants, 8 of the DRG consolidations 

from 1994 were not done. For example, 

interstitial lung disease (DRGs 92 and 

93) was not consolidated with simple 

pneumonia and pleurisy (DRGs 89, 90, 

91) as was done in the 1994 

consolidations. 

(2) Categorization of Diagnoses 

We decided to establish three 

different levels of CC severity into 

which we would subdivide the 

diagnosis codes. The proposed three 

levels are MCC, CC, and non-CC. 

Diagnosis codes classified as MCCs 

reflect the highest level of severity. The 

next level of severity includes diagnosis 

codes classified as CCs. The lowest level 

is for non-CCs. Non-CCs are diagnosis 

codes that do not significantly affect 

severity of illness and resource use. 

Therefore, secondary diagnoses that are 

non-CCs do not affect the DRG 

assignment under either the current 

CMS DRGs or the proposed MS–DRGs. 

The categorization of diagnoses as an 

MCC, CC, or non-CC was accomplished 

using an iterative approach in which 

each diagnosis was evaluated to 

determine the extent to which its 

presence as a secondary diagnosis 

resulted in increased hospital resource 

use. In order to begin this iterative 

process, we started with an initial 

categorization of each diagnosis as an 

MCC, CC, or non-CC. As noted 

previously the 1994 CC revision began 

by separating CCs into MCC and CC 

based on the AP–DRG major CCs. One 

way to begin this iterative process 

would have been to use the 1994 CC 

categorization. However, the 1994 CC 

categorization was based on FY 1992 

data and ICD–9–CM diagnosis codes, 

which now are 15 years old. Since 1992, 

1,897 new diagnoses codes have been 

added, and 346 diagnoses codes have 

been deleted. Because the revised CC 

list (explained in section II.C.2.a. of this 

preamble) was based on current ICD–9– 

CM codes and used recent data, we 

decided to utilize the revised CC list 

rather than the 1994 categorization as 

our starting point for determining 

whether each secondary diagnosis 

should be an MCC, a CC, or a non-CC. 

The revised CC list categorizes each 

diagnosis as a CC or a non-CC. We 

decided to use this list in combination 

with the categorization under the AP– 

DRGs and the APR DRGs. The AP–DRGs 

and the APR–DRGs are updated 

annually with current codes and 

provide a good comparison source to 

use with the revised CC list. We 

designated as an MCC any diagnosis 

that was a CC in the revised CC list and 

was an AP–DRG major CC and was an 

APR DRG default severity level 3 

(major) or 4 (extensive). We designated 

as a non-CC any diagnosis that was a 

non-CC in the revised CC list and was 

an AP–DRG non-CC and was an APR 

DRG default severity level of 1 (minor). 

Any diagnoses that did not meet either 

of the above two criteria was designated 

as a CC. 

The only exception to our approach 

was for diagnoses related to newborns, 

maternity, and congenital anomalies. 

These diagnoses are very low volume in 

the Medicare population and were not 

reviewed for purposes of creating the 

revised CC list. We used the APR DRGs 

to categorize these diagnoses. For 

newborn, obstetric, and congenital 

anomaly diagnoses, we designated the 

APR DRG default severity level 3 

(major) and 4 (extreme) diagnoses as an 

MCC, the APR–DRG default severity 

level 2 (moderate) diagnoses as a CC, 

and the APR DRG default severity 1 

(minor) diagnoses as a non-CC. Table G 

summarizes the number of codes in 

each CC category. 

TABLE G.—INITIAL CATEGORIZATION

OF CC CODES

Number 

of codes 

MCC .............................................. 1,096 

CC ................................................. 4,221 

Non-CC ......................................... 8,232 

Total ....................................... 13,549 

This initial CC categorization of 

diagnosis codes was used to begin the 

iterative process of determining the 

proposed final CC categorization for 

each diagnosis code. 

(3) Additional CC Exclusions 

For some CMS DRGs, the presence of 

specific secondary diagnoses affects the 

base DRG assignment. For example, in 

MDC 5 (Diseases and Disorders of the 

Circulatory System), the presence of an 

AMI code as the principal diagnosis or 

as a secondary diagnosis will cause the 

patient to be assigned to the AMI DRGs 

(CMS DRGs 121 through 123). 

Therefore, if the AMI code is present as 

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a secondary diagnosis, it should not be 

used to assign the CC category for a 

patient because it is redundant within 

the definition of the base DRG. 

Similarly, for MDC 24 (Multiple 

Significant Trauma), specific 

combinations of significant trauma as 

principal or secondary diagnosis cause 

the assignment to the multiple trauma 

DRGs (CMS DRGs 484 through 487). 

Therefore, any secondary diagnosis of 

trauma is redundant with the definition 

of the multiple trauma DRGs and should 

not be used to determine the CC 

category for a patient. Any secondary 

diagnoses that are used to assign a 

specific proposed base MS–DRG were 

excluded from the determination of the 

CC category for patients assigned to that 

proposed base MS–DRG. 

(4) Analysis of Secondary Diagnoses 

The 311 proposed base MS-DRGs (335 

total base DRGs minus the MDC 14, 

MDC 5, and error DRGs) were 

subdivided into three CC subgroups. 

Patients were assigned to the subgroup 

corresponding to the most extreme CC 

present). All but four of the proposed 

base MS-DRGs had strictly 

monotonically increasing average 

charges across the three CC subgroups 

(that is, average charges progressively 

increased from the non-CC to the CC to 

the MCC subgroups). The four proposed 

MS-DRGs that failed to have 

monotonically increasing charges all 

had at least one CC subgroup with very 

low volume. For example, the non-CC 

subgroup for the pancreas transplant 

DRG (CMS DRG 513) had only 2 cases. 

The overall statistics by CC subgroup for 

the 311 proposed base MS-DRG is 

contained in Table H. Patients in the 

MCC subgroup have average charges 

that are nearly double the average 

charge for patients in the CC subgroup. 

The CC subgroup with the largest 

number of patients is the non-CC 

subgroup with 41.1 percent of the 

patients. 

TABLE H.—OVERALL STATISTICS FOR PROPOSED MS–DRGS EXCLUDING THOSE IN MDCS 14 AND 15 

CC subgroup Number of 

cases Percent Average charges 

Major ............................................................................................................................................ 2,604,696 22.2 $44,246 

CC ................................................................................................................................................ 4,293,744 36.6 24,131 

Non-CC ........................................................................................................................................ 4,818,411 41.1 18,435 

In order to evaluate the initial 

assignment of secondary diagnoses to 

the three CC subclasses, we devised a 

system that determined the impact on 

resource use of each secondary 

diagnosis. For each secondary diagnosis, 

we measured the impact in resource use 

for the following three subsets of 

patients: 

(a) Patients with no other secondary 

diagnosis or with all other secondary 

diagnoses that are non-CCs. 

(b) Patients with at least one other 

secondary diagnosis that is a CC but 

none that is an MCC. 

(c) Patients with at least one other 

secondary diagnosis that is an MCC. 

Numerical resource impact values 

were assigned for each diagnosis as 

follows: 

Value Meaning 

0 .......... Significantly below expected value 

for the non-CC subgroup. 

1 .......... Approximately equal to expected 

value for the non-CC subgroup. 

2 .......... Approximately equal to expected 

value for the CC subgroup. 

3 .......... Approximately equal to expected 

value for the MCC subgroup. 

Value Meaning 

4 .......... Significantly above the expected 

value for the MCC subgroup. 

Each diagnosis for which Medicare 

data were available was evaluated to 

determine its impact on resource use 

and to determine the most appropriate 

CC subclass (non-CC, CC, or MCC) 

assignment. In order to make this 

determination, the average charge for 

each subset of cases was compared to 

the expected charge for cases in that 

subset. The following format was used 

to evaluate each diagnosis: 

ODE

Code Diagnosis Cnt1 C1 Cnt2 C2 Cnt3 C3 

Count (Cnt) is the number of patients in 

each subset and C1, C2, and C3 are a 

measure of the impact on resource use 

of patients in each of the subsets. The 

C1, C2, and C3 values are a measure of 

the ratio of average charges for patients 

with these conditions to the expected 

average charge across all cases. The C1 

value reflects a patient with no other 

secondary diagnosis or with all other 

secondary diagnoses that are non-CCs. 

The C2 value reflects a patient with at 

least one other secondary diagnosis that 

is a CC but none that is a major CC. The 

C3 value reflects a patient with at least 

one other secondary diagnosis that is a 

major CC. A value close to 1.0 in the C1 

field would suggest that the code 

produces the same expected value as a 

non-CC diagnosis. That is, average 

charges for the case are similar to the 

expected average charges for that subset 

and the diagnosis is not expected to 

increase resource usage. A higher value 

in the C1 (or C2 and C3) field suggests 

more resource usage is associated with 

the diagnosis and an increased 

likelihood that it is more like a CC or 

major CC than a non-CC. Thus, a value 

close to 2.0 suggests the condition is 

more like a CC than a non-CC but not 

as significant in resource usage as an 

MCC. A value close to 3.0 suggests the 

condition is expected to consume 

resources more similar to an MCC than 

a CC or non-CC. For example, a C1 value 

of 1.8 for a secondary diagnosis means 

that for the subset of patients who have 

the secondary diagnosis and have either 

no other secondary diagnosis present, or 

all the other secondary diagnoses 

present are non-CCs, the impact on 

resource use of the secondary diagnoses 

is greater than the expected value for a 

non-CC by an amount equal to 80 

percent of the difference between the 

expected value of a CC and a non-CC 

(that is, the impact on resource use of 

the secondary diagnosis is closer to a CC 

than a non-CC). 

Table I below shows examples of the 

results. 

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TABLE I.—EXAMPLES OF IMPACT ON RESOURCE USE OF SECONDARY DIAGNOSES

Code Cnt1 C1 CntC2 C2 Cnt3 C3 CC subclass 

401.1, Benign essential hypertension .............................. 12,308 0.955 40,113 1.715 5,297 2.384 Non-CC. 

530.81, Esophageal reflux ................................................ 294,673 0.986 917,058 1.639 122,076 2.302 Non-CC 

560.1, Paralytic Ileus ........................................................ 10,651 1.466 87,788 2.320 51,303 3.226 CC 

491.20, Obstructive chronic bronchitis ............................. 7,003 1.416 32,276 2.193 13,355 3.035 CC 

410.71, Subendocardial infarction initial episode ............. 1,657 2.245 30,226 2.778 42,862 3.232 MCC 

518.81, Acute respiratory failure ...................................... 5,332 2.096 118,937 2.936 223,054 3.337 MCC 

The resource use impact reports were 

produced for all diagnoses except 

obstetric, newborn, and congenital 

anomalies (10,690 diagnoses). These 

mathematical constructs were used as 

guides in conjunction with the 

judgment of our clinical staff to classify 

each secondary diagnosis reviewed as 

an MCC, CC or non-CC. Our clinical 

panel reviewed the resource use impact 

reports and modified 14.9 percent of the 

initial CC subclass assignments as 

summarized in Table J below. The rows 

in the table are the initial CC subclass 

categories and the columns are the final 

CC subclass categories. 

TABLE J.—CC SUBCLASS MODIFICATIONS

Initial CC subclass 

Final CC subclass 

Total Percent 

MCC CC Non-CC 

MCC ............................................................................... 847 62 0 909 8.5 

CC .................................................................................. 542 2,579 737 3,858 36.1 

Non-CC .......................................................................... 0 272 5,651 5,923 55.4 

Total ........................................................................ 1,389 2,913 6,388 10,690 ........................

Percent ........................................................................... 13 .0 27 .2 59 .8 ........................ ........................

Of the diagnoses initially designated 

as an MCC, 6.8 percent were made a CC 

(62/909), and of the diagnoses initially 

designated as non-CC, 4.6 percent were 

made a CC (272/5,923). The major shift 

occurred in the diagnoses initially 

assigned to the CC subclass. Fourteen 

percent of the diagnoses initially 

designated as a CC were made an MCC 

(542/3858), and 19.1 percent of the 

diagnoses initially designated a CC were 

made a non-CC (737/3,858). In 

determining the CC subclass assigned to 

a diagnosis, imprecise codes were, in 

general, not assigned to the MCC or CC 

subclass. For example, the congestive 

heart failure codes have the following 

CC subclass assignments: 

Code CC subclass 

assignment 

428.21, Acute systolic heart 

failure.

MCC 

428.41, Acute systolic & diastolic heart failure.MCC 

428.43, Acute on chronic 

systolic heart failure.

MCC 

428.31, Acute diastolic heart 

failure.

MCC 

428.33, Acute on chronic diastolic heart failure.MCC 

428.1, Left heart failure ......... CC 

428.20, Systolic heart failure 

NOS.

CC 

428.22, Chronic systolic heart 

failure.

CC 

Code CC subclass 

assignment 

428.32, Chronic diastolic 

heart failure.

CC 

428.40, Systolic & diastolic 

heart failure.

CC 

428.0, Congestive heart failure NOS.NonCC 

428.9, Heart failure NOS ...... Non-CC 

The acute heart failure codes are 

MCCs, and the chronic heart failure 

codes are CCs. However, Not Otherwise 

Specified (NOS) heart failure codes are 

non-CCs. Thus, the precise type of heart 

failure must be specified in order for an 

MCC or CC to be assigned. 

There are currently 13,549 ICD–9-CM 

diagnosis codes. The External Cause of 

Injury and Poisoning codes (E800— 

E999) and congenital codes were not 

included in our current CC review for 

the proposed MS-DRGs. We excluded 

the External Cause of Injury and 

Poisoning codes (E codes) from 

consideration as an MCC or a CC 

because they describe how an injury 

occurred, and not the exact nature of the 

injury. For instance, if a patient fell on 

the deck of a boat and fractured his or 

her skull, one would assign an E code 

to describe the fall on the boat. A 

separate diagnosis code would be 

assigned to describe the exact nature of 

any resulting injury such as a contusion, 

fractured bone, or skull fracture and 

concussion. A patient would be 

assigned to a severity level based on the 

exact nature of the injury and not the 

manner in which the injury occurred. 

Therefore, we decided not to classify 

any of the E codes as either an MCC or 

a CC. The congenital codes describe 

abnormalities when a baby is born. At 

times, a beneficiary may live with these 

congenital abnormalities for years 

without a problem. The congenital 

abnormalities may later lead to 

complications that require hospital 

admissions. Should these congenital 

abnormalities lead to medical problems 

that result in a hospital admission for a 

Medicare beneficiary, the exact nature 

of the condition being treated would 

also be assigned a code. This more 

precise code would be evaluated to 

determine whether or not it was an MCC 

or a CC. Therefore, we decided not to 

classify congenital abnormality codes as 

an MCC or a CC, but to instead use the 

other reported diagnosis codes that 

better describe the reason for the 

admission. Excluding the external cause 

of injury codes, we reviewed 10,690 

diagnosis codes. 

As was done in our 1994 severity 

proposal, diagnoses that were closely 

associated with patient mortality were 

assigned different CC subclasses, 

depending on whether the patient lived 

or died. These diagnoses are: 

<bullet≤ 427.41, Ventricular fibrillation 

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<bullet≤ 427.5, Cardiac arrest 

<bullet≤ 785.51, Cardiogenic shock 

<bullet≤ 785.59, Other shock without 

mention of trauma 

<bullet≤ 799.1, Respiratory arrest 

Resource use for patients with these 

diagnoses who were discharged alive 

was consistent with an MCC. Resource 

use for patients with these diagnoses 

who died was consistent with a non-CC. 

Further, most patients who died could 

legitimately have one of these diagnoses 

coded. As a result, these diagnoses are 

assigned an MCC subclass for patients 

who lived and a non-CC subclass for 

patients who died. 

For some secondary diagnoses 

assigned to the CC subclass, our medical 

consultants identified specific clinical 

situations in which the diagnosis should 

not be considered a CC. In such clinical 

situations, the CC exclusion list was 

used to exclude the secondary diagnosis 

from consideration in determining the 

CC subgroup essentially making the 

secondary diagnosis a non-CC. For 

example, primary cardiomyopathy (code 

425.4) is designated as a CC. However, 

for patients admitted for congestive 

heart failure, our medical consultants 

believed that primary cardiomyopathy 

should be treated as a non-CC. In order 

to accomplish that, the congestive heart 

failure principal diagnoses were added 

to the CC exclusion list for primary 

cardiomyopathy as a secondary 

diagnosis. 

The list of diagnosis codes that we are 

proposing to classify as an MCC is 

included in Table 6J in the Addendum 

of this proposed rule. The diagnosis 

codes that we are proposing to classify 

as a CC are included in Table 6K in the 

Addendum of this proposed rule. The 

proposed E-codes, which are diagnosis 

codes used to classify external causes of 

injury and poisoning, are not included 

in this list. All proposed E-codes are 

designated as non-CCs under the current 

CMS DRG system and our evaluation 

supports this non-CC designation as 

appropriate. 

3. Dividing Proposed MS–DRGs on the 

Basis of the CCs and MCCs 

In developing the proposed MS– 

DRGs, two of our major goals were to 

create DRGs that would more accurately 

reflect the severity of the cases assigned 

to them and to create groups that would 

have sufficient volume so that 

meaningful and stable payment weights 

could be developed. As noted above, we 

excluded the CMS DRGs in MDCs 14 

and 15 from consideration because these 

DRGs are low volume. As stated 

previously, we do not have the expertise 

or data to maintain the CMS DRGs for 

newborns, pediatric, and maternity 

patients. We continue to maintain MDCs 

14 and 15 without modification in order 

to have MS–DRGs available for these 

patients in the rare instance where there 

is a Medicare beneficiary admitted for 

maternity or newborn care. 

In designating a proposed MS–DRG as 

one that will be subdivided into 

subgroups based on the presence of a CC 

or MCC, we developed a set of criteria 

to facilitate our decision-making 

process. In order to warrant creation of 

a CC or major CC subgroup within a 

base MS–DRG, the subgroup had to 

meet all of the following five criteria: 

<bullet≤ A reduction in variance of 

charges of at least 3 percent. 

<bullet≤ At least 5 percent of the 

patients in the MS–DRG fall within the 

CC or MCC subgroup. 

<bullet≤ At least 500 cases are in the 

CC or MCC subgroup. 

<bullet≤ There is at least a 20-percent 

difference in average charges between 

subgroups. 

<bullet≤ There is a $4,000 difference 

in average charge between subgroups. 

Our objective in developing these 

criteria was to create homogeneous 

subgroups that are significantly different 

from one another in terms of resource 

use, that have enough volume to be 

meaningful, and that improve our 

ability to explain variance in resource 

use. These criteria are essentially the 

same criteria we used in our 1994 

severity analysis. 

To begin our analysis, we subdivided 

each of the base MS–DRGs into three 

subgroups: non-CC, CC, and MCC. Each 

subgroup was then analyzed in relation 

to the other two subgroups using the 

volume, charge, and reduction in 

variance criteria. The criteria were 

applied in the following hierarchical 

manner: 

<bullet≤ If a three-way subdivision 

met the criteria, we subdivided the base 

MS–DRG into three CC subgroups. 

<bullet≤ If only one type of two-way 

subdivisions met the criteria, we 

subdivided the base MS–DRG into two 

CC subgroups based on the type of twoway subdivision that met the criteria. 

<bullet≤ If both types of two-way 

subdivisions met the criteria, we 

subdivided the base MS–DRG into two 

CC subgroups based on the type of twoway subdivision with the highest R2

(most explanatory power to explain the 

difference in average charges). 

<bullet≤ Otherwise, we did not 

subdivide the base MS–DRG into CC 

subgroups. 

For any given base MS–DRG, our 

evaluation in some cases showed that a 

subdivision between a non-CC and a 

combined CC/MCC subgroup was all 

that was warranted (that is, there was 

not a great enough difference between 

the CC and MCC subgroups to justify 

separate CC and MCC subgroups). 

Conversely, in some cases, even though 

an MCC subgroup was warranted, there 

was not a sufficient difference between 

the non-CC and CC subgroups to justify 

separate non-CC and CC subgroups. 

Based on this methodology, a base 

MS–DRG may be subdivided according 

to the following three alternatives, 

rather than the current ‘‘with CC’’ and 

‘‘without CC’’ division. 

<bullet≤ DRGs with three subgroups 

(MCC, CC, and non-CC). 

<bullet≤ DRGs with two subgroups 

consisting of an MCC subgroup but with 

the CC and non-CC subgroups 

combined. We refer to these groups as 

‘‘with MCC’’ and ‘‘without MCC.’’ 

<bullet≤ DRGs with two subgroups 

consisting of a non-CC subgroup but 

with the CC and MCC subgroups 

combined. We refer to these two groups 

as ‘‘with CC/MCC’’ and ‘‘without CC/ 

MCC.’’ 

As a result of the application of these 

criteria, 745 proposed MS–DRGs were 

created as shown in the following table. 

TABLE K.—NUMBER OF CC SUBGROUPS

Subgroups 

Number of 

proposed base 

MS–DRGs 

Number of 

proposed MS– 

DRGs 

No Subgroups .......................................................................................................................................................... 53 53 

Three subgroups ...................................................................................................................................................... 152 456 

Two subgroups: major CC and CC; non-CC .......................................................................................................... 63 126 

Two subgroups: non-CC and CC; major CC .......................................................................................................... 43 86 

Subtotal .................................................................................................................................................................... 311 721 

MDC 14 .................................................................................................................................................................... 22 22 

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TABLE K.—NUMBER OF CC SUBGROUPS—Continued 

Subgroups 

Number of 

proposed base 

MS–DRGs 

Number of 

proposed MS– 

DRGs 

Error DRGs .............................................................................................................................................................. 2 2 

Total .................................................................................................................................................................. 335 745 

The 745 proposed MS–DRGs 

represent an increase over the 652 DRGs 

created in our 1994 CC revision 

analysis. The increase in the number of 

DRGs is primarily the result of an 

increase in the number of proposed base 

MS–DRGs that are subdivided into three 

CC subgroups. The distribution of 

patients across the different types of CC 

subdivisions is contained in Table L 

below. The table shows that 51.7 

percent of the patients are assigned to 

base MS–DRGs with three CC 

subgroups, and only 11.8 percent of the 

patients are assigned to base MS–DRGs 

with no CC subgroups. 

TABLE L.—DISTRIBUTION OF PATIENTS

BY TYPE OF CC SUBDIVISION

CC subdivision Count Percent 

None ................. 1,382,810 11.8 

(MCC and CC), 

Non-CC ......... 629,639 5.4 

MCC, (CC and 

Non-CC) ........ 3,650,321 31.2 

MCC, CC, and 

Non-CC ......... 6,054,081 51.7 

Using Medicare charge data (without 

applying any criteria to remove 

statistical outlier cases), the reduction in 

variance (R2) was computed for current 

CMS DRGs, the MS–DRGs with all 311 

base MS–DRGs subdivided into 3 CC 

subgroups, and the MS–DRGs collapsed 

into 745 DRGs. Table L below shows 

that the R2 for the proposed MS–DRGs 

with all 311 base MS–DRGs subdivided 

into 3 CC subgroups (957 DRGs 

composed of 311 base MS–DRGs 

subdivided into 3 CC subgroups plus an 

additional 22 MDC 14 and MDC 15 

DRGs as well as 2 error DRGs) is 10.62 

percent higher than the current CMS 

DRGs. Collapsing the 957 proposed MS– 

DRGs down to 745 proposed MS–DRGs 

lowers this increase in R2 slightly to 

9.41 percent. Although adopting a 3- 

way split for each base MS–DRG would 

produce a DRG system with higher 

explanatory power, the 957 MS–DRGs 

would not meet the criteria we specified 

above for subdividing each base DRG. 

The criteria we specified above would 

create a monotonic DRG system. We 

believe that the value of having a 

monotonic DRG system outweighs the 

slight decrease in explanatory power. 

For this reason, we are proposing to 

adopt the 745 MS–DRGs. 

TABLE M.—EXPLANATORY POWER (R2) 

FOR PROPOSED MS–DRGS

R2 Percent 

change 

Current CMS DRG ... 36.19 ................

2007 CMS Severity 

DRGs with 3 CC 

Subgroups ............. 40.03 10.62 

2007 CMS Severity 

DRGs Collapsed to 

714 DRGs ............. 39.59 9.41 

4. Conclusion 

We believe the proposed MS–DRGs 

represent a substantial improvement 

over the current CMS DRGs in their 

ability to differentiate cases based on 

severity of illness and resource 

consumption. As developed, the 

proposed MS–DRGs increase the 

number of DRGs by 207, while 

maintaining the reasonable patient 

volume in each DRG. The proposed 

MS–DRGs increase the explanation of 

variance in hospital resource use 

relative to the current CMS DRGs by 

9.41 percent. Further, the data shown 

below in Table N and Table O illustrate 

how assignment of cases to different 

severity of illness subclasses improves 

in the proposed MS–DRGs relative to 

the CMS DRGs. 

TABLE N.—OVERALL STATISTICS FOR CMS DRGS

CC subclass—Current CMS DRG Percent Average 

charges 

One or more CCs .................................................................................................................................................................... 77.66 $24,538 

Non-CC .................................................................................................................................................................................... 22.34 14,795 

TABLE O.—OVERALL STATISTICS FOR PROPOSED MS–DRGS

CC subgroup Number of 

cases Percent Average charges 

MCC ................................................................................................................................................................. 2,607,351 22.2 $44,219 

CC .................................................................................................................................................................... 4,298,362 36.6 24,115 

Non-CC ............................................................................................................................................................ 4,826,980 41.1 18,416 

Under the current CMS DRGs, 78 

percent of cases are assigned to the 

highest severity levels (CC) and the 

remaining 22 percent are assigned to the 

lowest severity level (non-CC). Applying 

the three severity subclasses to FY 2006 

data would result in approximately 22 

percent of patients being assigned to the 

severity subgroup with the highest level 

of severity (MCC), 41 percent being 

assigned to the lowest severity subclass 

(non-CC), and the remaining 37 percent 

being assigned to the middle severity 

subclass (CC). Adding the new MCC 

subgroup greatly enhances our ability to 

identify and reimburse hospitals for 

treating patients with high levels of 

severity. As Table N above shows, the 

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new subgroups also have significantly 

different resource requirements. The 

MCC subgroup contains patients with 

average charges almost twice as large as 

for those in the CC group ($44,219 

compared to $24,115). 

In addition to resulting in 

improvements in the DRG system’s 

recognition of severity of illness, we 

believe the proposed MS–DRGs are 

responsive to the public comments that 

were made on last year’s IPPS proposed 

rule with respect to how we should 

undertake further DRG reform. In the FY 

2007 IPPS final rule, we identified three 

major concerns in the public comments 

about our proposed adoption of CS 

DRGs: 

We received comments after the FY 

2007 IPPS final rule suggesting that 

further adjustments are needed to the 

proposed DRG system. The commenters 

believed that the CS DRGs did not 

incorporate many of the changes to the 

DRG assignments that have been made 

over the year to the CMS DRGs. There 

was significant interest in the public 

comments in either revising the CS 

DRGs to reflect these changes or using 

the CMS DRGs at the starting point to 

better recognize severity. 

We believe that the proposed MS– 

DRGs discussed in this proposed rule 

are responsive to these suggestions. The 

proposed MS–DRGs use the CMS DRGs 

as the starting point for revising the 

DRGs to better recognize resource 

complexity and severity of illness. We 

are generally retaining all of the 

refinements and improvements that 

have been made to the base DRGs over 

the years that recognize the significant 

advancements in medical technology 

and changes to medical practice. At the 

same time, the proposed MS–DRGs 

greatly improve our ability to identify 

groups of patients with varying levels of 

severity. They retain all of the 

improvements made to the DRGs over 

the years, while providing a more 

equitable basis for hospital payment. 

We received many comments about 

the potential use of a proprietary DRG 

system. The comments about the CS 

DRGs raised compelling issues about the 

potential government use of a 

proprietary system including concerns 

about the availability, price, and 

transparency of the source code, logic 

and documentation of the DRG system. 

The commenters noted that CMS makes 

available these resources in the public 

domain for purchase through the 

National Technical Information Service 

at nominal fees to cover costs. The 

commenters urged CMS not to adopt a 

proprietary DRG system that would not 

be available on the same terms as the 

current CMS DRGs. 

There are no proprietary issues 

associated with the proposed MS–DRGs 

in this proposed rule. The proposed 

MS–DRGs would be available on the 

same terms as the current CMS DRGs 

through the National Technical 

Information Service. 

We also received other comments 

concerning the use of CS DRGs. The 

commenters stated that no alternatives 

to CS DRGs had been evaluated. The 

commenters suggested that alternative 

DRG systems can better recognize 

severity than the CS DRGs and should 

be evaluated before CMS decides which 

system to adopt. 

We currently have a contract with the 

RAND Corporation to evaluate several 

alternative DRG systems. We believe it 

is premature to propose adopting one of 

the systems as RAND has not yet 

completed its evaluation. However, we 

believe the proposed MS–DRGs should 

be part of this process and have asked 

RAND to evaluate the proposed MS– 

DRGs with other DRG products that 

have been submitted for review. 

Although we are proposing to adopt the 

MS–DRGs for FY 2008, this decision 

would not preclude us from adopting 

any of the systems being evaluated by 

RAND for FY 2009. 

As indicated above, we believe the 

proposed MS–DRGs offer significant 

improvements to the DRG system 

without many of the liabilities the 

public commenters identified with the 

CS DRGs. Thus, we believe the 

proposed MS–DRGs offer significant 

improvements in recognition of severity 

of illness and complexity of resources 

and are proposing to adopt them for FY 

2008. However, we are continuing our 

evaluation of alternative DRG systems 

that can better recognize severity of 

illness and resource consumption and 

have submitted the proposed MS–DRGs 

to RAND for further evaluation. 

5. Impact of the Proposed MS–DRGs 

Unlike the CS DRGs we proposed last 

year for FY 2008, the payment impacts 

from the MS–DRGs we are proposing to 

adopt this year would largely be 

redistributive within each base MS– 

DRG. Such a result occurs because we 

collapse the current CC/non-CC, age and 

other distinctions that exist in the CMS 

DRGs and redivide them based on 

MCCs, CCs, and non-CCs. Thus, within 

each proposed base MS–DRG, some 

cases will be paid more and some less, 

but the base MS–DRGs are retained so 

there is no redistribution between types 

of cases as would have occurred under 

the proposed CS DRGs. We encourage 

readers to review Table 5 in the 

Addendum to this proposed rule for a 

list of the proposed MS–DRGs and the 

proposed respective relative weight 

from the revisions we are proposing to 

better recognize severity of illness to 

better understand how payment for 

cases within each base MS–DRG will be 

affected. 

As indicated above, all of the severity 

DRG systems being evaluated by RAND 

can be expected to result in similar 

redistributions in case-mix among 

hospitals. The payment models used by 

RAND and CMS (and RTI as well) all 

assume static utilization. That is, 

payment impact models simulate the 

effects of a change in policy, assuming 

no change to Medicare utilization. Any 

system adopted to better recognize 

severity of illness with a budget 

neutrality constraint will result in casemix changes that can be expected to 

benefit urban hospitals at the expense of 

rural hospitals. This impact occurs 

because patients treated in urban 

hospitals are generally more severely ill 

than patients in rural hospitals and the 

CMS DRGs are not currently recognizing 

the full extent of these differences. 

Similarly, there will be differential 

impacts among other categories of 

hospitals (for example, teaching, 

disproportionate share, large urban, and 

other urban hospitals) depending on the 

mix of cases that each hospital treats. 

The impact of the proposed MS–DRGs 

can be expected to have similar effects 

on case-mix as the DRG systems being 

analyzed by RAND. In addition, we 

believe that it is important to note that 

the MS–DRGs are proposed to be 

adopted for FY 2008 at the same time 

that we are phasing in cost weights. In 

the FY 2007 IPPS final rule, we adopted 

cost weights over a 3-year transition 

period in 1⁄3 increments. Thus, the full 

impact of adopting cost weights will not 

be incorporated into IPPS payments 

until FY 2009. Nevertheless, we believe 

it is important to consider together the 

effect on case-mix of the fully phasedin cost weights and proposed MS–DRGs 

to get a complete understanding of how 

IPPS payment reforms would affect 

case-mix for different categories of 

hospitals from FY 2007 through FY 

2009. For instance, using cost weights 

are estimated to increase payments to 

rural hospitals (see 71 FR 47917). In FY 

2007, we are paying hospitals using a 

blend of 1⁄3 cost and 2⁄3 charge relative 

weights. In FY 2008, we will pay 

hospitals using a blend of 2⁄3 cost and 1⁄3 charge relative weights. In FY 2009, 

we will pay hospitals using 100 percent 

cost relative weights. Therefore, there 

will likely be some additional increases 

in payments to rural hospitals from the 

final year of the transition to fully 

implemented cost weights that are not 

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24708 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

2 Carter, Grace M. and Ginsburg, Paul: The 

Medicare Case Mix Index Increase, Medical Practice 

Changes, Aging and DRG Creep, Rand, 1985. 

3 Review of Assumptions and Methods of the 

Medicare Trustees’ Financial Projections; Technical 

Review Panel on the Medicare Trustees Reports, 

December 2000. 

4 ‘‘Has DRG Creep Crept Up? Decomposing the 

Case Mix Index Change Between 1987 and 1988’’; 

Carter, Newhouse, Relles ; R–4098–HCFA/ProPAC 

(1991). 

5 Medicare Payment Advisory Commission: 

Report to the Congress, March 2006 (p. 52). 

6 Medicare Payment Advisory Commission: 

Report to Congress on Physician-Owned Specialty 

Hospitals, March 2005, p. 42. 

7 Carter, Paddock: Preliminary Analyses of 

Changes in Coding and Case Mix Under the 

Inpatient Rehabilitation Facility Prospective 

Payment System, RAND, 2004. 

illustrated in the table in the impact 

section of this proposed rule. 

6. Changes to Case-Mix Index (CMI) 

From the Proposed MS–DRGs 

After the 1983 implementation of the 

IPPS DRG classification system, CMS 

observed unanticipated growth in 

inpatient hospital case-mix (the average 

relative weight of all inpatient hospital 

cases), which we use as a proxy 

measurement for severity of illness. We 

had projected the rate of growth in casemix for the period 1981 to 1984 to be 

3.4 percent. The realized rate of growth 

during this period, which included the 

introduction of the IPPS, was 8.4 

percent, a variance in excess of 1.6 

percent per year. The unexpected 

growth in payments was due to 

increases in the hospital case-mix index 

(CMI) beyond the previously projected 

trend. Hospitals’ CMI values measure 

the expected treatment cost of the mix 

of patients treated by a particular 

hospital. There are three factors that 

determine changes in a hospital’s CMI: 

(a) Admitting and treating a more 

resource intensive patient-mix (due, for 

example, to technical changes that allow 

treatment of previously untreatable 

conditions and/or an aging population); 

(b) Providing services (such as higher 

cost surgical treatments, medical 

devices, and imaging services) on an 

inpatient basis that previously were 

more commonly furnished in an 

outpatient setting; and 

(c) Changes in documentation (more 

complete medical records) and coding 

practice (more accurate and complete 

coding of the information contained in 

the medical record). 

We note that changes in patient-mix 

and medical practice signal real changes 

in underlying resource utilization and 

cost of treatment. While these changes 

may have occurred in response to 

incentives from IPPS policies, they 

represent real changes in resource 

needs. In contrast, changes in CMI as a 

result of improved documentation and 

coding do not represent real increases in 

underlying resource demands. For the 

implementation of the IPPS in 1983, 

improved documentation and coding 

were found to be the primary cause in 

the underprojection of CMI increases, 

accounting for as much as 2 percent in 

the annual rate of CMI growth observed 

post-PPS.2

The Medicare Trustees Technical 

Review Panel 3 has previously 

determined the annual measured change 

in CMI for inpatient hospital services to 

oscillate around an underlying real 

trend of 1 percent annual growth. In 

1991 the Medicare specific trend in real 

CMI growth was found in a then-HCFA 

funded study 4 to be within a range of 

1 to 1.4 percent. In the annual study 

conducted by CMS, there has been no 

evidence to support a real case-mix 

increase in excess of the annually 

projected 1 percent upper bound in the 

period. MedPAC findings have echoed 

this with its recent study of real casemix change finding growth rates for 

years 2002, 2003, and 2004 of 1 percent, 

0.6 percent, and 0.4 percent, 

respectively.5

We believe that adoption of the MS– 

RGs proposed in this proposed rule 

would create a risk of increased 

aggregate levels of payment as a result 

of increased documentation and coding. 

MedPAC notes that ‘‘refinements in 

DRG definitions have sometimes led to 

substantial unwarranted increase in 

payments to hospitals, reflecting more 

complete reporting of patients’ 

diagnoses and procedures.’’ MedPAC 

further notes that ‘‘refinements to the 

DRG definitions and weights would 

substantially strengthen providers’ 

incentives to accurately report patients’ 

comorbidities and complications.’’ To 

address this issue, MedPAC 

recommended that the Secretary 

‘‘project the likely effect of reporting 

improvements on total payments and 

make an offsetting adjustment to the 

national average base payment 

amounts.’’ 6

The Secretary has broad discretion 

under section 1886(d)(3)(A)(vi) of the 

Act to adjust the standardized amount 

so as to eliminate the effect of changes 

in coding or classification of discharges 

that do not reflect real changes in casemix. While we modeled the changes to 

the DRG system and relative weights to 

ensure budget neutrality, we are 

concerned that the large increase in the 

number of DRGs will provide 

opportunities for hospitals to do more 

accurate documentation and coding of 

information contained in the medical 

record. Coding that has no effect on 

payment under the current CMS DRGs 

may result in a case being assigned to 

a higher paid DRG under the proposed 

MS–DRGs. Thus, more accurate and 

complete documentation and coding 

may occur because it will result in 

higher payments under the proposed 

MS–DRGs. We believe the potential for 

more accuate and complete 

documentation and coding will apply 

equally under the acute IPPS as well as 

under the LTCH PPS because the same 

DRGs are used for both payment 

systems. Thus, the analysis below will 

apply to both the IPPS and the LTCH 

PPS. 

CMS in the past has adjusted 

standardized amounts under the IRF 

PPS to account for case-mix increases 

due to improvements in documentation 

and coding. In 2004, RAND 7 published 

a technical report as part of the 

followup to the implementation of the 

IRF PPS. The initial weights used 

within the IRF PPS were based on a mix 

of CY 1999 and CY 1998 data. The study 

reviewed the changes between this base 

data set and the IRF PPS 

implementation year of 2002. The report 

found that the weight per discharge for 

IRFs had grown by 3.4 percent between 

the CY 1999 data set and the CY 2002 

data set. In a detailed analysis of both 

statistical patterns in acute stay records 

and directly measured coding behaviors, 

RAND found that the level of case-mix 

increase associated with documentation 

and coding-induced changes in the 

transition year ranged between 1.9 and 

5.8 percent, with the upper end of the 

estimate associated with real declines in 

resource use. (We note that RAND 

revised its report in late 2005 to reflect 

an upper bound of 5.9 percent, instead 

of the 5.8 percent that we reported in 

the FY 2006 IRF PPS proposed and final 

rules.) 

We used the results of this analysis to 

justify a 1.9 percent adjustment to 

payment rates for IRFs in FY 2006 (70 

FR 47904) and a 2.6 percent adjustment 

to payment rates for IRFs in FY 2007 (71 

FR 48370), for a combined total 

adjustment of 4.5 percent. The 

implementation year was marked by the 

transitioning of hospitals to the IRF PPS 

payment based on cost reports 

beginning January 1, 2002, and 

staggered to October 1, 2002. A 

combination of increased familiarity 

with the system by providers and the 

staggered transition could mean that 

documentation and coding-induced 

case-mix change continued as hospitals 

experienced ongoing changes in the 

early years of the IRF PPS and as the 

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8 Maryland uses a July 1 to June 30 State fiscal 

year. Prior to FY 2003, Maryland had a 6-month lag 

in the data used to calculate the hospital base casemix index and case-mix change. Maryland used 12 

months data ending December even though the 

hospitals’ rate year was July 1 to June 30. In FY 

2003, Maryland moved to what it called ‘‘Real Time 

Case-Mix’’ and started using 12 months data ending 

June 30 to calculate case-mix index and case-mix 

change for a rate year beginning July 1. 

9 The HSCRC informed us that it began using APR 

DRGs for this hospital to calculate the CMI and 

case-mix change to set the hospital’s charge per case 

target (CPC) that is used in Maryland’s all-payer 

ratesetting system for payment. However the 

HSCRC also compared the reasonableness of 

hospital rates and costs for this hospital relative to 

peer institutions using modified CMS DRGs to 

calculate CMI and case-mix change. This use of 

dual systems to calculate CMI and case-mix change 

made it difficult for the hospital to code 

aggressively in the first few years of using APR 

DRGs. 

incentives within the system were more 

widely recognized. We also recognize 

that significant changes in IRF patient 

populations may be occurring as a result 

of recent regulatory changes, such as the 

phase-in of the 75 percent rule 

compliance percentage. We intend to 

continue analyzing changes in coding 

and case-mix closely, using the most 

current available data, as part of our 

ongoing monitoring of the IRF PPS and, 

based on this analysis, we intend to 

propose additional payment refinements 

for IRFs in the future as the analysis 

indicates such adjustments are 

warranted. 

Furthermore, as part of our analysis of 

this issue, we considered the recent 

experience of the State of Maryland 

with adopting the APR DRG system. 

Maryland introduced APR DRGs for 

payment for three teaching hospitals in 

2000. Between State fiscal years (SFYs) 

2001 and 2005,8 the remaining hospitals 

continued to be paid using modified 

CMS DRGs. In June 2004, the remaining 

hospitals were notified that Maryland 

would expand the use of APR DRGs 

throughout its all payer charge-per-case 

system beginning in July 2005. 

Hospitals in Maryland improved coding 

and documentation in response to the 

adoption of APR DRGs. As a result of 

this improved documentation and 

coding, reported CMI increased at a 

greater rate than real CMI. Given the 

similarity between coding incentives 

using the APR DRGs in Maryland and 

the MS–DRGs that are being proposed 

for Medicare, we analyzed Maryland 

data to develop an adjustment for 

improved documentation and coding. 

For the Maryland analysis, we assume 

that, in SFY 2005, those hospitals not 

already being paid under the APR DRG 

system began acting as if the transition 

to the new DRG logic had already taken 

place. This assumption is supported by 

the following facts: (a) Maryland 

hospitals were reporting to the Health 

Services and Cost Review Commission 

(HSCRC), Maryland’s governing body of 

its all-payer ratesetting system) using 

the APR DRG GROUPER in 2005; (b) 

hospitals were provided training in 

coding under the APR DRG GROUPER; 

(c) hospitals had access to reports based 

on APR DRG logic; and (d) hospitals 

were given large amounts of feedback as 

to their performance under the 

GROUPER by the HSCRC relative to 

peer hospitals. 

The incentives for Maryland hospitals 

are to code as completely and accurately 

as possible because, beginning in July 

2005, all Maryland hospitals were paid 

using APR DRGs. SFY 2005 was an 

important year in Maryland, as it 

marked the beginning of the 2-year 

period of transition after which a 

hospital’s revenues were reduced if 

coding was not as complete as a peer 

hospital. Under the current CMS DRGs, 

each secondary diagnosis code is 

recognized as either a CC or non-CC. 

Hospitals in Maryland and nationally 

for Medicare only needed to code one 

secondary diagnosis as a CC when paid 

using CMS DRGs for the patient to be 

assigned to a higher weighted DRG split 

based on the presence or absence of a 

CC. Under the APR DRGs, each 

secondary diagnosis is designated as 

minor, moderate, major, or extreme. 

Under the proposed MS–DRGs, each 

secondary diagnosis is designated as a 

non-CC, CC, or MCC. Hospitals in 

Maryland have incentives under the 

APR DRGs to code until a case is 

assigned to the highest of the four 

severity levels within a base DRG. 

Under the proposed MS–DRGs, 

hospitals will have incentives to code 

until a case is assigned to one of up to 

three severity levels within a base DRG. 

Although the APR DRGs and the 

proposed MS–DRGs may be different, 

we believe that hospitals have the same 

incentive under both systems to code as 

completely as possible. For this reason, 

we believe that the Maryland experience 

is a reasonable basis for projecting 

behavioral changes in the wider 

national hospital population for the first 

2 years of the MS–DRGs. 

We believe the analysis presented 

below provides a reasonable analysis of 

the potential growth in CMI due to 

improved documentation and coding. In 

addition to the similarity between 

coding incentives under the proposed 

MS–DRGs and the APR DRGs, we note 

that Maryland is an all-payer State; 

therefore, hospitals are paid by all third 

party payers—not just the State’s 

Medicaid program—using the APR 

DRGs. Coding has been very important 

for each hospital’s overall revenue for 

many years, and the incentives are 

uniform across all third party payers. 

The transition to APR DRGs was known 

well in advance of the actual date and, 

as stated above, hospitals were provided 

training in coding under the APR DRGs. 

It is reasonable to expect that hospitals’ 

experience with improved 

documentation and coding will occur 

over a period of at least 2 years. Thus, 

the experience in Maryland may be 

similar to expectations for case-mix 

growth for the nation as a whole. 

Finally, in reviewing the results from 

Maryland, we note that three large 

teaching hospitals began using APR 

DRGs prior to SFY 2005. These facilities 

generally treat a wider variety of 

patients with higher acuity that gives 

them a greater potential for increasing 

coding under the APR DRG system than 

other hospitals throughout Maryland. 

Because these hospitals were paid using 

the APR DRGs earlier than other 

Maryland hospitals, we believe data for 

them need to be analyzed from an 

earlier time period. However, based on 

the consultations with the HSCRC, we 

believe there were special issues with 

one of these hospitals that may have 

made its case-mix growth during the 

early years of the transition to the APR 

DRGs atypical of the other teaching 

hospitals.9 Therefore, we did not 

separately analyze the data for this 

hospital from the earlier time period 

and, as stated below, included its data 

with the rest of Maryland hospitals. 

As part of its contract with CMS, 3M 

Health Information Systems reviewed 

the Maryland data in the context of our 

proposed changes to adopt MS–DRGs. 

3M grouped Medicare cases in 

Maryland through both the CMS DRGs 

Version 24.0 and the MS–DRGs that we 

are proposing to adopt for FY 2008. At 

our request, 3M deleted two of the three 

early transition hospitals from the data. 

It compared the results of the observed 

growth in case-mix from these data to 

the same process applied to Medicare 

data, excluding Maryland hospitals. 

The MedPAR data file for Federal 

fiscal year (FFY) 2006 (October 2005 

through September 2006) was used to 

create relative weights for both CMS 

DRG Version 24.0 and the proposed 

MS–DRGs. The MedPAR data file 

contained 12,794,280 records. In 

constructing the weights, the following 

edits were used: 

<bullet≤ Cases with zero covered 

charges or length of stay were excluded. 

<bullet≤ Cases with length of stay 

greater than 2 years were excluded. 

<bullet≤ Only hospitals contained in 

the impact file for the FY 2007 IPPS 

final rule were included. 

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24710 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

The latter criterion excluded 

providers reimbursed outside of the 

IPPS, including Maryland hospitals, 

from the weight calculation. 3M 

employed standardized charge-based 

relative weights developed in 

accordance with the CMS methodology. 

Cost-based weights were not used and 

no adjustment to the charge weights was 

made for application of CMS transfer 

and postacute care transfer payment 

policy. 

3M further grouped 2 years of 

MedPAR data from FY 2004 and FY 

2005, using CMS DRG Version 24.0 and 

the proposed MS–DRGs for hospitals 

nationally. Using 2 years of MedPAR 

data with one version of each DRG 

system further required 3M to make 

adjustments to the data to reflect 

revisions to ICD–9–CM codes that are 

made each year. MedPAR data for 

Maryland IPPS acute care providers 

within the IPPS data set were similarly 

assigned to the proposed MS–DRGs and 

CMS DRGs for FYs 2004 through 2006. 

Each Maryland record, exclusive of 

the two early transition teaching 

hospitals for the 3 observed years (SFY 

2004 to SFY 2006), was assigned to a 

proposed MS–DRG based on the ICD–9– 

CM codes the hospital submitted. The 

same results were obtained from data at 

the national level using the proposed 

MS–DRGs. Further, we obtained data 

from the HSCRC showing the weighted 

average increase in case-mix for 

calendar years 2001 to 2003 for the two 

large academic medical centers that 

began an early transition to the APR 

DRGs. In addition, we also obtained 

case-mix increases under the CMS DRGs 

for FYs 2004 through 2006. The 

Medicare Actuary examined the data 

below: 

TABLE Q.—MARYLAND AND NATIONAL DATA USED FOR CASE-MIX ADJUSTMENT ANALYSIS

FY 2004 to 

2005 

FY 2005 to 

2006 

FY 2004 to 

2006 

Rest of Maryland MS–DRG CMI [Delta] ..................................................................................................... 2.30% 2.57% 4.93% 

.................. .................. CY 2000 to 

FY 2003 

Early Transition Hospitals ............................................................................................................................ 4.4 6.7 11.4 

National MS–DRG CMI [Delta] .................................................................................................................... 0.47 2.65 3.13 

National CMS DRG CMI [Delta] .................................................................................................................. -0.04 1.20 1.16 

Blend of MS–DRG & CMS DRG [Delta] using 0.47 Percent for 2005 and 1.2 Percent for 2006 .............. .................. .................. 1.68 

Difference between Maryland Early Transition Hospitals and National Data ............................................. .................. .................. 9.58 

Difference between Rest of Maryland and National Data ........................................................................... .................. .................. 3.20 

Medicare Actuary Estimate (75%/25%) between Early Transition and Rest of Maryland ......................... .................. .................. 4.8 

The data above show that case-mix for 

hospitals increased by 4.93 percent from 

SFYs 2004 to 2006, during which 

Maryland adopted the APR DRGs for 

most hospitals. Case-mix for the two 

large teaching hospitals that were paid 

using the APR DRGs earlier than other 

hospitals in the State increased by 11.4 

percent from SFYs 2001 to 2003. The 

weighted average increase in Maryland 

from these two categories of hospitals is 

5.58 percent. Case-mix using the 

proposed MS–DRGs would have 

increased 0.47 percent in FY 2005 and 

2.65 percent in FY 2006. Nationally, 

Medicare case-mix using the CMS DRGs 

decreased by 0.04 percent in FY 2005 

and increased by 1.2 percent in FY 

2006. The Actuary calculated a 

Medicare case-mix increase nationally 

over 2 years using a blend of these data 

from proposed MS–DRGs for FY 2005 

and national Medicare data for FY 2006 

from the CMS DRGs. The Actuary did 

not use either the -0.04 percent for the 

CMS DRGs or the 2.65 percent for the 

proposed MS–DRGs to create this 

blended case-mix because these figures 

appeared atypical to national trends. 

Therefore, the Actuary dropped one 

atypically high and low number from 

each of the 2 years of data and 

calculated an average increase of 1.68 

percent from FY 2004 to FY 2006. These 

data demonstrate that the measure of 

average CMI for Medicare cases is 

growing more rapidly within Maryland 

than nationally. Case-mix for the 

Maryland teaching hospitals and the 

rest of Maryland increased 9.58 percent 

and 3.20 percent more, respectively, 

than the national average over 2 years, 

suggesting that improved 

documentation and coding lead to 

perceived, but not real, changes in casemix. 

The Actuary noted that the case-mix 

increase in Maryland for two large 

teaching hospitals over a 2-year period 

was much higher in the early years of 

the APR DRGs than other Maryland 

hospitals (11.4 percent compared to 4.93 

percent for the rest of Maryland). 

Further, teaching hospitals generally 

treat cases with higher acuity than other 

hospitals and have more opportunity to 

improve coding and documentation to 

increase case-mix than other hospitals. 

Teaching hospitals also represent a 

higher proportion of national Medicare 

data than they do of the data in 

Maryland. The two early transition 

teaching hospitals in Maryland account 

for approximately 10 percent of the 

Medicare discharges in Maryland. 

Nationally, teaching hospitals account 

for approximately 50 percent of 

Medicare discharges. Therefore, the 

Actuary believes that the teaching 

hospitals should be given a higher 

weight in the national data than they 

represent in Maryland. However, like 

other hospitals, teaching hospitals vary 

in size and patient-mix and not all have 

the same opportunity to improve 

documentation and coding. Therefore, 

we believe the weight given to teaching 

hospitals should be higher than the 10 

percent for the two early transition 

hospitals in Maryland but lower than 

the 50 percent of discharges that they 

account for in Maryland. The Actuary 

gave a weight of 25 percent for teaching 

hospitals and 75 percent for the rest of 

Maryland to the excess growth in casemix over the national average and 

estimates that an adjustment of 4.8 

percent will be necessary to maintain 

budget neutrality for the transition to 

the MS–DRGs. This analyis reflects our 

current estimate of the necessary 

adjustment needed to maintain budget 

neutrality for improvements in 

documentation and coding that lead to 

increases in case-mix. Consistent with 

the statute, we will compare the actual 

increase in case-mix due to 

documentation and coding to our 

projection once we have actual data to 

revise the Actuary’s estimate and the 

adjustment we make to the standardized 

amounts. 

Based on the Actuary’s analysis, using 

the Secretary’s authority under section 

1886(d)(3)(A)(vi) of the Act to adjust the 

standardized amount to eliminate the 

effect of changes in coding or 

classification of discharges that do not 

reflect real changes in case-mix, we are 

proposing to reduce the IPPS 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24711 

standardized amounts by 2.4 percent 

each year for FY 2008 and FY 2009. We 

are considering proposing a 4.8 percent 

adjustment for FY 2008. However, we 

believe it would be appropriate to 

provide a transition because we would 

be making a significant adjustment to 

the standardized amounts. We are 

interested in public comments on 

whether we should apply the proposed 

adjustment in a single year, over 2 years, 

or in different increments than 1⁄2 of the 

adjustment each year. Section 

1886(d)(3)(A)(vi) of the Act further gives 

the Secretary authority to revisit 

adjustments to the standardized 

amounts for changes in coding or 

classification of discharges that were 

based on estimates in a future year. 

Consistent with the statute, we will 

compare the actual increase in case-mix 

due to documentation and coding to our 

projection once we have actual data for 

FY 2008 and FY 2009 for the FY 2010 

and FY 2011 IPPS rules. At that time, if 

necessary, we may make a further 

adjustment to the standardized amounts 

to account for the difference between 

our projection and actual data. 

Under section 123(a)(1) of Pub. L. 

105–33, as amended by section 307(b) of 

Pub. L. 106–554, we are also proposing 

to adjust the DRG relative weights that 

are used for the LTCH PPS by -2.4 

percent (0.976) in FYs 2008 and 2009 to 

account for the anticipated increase in 

case mix from improved documentation 

and coding. This proposed budget 

neutrality adjustment is necessary to 

ensure that estimated aggregate LTCH 

PPS payments would be neither greater 

than nor less than the estimated 

aggregate LTCH PPS payments that 

would have been made without the 

proposed LTC–DRG reclassification and 

update of the relative weights. As 

discussed earlier with regards to the 

IPPS, we have estimated that a 2.4 

percent adjustment is needed to 

maintain budget neutrality. We believe 

an adjustment of at least 2.4 percent for 

both FYs 2008 and 2009 is appropriate 

under the LTCH PPS because LTCHs 

have an average inpatient length of stay 

greater than 25 days and due to the 

comorbidities of these patients, LTCHs 

will have a significantly increased 

opportunity to better code for these 

paitents under the proposed MS–LTC– 

DRG system. In the LTCH proposed rule 

(72 FR 4793) for rate year (RY) 2008, we 

proposed to update the LTCH 

standardized amounts by 0.71 percent. 

The proposed changes to the LTCH 

standardized amounts will be effective 

on July 1. However, the proposed 

changes to adopt MS–LTC–DRGs for 

LTCHs would not be effective until 

October 1 if finalized. Because changes 

to the LTCH standardized amounts for 

RY 2008 are already being set through 

a separate rulemaking process and are 

effective on July 1 instead of October 1, 

we decided that the adjustment for 

increases in case mix due to 

improvements and documentation and 

coding should be applied to the LTCH 

relative weights rather than the 

standardized amounts. 

7. Effect of the Proposed MS–DRGs on 

the Outlier Threshold 

To qualify for outlier payments, a case 

must have costs greater than Medicare’s 

payment rate for the case plus a ‘‘fixed 

loss’’ or cost threshold. The statute 

requires that the Secretary set the cost 

threshold so that outlier payments for 

any year are projected to be not less 

than 5 percent or more than 6 percent 

of total operating DRG payments plus 

outlier payments. The Secretary is 

required by statute to reduce the average 

standardized amount by a factor to 

account for the estimated proportion of 

total DRG payments made to outlier 

cases. Historically, the Secretary has set 

the cost threshold so that 5.1 percent of 

estimated IPPS payments are paid as 

outliers. The FY 2007 cost outlier 

threshold is $24,485. Therefore, for any 

given case, a hospital’s charge adjusted 

to cost by its hospital-specific CCR must 

exceed Medicare’s DRG payment by 

$24,485 for the case to receive cost 

outlier payments. 

Adoption of the proposed MS–DRGs 

will have an effect on calculation of the 

outlier threshold. For this proposed 

rule, we analyzed how the outlier 

threshold would be affected by adopting 

the proposed MS–DRGs. Using FY 2005 

MedPAR data, we have simulated the 

effect of the proposed MS–DRGs on the 

outlier threshold. By increasing the 

number of DRGs from 538 to 745 to 

better recognize severity of illness, the 

proposed MS–DRGs would be providing 

increased payment that better 

recognizes complexity and severity of 

illness for cases that are currently paid 

as outliers. That is, many cases that are 

high-cost outlier cases under the current 

CMS DRG system would be paid using 

an MCC DRG under the proposed MS– 

DRGs and could potentially be paid as 

nonoutlier cases. For this reason, we 

expected the proposed FY 2008 outlier 

threshold to decline from its FY 2007 

level of $24,485. We are proposing an 

FY 2008 outlier threshold of $23,015. In 

section II.A.4. of the Addendum to this 

proposed rule, we provide a more 

detailed explanation of how we 

determined the proposed FY 2008 cost 

outlier threshold. 

8. Effect of the Proposed MS–DRGs on 

the Postacute Care Transfer Policy 

Existing regulations at § 412.4(a) 

define discharges under the IPPS as 

situations in which a patient is formally 

released from an acute care hospital or 

dies in the hospital. Section 412.4(b) 

defines transfers from one acute care 

hospital to another. Section 412.4(c) 

establishes the conditions under which 

we consider a discharge to be a transfer 

for purposes of our postacute care 

transfer policy. In transfer situations, 

each transferring hospital is paid a per 

diem rate for each day of the stay, not 

to exceed the full DRG payment that 

would have been made if the patient 

had been discharged without being 

transferred. 

The per diem rate paid to a 

transferring hospital is calculated by 

dividing the full DRG payment by the 

geometric mean length of stay for the 

DRG. Based on an analysis that showed 

that the first day of hospitalization is the 

most expensive (60 FR 45804), our 

policy provides for payment that is 

double the per diem amount for the first 

day (§ 412.4(f)(1)). Transfer cases are 

also eligible for outlier payments. The 

outlier threshold for transfer cases is 

equal to the fixed-loss outlier threshold 

for nontransfer cases, divided by the 

geometric mean length of stay for the 

DRG, multiplied by the length of stay for 

the case, plus one day. The purpose of 

the IPPS postacute care transfer 

payment policy is to avoid providing an 

incentive for a hospital to transfer 

patients to another hospital early in the 

patients’ stay in order to minimize costs 

while still receiving the full DRG 

payment. The transfer policy adjusts the 

payments to approximate the reduced 

costs of transfer cases. 

Beginning with FY 2006 IPPS, the 

regulations at § 412.4 specified that, 

effective October 1, 2005, we make a 

DRG subject to the postacute care 

transfer policy if, based on Version 23.0 

of the DRG Definitions Manual (FY 

2006), using data from the March 2005 

update of FY 2004 MedPAR file, the 

DRG meets the following criteria: 

<bullet≤ The DRG had a geometric 

mean length of stay of at least 3 days; 

<bullet≤ The DRG had at least 2,050 

postacute care transfer cases; and 

<bullet≤ At least 5.5 percent of the 

cases in the DRG were discharged to 

postacute care prior to the geometric 

mean length of stay for the DRG. 

In addition, if the DRG was one of a 

paired set of DRGs based on the 

presence or absence of a CC or major 

cardiovascular condition (MCV), both 

paired DRGs would be included if either 

one met the three criteria above. 

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10 Medicare Payment Advisory Commission: 

Report to the Congress: Physician-Owned Specialty 

Hospitals, March 2005, p. 26. 

If a DRG met the above criteria based 

on the Version 23.0 DRG Definitions 

Manual and FY 2004 MedPAR data, we 

made the DRG subject to the postacute 

care transfer policy. We noted in the FY 

2006 final rule that we would not revise 

the list of DRGs subject to the postacute 

care transfer policy annually unless we 

make a change to a specific CMS DRG. 

We established this policy to promote 

certainty and stability in the postacute 

care transfer payment policy. Annual 

reviews of the list of CMS DRGs subject 

to the policy would likely lead to great 

volatility in the payment methodology 

with certain DRGs qualifying for the 

policy in one year, deleted the next 

year, only to be reinstated the following 

year. However, we noted that, over time, 

as treatment practices change, it was 

possible that some CMS DRGs that 

qualified for the policy will no longer be 

discharged with great frequency to 

postacute care. Similarly, we explained 

that there may be other CMS DRGs that 

at that time had a low rate of discharges 

to postacute care, but which might have 

very high rates in the future. 

The regulations at § 412.4 further 

specify that if a DRG did not exist in 

Version 23.0 of the DRG Definitions 

Manual or a DRG included in Version 

23.0 of the DRG Definitions Manual is 

revised, the DRG will be a qualifying 

DRG if it meets the following criteria 

based on the version of the DRG 

Definitions Manual in use when the 

new or revised DRG first became 

effective, using the most recent 

complete year of MedPAR data: 

<bullet≤ The total number of 

discharges to postacute care in the DRG 

must equal or exceed the 55th percentile 

for all DRGs; and 

<bullet≤ The proportion of short-stay 

discharges to postacute care to total 

discharges in the DRG exceeds the 55th 

percentile for all DRGs. A short-stay 

discharge is a discharge before the 

geometric mean length of stay for the 

DRG. 

A DRG also is a qualifying DRG if it 

is paired with another DRG based on the 

presence or absence of a CC or MCV that 

meets either of the above two criteria. 

The MS–DRGs that we are proposing 

to adopt for FY 2008 are a significant 

revision to the current CMS DRG 

system. Because the proposed new MS– 

DRGs are not reflected in Version 23.0 

of the DRG Definitions Manual, 

consistent with § 412.4, we will need to 

recalculate the 55th percentile 

thresholds in order to determine which 

proposed MS–DRGs, if adopted, would 

be subject to the postacute care transfer 

policy. Further, under the proposed 

MS–DRGs, the subdivisions within the 

base DRGs will be different than those 

under the current CMS DRGs. Unlike 

the current CMS DRGs, the proposed 

MS–DRGs are not divided based on the 

presence or absence of a CC or MCV. 

Rather, the proposed MS–DRGs have up 

to three subdivisions based on: (1) The 

presence of a MCC; (2) the presence a 

CC; or (3) the absence of either an MCC 

or CC. Consistent with our existing 

policy under which both DRGs in a CC/ 

non-CC pair are qualifying DRGs if one 

of the pair qualifies, we are proposing 

that each MS–DRG that shares a base 

MS–DRG would be a qualifying DRG if 

one of the MS–DRGs that shares the 

base DRG qualifies. We are proposing to 

revise § 412.4(d)(3)(ii) to codify this 

proposed policy. 

Similarly, we believe that the 

proposed changes to adopt MS–DRGs 

also necessitate a revision to one of the 

criteria used in § 412.4(f)(5) of the 

regulations to determine whether a DRG 

meets the criteria for payment under the 

‘‘special payment methodology.’’ Under 

the special payment methodology, a 

case subject to the special payment 

methodology that is transferred early to 

a postacute care setting will be paid 50 

percent of the total IPPS payment plus 

the average per diem for the first day of 

the stay. Fifty percent of the per diem 

amount will be paid for each subsequent 

day of the stay, up to the full MS–DRG 

payment amount. A CMS DRG is 

currently subject to the special payment 

methodology if it meets the criteria of §

412.4(f)(5). Section 412.4(f)(5)(iv) 

specifies that if a DRG meets the criteria 

specified under § 412.4(f)(5)(i) through 

(f)(5)(iii), any DRG that is paired with it 

based on the presence or absence of a 

CC or MCV is also subject to the special 

payment methodology. Given that this 

criterion would no longer be applicable 

under the proposed MS–DRGs, we are 

proposing to add a new § 412.4(f)(6) 

that includes a DRG in the special 

payment methodology if it is part of a 

CC/non-CC MCV/non-MCV pair. We are 

proposing to update this criterion so 

that it conforms to the proposed changes 

to adopt MS–DRGs for FY 2008. The 

proposed revision would make an MS– 

DRG subject to the special payment 

methodology if it shares a base MS–DRG 

with an MS–DRG that meets the criteria 

for receiving the special payment 

methodology. 

Section 412.4(f)(3) states that the 

postacute care transfer policy does not 

apply to CMS DRG 385 for newborns 

who die or are transferred. We are 

proposing to make a conforming change 

to this paragraph to reflect that this CMS 

DRG would become MS–DRG 789 

(Neonates, Died or Transferred to 

Another Acute Care Facility) under our 

proposed DRG changes for FY 2008. 

These revisions do not constitute a 

change to the application of the 

postacute care transfer policy. 

Therefore, any savings attributed to the 

postacute care transfer policy would be 

unchanged as a result of adopting the 

MS–DRGs. Consistent with section 

1886(d)(4)(C)(iii) of the Act, aggregate 

payments from adoption of the 

proposed MS–DRGs cannot be greater or 

less than those that would have been 

made had we not proposed to make any 

DRG changes. 

We are also proposing technical 

changes to § § 412.4(f)(5)(i) and (f)(5)(iv) 

to correct a cross-reference and a 

typographical error, respectively. 

E. Refinement of the Relative Weight 

Calculation 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Relative Weight 

Calculations’’ at the beginning of your 

comment.) 

In the FY 2007 IPPS final rule (71 FR 

47882), effective for FY 2007, we began 

to implement significant revisions to 

Medicare’s inpatient hospital rates by 

basing the relative weights on hospitals’ 

estimated costs rather than on charges. 

This reform was one of several 

measured steps to improve the accuracy 

of Medicare’s payment for inpatient 

stays that include using costs rather 

than charges to set the relative weights 

and making refinements to the current 

DRGs so they better account for the 

severity of the patient’s condition. Prior 

to FY 2007, we used hospital charges as 

a proxy for hospital resource use in 

setting the relative weights. Both 

MedPAC and CMS have found that the 

limitations of charges as a measure of 

resource use include the fact that 

hospitals cross-subsidize departmental 

services in many different ways that 

bear little relation to cost, frequently 

applying a lower charge markup to 

routine and special care services than to 

ancillary services. In MedPAC’s 2005 

Report to the Congress on PhysicianOwned Specialty Hospitals, MedPAC 

found that hospitals charge much more 

than their costs for some types of 

services (such as operating room time, 

imaging services and supplies) than 

others (such as room and board and 

routine nursing care).10 Our analysis of 

the MedPAC report in the FY 2007 IPPS 

proposed rule (71 FR 24006) produced 

consistent findings. 

In the FY 2007 IPPS proposed rule, 

we proposed to implement cost-based 

weights incorporating aspects of a 

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11 Hackbarth, Glenn: MedPAC Comments on the 

IPPS Rule, June 12, 2006, page 2. 

methodology recommended by 

MedPAC, which we called the hospitalspecific relative value cost center 

(HSRVcc) methodology. MedPAC 

indicated that an HSRVcc methodology 

would reduce the effect of cost 

differences among hospitals that may be 

present in the national relative weights 

due to differences in case-mix adjusted 

costs. After studying Medicare cost 

report data, we proposed to establish 10 

national cost center categories from 

which to compute 10 national CCRs 

based upon broad hospital accounting 

definitions. We made several important 

changes to the HSRVcc methodology 

that MedPAC recommended using in its 

March 2005 Report to the Congress on 

Physician-Owned Specialty Hospitals. 

We refer readers to the FY 2007 IPPS 

proposed rule (71 FR 24007 through 

24011) for an explanation and our 

reasons for the modification to 

MedPAC’s methodology. In its public 

comments on the FY 2007 IPPS 

proposed rule, MedPAC generally 

agreed with the adaptations we made to 

its methodology, with the exception of 

expanding the number of distinct 

hospital department CCRs being used 

from 10 to 13 and basing the CCRs on 

Medicare-specific costs and charges.11

We did not finalize the HSRVcc 

methodology for FY 2007 because of 

concerns raised in the public comments 

on the FY 2007 IPPS proposed rule (71 

FR 47882 through 47898). Rather, we 

adopted a cost-weighting methodology 

without the hospital-specific relative 

weight feature. We also expanded the 

number of distinct hospital departments 

with CCRs from 10 to 13. We indicated 

our intent to study whether to adopt the 

HSRVcc methodology after we had the 

opportunity to further consider some of 

the issues raised in the public 

comments. In the interim, we adopted a 

cost-weighting methodology over a 3- 

year transition period, substantially 

mitigating the redistributive payment 

impacts illustrated in the proposed rule, 

while we engaged a contractor to assist 

us with evaluating the HSRVcc 

methodology. Some public commenters raised 

concerns about potential bias in cost 

weights due to ‘‘charge compression,’’ 

which is the practice of applying a 

lower percentage markup to higher cost 

services and a higher percentage 

markup to lower cost services. These 

commenters were concerned that our 

proposed weighting methodology may 

undervalue high cost items and 

overvalue low cost items if a single CCR 

is applied to items of widely varying 

costs in the same cost center. The 

commenters suggested that the HSRVcc 

methodology would exacerbate the 

effect of charge compression on the final 

relative weights. One of the commenters 

suggested an analytic technique of using 

regression analysis to identify 

adjustments that could be made to the 

CCRs to better account for charge 

compression. We indicated our interest 

in researching whether a rigorous model 

should allow an adjustment for charge 

compression to the extent that it exists. 

We engaged a contractor, RTI 

International (RTI), to study several 

issues with respect to the cost weights, 

including charge compression, and to 

review the statistical model provided to 

us by the commenter for adjusting the 

weights to account for it. We discuss 

RTI’s findings in detail below. Commenters also suggested that the 

cost report data used in the cost 

methodology are outdated, not 

consistent across hospitals, and do not 

account for the costs of newer 

technologies such as medical devices. 

However, the relationship between costs 

and charges (not costs alone) is the 

important variable in setting the relative 

weights under this new system. Older 

cost reports also do not include the 

hospital’s higher charges for these same 

medical devices. Therefore, it cannot be 

known whether the CCR for the more 

recent technologies will differ from 

those we are using to set the relative 

weights. The use of national average 

cost center CCRs rather than hospitalspecific CCRs may mitigate potential 

inconsistencies in hospital cost 

reporting. Nevertheless, we agree that it 

is important to review how hospitals 

report costs and charges on the cost 

reports and on the Medicare claims and 

asked RTI to further study this issue as 

well. 

In summary, we proposed to adopt 

HSRVcc relative weights for FY 2007 

using national average CCRs for 10 

hospital departments. Based on public 

comments concerned about charge 

compression and the accuracy of cost 

reporting, we decided not to finalize the 

HSRVcc methodology, but adopted costs 

weights without the hospital-specific 

feature. In response to comments from 

MedPAC, we expanded the number of 

hospital cost centers used in calculating 

the national CCRs from 10 to 13. 

Finally, we decided to implement the 

cost-based weighting methodology 

gradually, by blending the cost and 

charge weights over a 3-year transition 

period beginning with FY 2007, while 

we further studied many of the issues 

raised in the public comments. We refer 

readers to the FY 2007 IPPS final rule 

(71 FR 47882) for more details on our 

final policy for calculating the costbased DRG relative weights. 

1. Summary of RTI’s Report on Charge 

Compression 

In August 2006, we awarded a 

contract to RTI to study the effects of 

charge compression in calculating DRG 

relative weights. The purpose of the 

study was to develop more accurate 

estimates of the costs of Medicare 

inpatient hospital stays that can be used 

in calculating the relative weights per 

DRG. RTI was asked to assess the 

potential for bias in relative weights due 

to CCR differences within the 13 CCR 

groups used in calculating the costbased DRG relative weights and to 

develop an analysis plan that explored 

alternative methods of estimating costs, 

with the objective of better aligning the 

charges and costs used in those 

calculations. RTI was asked to consider 

methods of reducing the variation in 

CCRs across services within cost centers 

by: 

<bullet≤ Modifying existing cost 

centers and/or creating new costs 

centers. 

<bullet≤ Using statistical methods, 

such as the regression adjustment for 

charge compression. Some commenters 

on the FY 2007 IPPS proposed rule 

suggested that we use a regression 

adjustment to account for charge 

compression. 

As part of its contract, RTI convened 

a Technical Expert Panel composed of 

individuals representing academic 

institutions, hospital associations, 

medical device manufacturers, and 

MedPAC. The members of the panel met 

on October 27, 2006, to evaluate RTI’s 

analytic plan, to identify other areas that 

are likely to be affected by compression 

or aggregation problems, and to propose 

suggestions for adjustments for charge 

compression. We posted RTI’s draft 

interim report on the CMS Web site in 

March 2007. For more information, 

interested individuals can view RTI’s 

report at the following Web site: http:// 

cms.hhs.gov/reports/downloads/ 

Dalton.pdf. 

As the first step in its analysis, RTI 

compared the reported Medicare 

program charge amounts from the cost 

reports to the total Medicare charges 

summed across all claims filed by 

providers. Using cost and charge data 

from the most recent available Medicare 

cost reports and inpatient claims from 

IPPS hospitals, RTI was charged with 

performing an analysis to determine 

how well the MedPAR charges matched 

the cost report charges used to compute 

CCRs. The accuracy of the DRG cost 

estimates is directly affected by this 

match because MedPAR charges are 

multiplied by CCRs to estimate cost. RTI 

found consistent matching of charges 

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24714 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

from the Medicare cost report to charges 

grouped in the MedPAR claims for some 

cost centers but there appeared to be 

problems with others. For example, RTI 

found that the data between the cost 

report and the claims matched well for 

total discharges, days, covered charges, 

nursing unit charges, pharmacy, and 

laboratory. However, there appeared to 

be inconsistent reporting between the 

cost reports and the claims data for 

charges in several ancillary departments 

(medical supplies, operating room, 

cardiology, and radiology). For example, 

the data suggested that hospitals often 

include costs and charges for devices 

and other medical supplies within the 

Medicare cost report cost centers for 

Operating Room, Radiology or 

Cardiology instead of the Medical 

Supplies cost center. 

RTI found that some charge 

mismatching results from the way in 

which charges are grouped in the 

MedPAR file. Examples include the 

intermediate care nursing charges being 

grouped with intensive care nursing 

charges, and electroencephalography 

(EEG) charges being grouped with 

laboratory charges. RTI suggested that 

reclassifying intermediate care charges 

from the intensive care unit to the 

routine cost center could address the 

former problem. 

As the second step in its analysis, RTI 

reviewed the existing cost centers that 

are combined into the 13 groups used in 

calculating the national average CCRs. 

RTI identified CCRs with potential 

aggregation problems and considered 

whether separating the charge groups 

could result in more accurate cost 

conversion at the DRG level. The 

analysis led RTI to calculate separate 

CCRs for Emergency Room and Blood 

and Blood Administration, both of 

which had been included in ‘‘Other 

Services’’ in FY 2007. 

During this second step, RTI noted 

that a variation of charge compression is 

also present in inpatient nursing 

services because most patients are 

charged a single type of accommodation 

rate per day that is linked to the type of 

nursing unit (routine, intermediate, or 

intensive), but not to the hours of 

nursing services given to individual 

patients. Unlike the situation with 

charge compression in ancillary service 

areas, there are virtually no detailed 

charge codes that can distinguish 

patient nursing care use. Therefore, any 

potential bias cannot be empirically 

evaluated or adjustments made without 

additional data. 

Next, RTI examined individual 

revenue codes within the cost centers 

and used regression analysis to 

determine whether certain revenue 

codes in the same cost center had 

significantly different markup rates. 

Those revenue codes include devices, 

prosthetics, implants within the 

Medical Supplies cost center, IV 

Solutions within the Drugs cost center, 

CT scanning and MRI within the 

Radiology cost center, Cardiac 

Catheterization within the Cardiology 

cost center, and Intermediate Care Units 

within the Routine Nursing Care cost 

center. Devices, prosthetics, and 

implants within the Medical Supplies 

cost center have a lower markup and, as 

a result, a higher CCR than the 

remainder of the medical supplies group 

according to RTI’s analysis. Within the 

Drugs CCR, IV Solutions have a much 

higher markup and much lower CCR 

than the other drugs included in the 

category. Within the Radiology CCR, CT 

scanning and MRI have higher markups 

and lower CCRs than the remaining 

radiology services. RTI’s results for 

Cardiac Catheterization and 

Intermediate Care Units were 

ambiguous due to data problems. 

RTI’s analysis also determined the 

impact of the disaggregated CCRs on the 

relative weights. Differences in CCRs 

alone do not necessarily alter the DRG 

relative weights. The impact on the 

relative weights is the result of the 

interaction of CCR differences and DRG 

differences in the proportions of the 

services with different CCRs. In FY 

2007, we calculated relative weights 

using CCRs for 13 hospital departments. 

The RTI analysis suggests expanding the 

number of distinct hospital department 

CCRs from 13 to 19. Of the additional 

six CCRs, two would result from 

separating the Emergency Department 

and Blood (Products and 

Administration) from the residual 

‘‘Other Services’’ category. Four 

additional CCRs would result from 

applying a regression method similar to 

a method suggested in last year’s public 

comments to three existing categories: 

supplies, radiology, and drugs. This 

method, as adapted by RTI, used 

detailed coding of charges to 

disaggregate hospital cost centers and 

derive separate, predicted alternative 

CCRs for the disaggregated services. 

RTI’s analysis suggests splitting Medical 

Supplies into one CCR for devices, 

implants, and prosthetics and one CCR 

for Other Supplies; splitting Radiology 

into one CCR for MRIs, one CCR for CT 

scans, and one CCR for Other Radiology; 

and splitting Drugs into one CCR for IV 

Solutions and one CCR for Other Drugs. 

RTI’s draft report provides the 

potential impacts of adopting these 

changes to the CCRs. We note that RTI’s 

analysis was based on Version 24.0 of 

the CMS DRGs. Because the proposed 

MS–DRGs were under development for 

the FY 2008 IPPS proposed rule, they 

were unavailable to RTI for their 

analysis. The results of RTI’s analysis 

may be different if applied to the 

proposed MS–DRGs. However, it seems 

reasonable to believe that the impact of 

RTI’s suggestions will be consistent 

using Version 24.0 of the CMS DRGs 

and the proposed MS–DRGs, as both 

systems generally use the same base 

DRGs while applying different 

subdivisions to recognize severity of 

illness. Of all the adjusted CCRs, the 

largest impact on weights came from 

accounting for charge compression in 

medical supplies for devices and 

implants. The impact on weights from 

accounting for CCR differences among 

drugs was modest. The impact of 

splitting MRI and CT scanning from the 

radiology CCR was greater than the 

impact of modifying the Drugs CCRs, 

but less than the impact of splitting the 

medical supplies group. Separating 

Emergency Department and Blood 

Products and Administration from the 

‘‘Other Services’’ category would raise 

the CCR for other services in the group. 

RTI found that disaggregating cost 

centers may have a mitigating effect on 

the impact of transitioning from chargebased weights to cost-based weights. 

That is, the changes being suggested by 

RTI will generally offset (fully or more 

than fully in some cases or in part in 

other cases) the impacts of fully 

implemented cost weights that we are 

adopting over the FY 2007–FY 2009 

transition period. Thus, RTI’s analysis 

suggests that expanding the number of 

distinct hospital department CCRs used 

to calculate cost weights from 13 to 19 

will generally increase the relative 

weights for surgical DRGs and decrease 

them for the medical DRGs compared to 

the fully implemented cost-based 

weights to which we began transitioning 

in FY 2007. 

2. RTI Recommendations 

In its report, RTI provides 

recommendations for the short term, 

medium term, and long term, to mitigate 

aggregation bias in the calculation of 

relative weights. We summarize RTI’s 

recommendations below and respond to 

each of them. 

a. Short-Term Recommendations 

Most of RTI’s short-term 

recommendations have already been 

described above. The most immediate 

changes that RTI recommends 

implementing include expanding from 

13 distinct hospital department CCRs to 

19 by: 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24715 

<bullet≤ Disaggregating ‘‘Emergency 

Room’’ and ‘‘Blood and Blood Products’’ 

from the ‘‘Other Services’’ cost center; 

<bullet≤ Establishing regression-based 

estimates as a temporary or permanent 

method for disaggregating the Medical 

Supplies, Drugs, and Radiology cost 

centers; and 

<bullet≤ Reclassifying intermediate 

care charges from the intensive care unit 

cost center to the routine cost center. 

We believe these recommendations 

have significant potential to address 

issues of charge compression and 

potential mismatches between how 

costs and charges are reported in the 

cost reports and on the Medicare claims. 

RTI’s recommendations show 

significant promise in the short term for 

addressing issues raised in the public 

comments on the cost weights in the FY 

2007 IPPS proposed rule. However, in 

the time available for the development 

of this proposed rule, we have been 

unable to investigate how RTI’s 

recommended changes may interact 

with other potential changes to the 

DRGs and to the method of calculating 

the DRG relative weights. As we noted 

above, RTI’s analysis was done on the 

Version 24.0 of the CMS DRGs and not 

the MS-DRGs we are proposing for FY 

2008. For this proposed rule, we were 

not able to examine the combined 

impacts of the proposed MS-DRGs and 

RTI’s recommendations. In addition, we 

believe it is also important to consider 

that, in the FY 2007 IPPS final rule (71 

FR 47897), we anticipated undertaking 

further analysis of the HSRVcc 

methodology over the next year in 

conjunction with the research we were 

to do on charge compression. Analysis 

of the HSRVcc methodology will be part 

of the second phase of the RAND study 

of alternative DRG systems to be 

completed by September 1, 2007, that 

has not been completed in time for this 

proposed rule. As a result, we have also 

been unable to consider the effects of 

the HSRVcc methodology together with 

the proposed MS-DRGs and RTI’s 

recommendations. Finally, we note that 

in order to complete the analysis in time 

for this proposed rule, RTI’s study used 

only inpatient hospital claims. 

However, hospital ancillary 

departments typically include both 

inpatient and outpatient services within 

the same department and only a single 

CCR covering both inpatient and 

outpatient services can be calculated 

from Medicare cost reports. Although 

we believe that applying the regression 

method used by RTI to only inpatient 

services is unlikely to have had much 

impact for the adjustments 

recommended by RTI, the preferred 

approach would be to apply the 

regression method to the combined 

inpatient and outpatient services. The 

latter approach would ensure that any 

potential CCR adjustments in the IPPS 

would be consistent with potential CCR 

adjustments in the OPPS. We hope to 

expand their analysis to incorporate 

outpatient services during the coming 

year. For all of these reasons, we are not 

proposing to adopt RTI’s 

recommendations for FY 2008. 

Although we are not proposing to 

adopt RTI’s recommendations for FY 

2008, we are interested in public 

comments on expanding from 13 CCRs 

to 19 CCRs. Again, we note that RTI’s 

analysis suggests significant 

improvements that could result in the 

cost weights from adopting its 

recommendations to adjust for charge 

compression. Therefore, we are also 

interested in public comments on 

whether we should proceed to adopt the 

RTI recommended changes for FY 2008 

in the absence of a detailed analysis of 

how the relative weights would change 

if we were to address charge 

compression while simultaneously 

adopting an HSRVcc methodology 

together with the proposed MS-DRGs. 

Given the change in the impacts that 

were illustrated in last year’s FY 2007 

IPPS final rule (71 FR 47915–47916), 

going from a hospital-specific to a 

nonhospital-specific cost-weighting 

methodology, we believe that 

sequentially adjusting for charge 

compression and later adopting an 

HSRVcc methodology could create the 

potential for instability in IPPS 

payments over the next 2 years (that is, 

payments for surgical DRGs would 

increase and payment for medical DRGs 

would decrease if we were adopt the 

RTI recommended changes for FY 2008, 

but could potentially reverse direction if 

we were to adopt an HSRVcc 

methodology for FY 2009). Again, we 

are interested in public comments on all 

of these issues before we make a final 

decision as to whether to proceed with 

the RTI’s short-term recommendations 

in the final rule for FY 2008. 

Among its other short-term 

recommendations, RTI also suggested 

that we incorporate edits to reject or 

require more intensive review of cost 

reports from hospitals with extreme 

CCRs. This action would reduce the 

number of hospitals with excluded data 

in the national CCR computations, and 

would also improve the accuracy of all 

departmental CCRs within problem cost 

reports by forcing hospitals to review 

and correct the assignment of costs and 

charges before the cost report is filed. 

Although we do not have a substantive 

disagreement with the recommendation, 

we generally focus our audit resources 

on areas in which cost report 

information directly affects payments to 

individual providers. 

RTI further suggested revising cost 

report instructions to reduce cost and 

charge mismatching and program charge 

misalignment in its short-term 

recommendations. Although RTI 

suggests such an action could be 

immediately effective for correcting the 

reporting of costs and charges for 

medical supply items that are now 

distributed across multiple cost centers, 

we note that changes to improve cost 

reporting now will not become part of 

the relative weights for several years 

because of lags between the submission 

of hospital reports and our ability to use 

them in setting the relative weights. 

Currently, we expect there will continue 

to be a 3-year lag between a hospital’s 

cost report fiscal year and the year it is 

used to set the relative weights. Thus, 

even if it were possible to issue 

instructions immediately beginning for 

FY 2008, revised reporting would not 

affect the relative weights until at least 

FY 2011. Nevertheless, we agree with 

this recommendation, and we welcome 

public input on potential changes to 

cost reporting instructions to improve 

consistency between how charges are 

reported on cost reports and in the 

Medicare claims. We will consider these 

changes to the cost reporting 

instructions as we consider further 

changes to the cost report described 

below. 

b. Medium-Term Recommendations 

RTI recommended that we expand the 

MedPAR file to include separate fields 

that disaggregate several existing charge 

departments. For compatibility with 

prior years’ data, the new fields should 

partition the existing ones rather than 

recombine charges. RTI recommended 

including additional fields in the 

MedPAR file for the hospital 

departments that it statistically 

disaggregated in its report, as well as 

intermediate care, observation beds, 

other special nursing codes, therapeutic 

radiation and EEG, and possibly others. 

As with some of RTI’s earlier 

recommendations with respect to cost 

reports, we will examine this suggestion 

in conjunction with other competing 

priorities CMS has been given for our 

information systems. We have limited 

information systems resources, and we 

will need to consider whether the time 

constraints we have to develop the IPPS 

final rule, in conjunction with the 

inconvenience of using the SAF and 

accounting for charge compression 

through regression, will justify the 

infrastructure cost to our information 

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systems of incorporating these variables 

into the MedPAR. 

Finally, RTI’s medium-term 

recommendations include encouraging 

providers to use existing standard cost 

centers, particularly those for Blood and 

Blood Administration and for 

Therapeutic Radiology, in the current 

Medicare cost report. We believe this 

recommendation is closely related to the 

one for improved cost reporting 

instructions. Therefore, we will 

consider this recommendation as part of 

any further effort we may undertake to 

revise cost reporting instructions or 

change the cost report. 

c. Long-Term Recommendations 

RTI’s long-term recommendations 

include adding new cost centers to the 

Medicare cost report and/or undertaking 

the following activities: 

<bullet≤ Add ‘‘Devices, Implants and 

Prosthetics’’ under the line for ‘‘Medical 

Supplies Charged to Patients.’’ Consider 

also adding a similar line for IV 

Solutions as a subscripted line under 

the line for ‘‘Drugs Charged to Patients.’’ 

<bullet≤ Add CT Scanning and MRI 

as subscripted lines under the line for 

‘‘Radiology-Diagnostic.’’ About onethird of hospitals that offer CT Scanning 

and/or MRI services are already 

reporting these services on nonstandard 

line numbers. More consistent reporting 

for both cost centers would eliminate 

the need for statistical estimation on the 

radiology CCRs. 

<bullet≤ In consultation with hospital 

industry representatives, determine the 

best way to separate cardiology cost 

centers and add a new standard cost 

center for cardiac catheterization and/or 

for all other cardiac diagnostic 

laboratory services. About 20 percent of 

hospitals already include a nonstandard 

line on their cost reports for 

catheterization. Creating a new standard 

cost center could improve consistency 

in reporting and substantially improve 

the program charge mismatching that 

now occurs. 

<bullet≤ In consultation with hospital 

industry representatives, consider 

establishing a new cost center to capture 

intermediate care units as distinct from 

routine or intensive care. 

<bullet≤ Establish expert study groups 

or other research vehicles to study 

options for improving patient-level 

charging within nursing units. Nursing 

accounts for one-fourth of IPPS charges 

and 41 percent of the computed costs 

from our claims analysis file. 

Historically, nursing charges and costs 

have been assigned to patients without 

relying on individual measures of 

service use. Consideration should be 

given to finding ways to improve 

precision in nursing cost-finding that 

will improve relative resource weights 

without adding substantial 

administrative costs to either the 

Medicare program or to hospitals. 

We agree with RTI that attention 

should be paid to these issues as we 

consider changes to the Medicare cost 

report. The cost report has not been 

revised in nearly 10 years. During this 

time, there have been significant 

changes to the Medicare statute and 

regulations that have affected the 

Medicare payment policies. Necessary 

incremental changes have been made to 

the Medicare cost report over the years 

to accommodate the Medicare wage 

index, disproportionate share payments, 

indirect and direct graduate medical 

education payments, reporting of 

uncompensated care costs, among 

others. The adoption of cost-based 

weights for the IPPS beginning in FY 

2007 has brought further attention to the 

importance of the Medicare cost report 

and how hospitals report costs and 

charges. We recently began doing a 

comprehensive review of the Medicare 

cost report and plan to make updates 

that will consider its many uses. As we 

update the cost report, we will give 

strong consideration to RTI’s 

recommendations and potential longterm improvements that could be made 

to the IPPS cost-based relative weighting 

methodology. 

F. Hospital-Acquired Conditions, 

Including Infections 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Hospital-Acquired 

Conditions’’ at the beginning of your 

comment.) 

1. General 

Medicare’s IPPS encourages hospitals 

to treat patients efficiently. Hospitals 

receive the same DRG payment for stays 

that vary in length. In many cases, 

complications acquired in the hospital 

do not generate higher payments than 

the hospital would otherwise receive for 

other cases in the same DRG. To this 

extent, the IPPS does encourage 

hospitals to manage their patients well 

and to avoid complications, when 

possible. However, complications, such 

as infections, acquired in the hospital 

can trigger higher payments in two 

ways. First, the treatment of 

complications can increase the cost of 

hospital stays enough to generate outlier 

payments. However, the outlier 

payment methodology requires that 

hospitals experience large losses on 

outlier cases (for example, in FY 2007, 

the fixed-loss amount was $24,485 

before a case qualified for outlier 

payments, and the hospital then only 

received 80 percent of its costs above 

the fixed-loss cost threshold). Second, 

there are about 121 sets of DRGs that 

split based on the presence or absence 

of a complication or comorbidity (CC). 

The CC DRG in each pair would 

generate a higher Medicare payment. If 

a condition acquired during the 

beneficiary’s hospital stay is one of the 

conditions on the CC list, the result may 

be a higher payment to the hospital 

under a CC DRG. Under the proposed 

MS–DRGs, there will be 258 sets of 

DRGs that are split into 2 or 3 subgroups 

based on the presence or absence of a 

major CC (MCC) or CC. If a condition 

acquired during the beneficiary’s 

hospital stay is one of the conditions on 

the MCC or CC list, the result may be 

a higher payment to the hospital under 

the MS–DRGs. (See section II.C. of the 

FY 2007 IPPS final rule (71 FR 47881) 

for a detailed discussion of proposed 

DRG reforms.) 

2. Legislative Requirement 

Section 5001(c) of Pub. L. 109–171 

requires the Secretary to select, by 

October 1, 2007, at least two conditions 

that are (a) high cost or high volume or 

both, (b) result in the assignment of a 

case to a DRG that has a higher payment 

when present as a secondary diagnosis, 

and (c) could reasonably have been 

prevented through the application of 

evidence-based guidelines. For 

discharges occurring on or after October 

1, 2008, hospitals will not receive 

additional payment for cases in which 

one of the selected conditions was not 

present on admission. That is, the case 

will be paid as though the secondary 

diagnosis was not present. Section 

5001(c) provides that we can revise the 

list of conditions from time to time, as 

long as the list contains at least two 

conditions. Section 5001(c) also requires 

hospitals to submit the secondary 

diagnoses that are present at admission 

when reporting payment information for 

discharges on or after October 1, 2007. 

3. Public Input 

In the FY 2007 IPPS proposed rule (71 

FR 24100), we sought input from the 

public about which conditions and 

which evidence-based guidelines 

should be selected in order to 

implement section 5001(c) of Public 

Law 109–171. The comments that we 

received were summarized in the FY 

2007 IPPS final rule (71 FR 48051 

through 48053). In that final rule, we 

indicated that the next opportunity for 

formal public comment would be this 

FY 2008 proposed rule and encouraged 

the public to comment on our proposal 

at that time. 

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In summary, the majority of the 

comments that we received in response 

to the FY 2007 IPPS proposed rule 

addressed conceptual issues concerning 

the selection, measurement, and 

prevention of hospital-acquired 

infections. Many commenters 

encouraged CMS to engage in a 

collaborative discussion with relevant 

experts in designing, evaluating, and 

implementing this section. The 

commenters urged CMS to include 

individuals with expertise in infection 

control and prevention, as well as 

representatives from the provider 

community, in the discussions. Many commenters supported the 

statutory requirement for hospitals to 

submit information regarding secondary 

diagnoses present on admission 

beginning in FY 2008, and suggested 

that it would better enable CMS and 

health care providers to more accurately 

differentiate between comorbidities and 

hospital-acquired complications. 

MedPAC, in particular, noted that this 

requirement was recommended in its 

March 2005 Report to Congress and 

indicated that this information is 

important to Medicare’s value-based 

purchasing efforts. Other commenters 

cautioned us about potential problems 

with relying on secondary diagnosis 

codes to identify hospital-acquired 

complications, and indicated that 

secondary diagnosis codes may be an 

inaccurate method for identifying true 

hospital-acquired complications. A number of commenters expressed 

concerns about the data coding 

requirement for this payment change 

and asked for detailed guidance from 

CMS to help them identify and 

document hospital-acquired 

complications. Other commenters 

expressed concern that not all hospitalacquired infections are preventable and 

noted that sicker and more complex 

patients are at greater risk for hospitalacquired infections and complications. 

Commenters suggested that CMS 

include standardized infectionprevention process measures, in 

addition to outcome measures of 

hospital-acquired infections. Some commenters proposed that CMS 

expand the scope of the payment 

changes beyond the statutory minimum 

of two conditions. They noted that the 

death, injury, and cost of hospitalacquired infections are too high to limit 

this provision to only two conditions. 

Commenters also recommended that 

CMS annually select additional 

hospital-acquired complications for the 

payment change. Conversely, a number 

of commenters proposed that CMS 

initially begin with limited 

demonstrations to test CMS’ 

methodology before nationwide 

implementation. One commenter 

recommended that CMS include 

appropriate consumer protections to 

prevent providers from billing patients 

for the nonreimbursed costs of the 

hospital-acquired complications and to 

prevent hospitals from selectively 

avoiding patients perceived at risk of 

complications. In addition to the broad conceptual 

suggestions, some commenters 

recommended specific conditions for 

possible inclusion in the payment 

changes, which we discuss in detail in 

section II.D.4. of this preamble. We also 

discuss throughout section II.D. of this 

preamble other comments that we have 

considered in developing hospitalacquired conditions that would be 

subject to reporting. 

4. Collaborative Effort 

CMS worked with public health and 

infectious disease experts from the 

Centers for Disease Control and 

Prevention (CDC) to identify a list of 

hospital-acquired conditions, including 

infections, as required by section 

5001(c) of Public Law 109–171. As 

previously stated, the selected 

conditions must meet the following 

three criteria: (a) High cost or high 

volume or both; (b) result in the 

assignment of the case to a DRG that has 

a higher payment when present as a 

secondary diagnosis; and (c) could 

reasonably have been prevented through 

the application of evidence-based 

guidelines. CMS and CDC staff also 

collaborated on developing a process for 

hospitals to submit a Present on 

Admission (POA) indicator with each 

secondary condition. The statute 

requires the Secretary to begin 

collecting this information as of October 

1, 2007. The POA indicator is required 

in order for us to determine which of 

the selected conditions developed 

during a hospital stay. The current 

electronic format used by hospitals to 

obtain this information (ASC X12N 837, 

Version 4010) does not provide a field 

to obtain the POA information. We are 

in the process of issuing instructions to 

require acute care IPPS hospitals to 

submit the POA indicator for all 

diagnosis codes effective October 1, 

2007. The instructions will specify how 

hospitals under the IPPS will submit 

this information in segment K3 in the 

2300 loop, data element K301 on the 

ASC X12N 837, Version 4010 claim. 

Specific instructions on how to select 

the correct POA indicator for a 

diagnosis code are included in the ICD– 

9–CM Official Guidelines for Coding 

and Reporting. These guidelines can be 

found at the following Web site: http:// 

www.cdc.gov/nchs/datawh/ftpserv/ 

ftpicd9/ftpicd9.htm 

CMS and CDC staff also received 

input from a number of groups and 

organizations on hospital-acquired 

conditions, including infections. Many 

of these groups and organizations 

recommended the selection of 

conditions mentioned in the FY 2007 

IPPS final rule, including the following 

because of the high cost or high volume 

(frequency) of the condition, or both, 

and because in some cases preventable 

guidelines already exist: 

<bullet≤ Surgical site infections. The 

groups and organizations stated that 

there were evidence-based measures to 

prevent the occurrence of these 

infections which are currently measured 

and reported as part of the Surgical Care 

Improvement Program (SCIP). 

<bullet≤ Ventilator-associated 

pneumonias. The groups and 

organizations pointed out that these 

conditions are currently measured and 

reported through SCIP. However, other 

organizations counseled against 

selecting these conditions because they 

believed it was difficult to obtain good 

definitions and that it was not always 

clear which ones are hospital-acquired. 

<bullet≤ Catheter associated 

bloodstream infections. 

<bullet≤ Pressure ulcers, as an 

alternative to hospital-acquired 

infections. The groups and 

organizations pointed out that the 

specific language in section 5001(c) of 

Public Law 109–171 mentions hospitalacquired conditions; therefore, the 

language does not restrict the Secretary 

to the selection of infections. 

<bullet≤ Hospital falls, as an 

alternative to hospital-acquired 

infections. The injury prevention groups 

included this condition among a group 

referred to as ‘‘serious preventable 

events,’’ also commonly referred to as 

‘‘never events’’ or ‘‘serious reportable 

events.’’ A serious preventable event is 

defined as a condition which should not 

occur during an inpatient stay. 

In addition to the aforementioned 

conditions, we received other 

recommendations for the selection of 

hospital-acquired conditions. These 

recommendations were also based on 

the high cost and the high volume of the 

condition, or both, or the fact that 

preventable guidelines exist. The 

recommendations include— 

<bullet≤ Bloodstream infections/ 

septicemia. Some commenters suggested 

that we focus on one specific organism, 

such as staph aureus septicemia. 

<bullet≤ Pneumonia. Some 

commenters recommended the 

inclusion of a broader group of 

pneumonia patients, instead of 

restricting cases to ventilator-associated 

pneumonias. Some commenters 

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mentioned that while prevention 

guidelines exist for pneumonia, it is not 

clear how effective these guidelines may 

be in preventing pneumonia. 

<bullet≤ Vascular catheter associated 

infections. Commenters pointed out that 

there are CDC guidelines for these 

infections. Other commenters pointed 

out that while this condition certainly 

deserves focused attention by health 

care providers, there is not a clear one 

unique ICD–9–CM code that identifies 

vascular catheter-associated infections. 

Therefore, these commenters suggested 

that there would be difficulty separately 

identifying these conditions. 

<bullet≤ Clostridium difficileassociated disease (CDAD). Several 

commenters identified this condition as 

a significant public health issue. Other 

commenters pointed out that while 

prevalence of this condition is emerging 

as a public health problem, there is not 

currently a strategy for reasonably 

preventing these infections. 

<bullet≤ Methicillin-resistant 

staphylococcus aureus (MRSA). Several 

commenters pointed out that MRSA has 

become a very common bacteria 

occurring both in and outside the 

hospital environment. However, other 

organizations pointed out that the code 

for MRSA (V09.0, Infection with 

microorganism resistant to penicillins 

Methicillin-resistant staphylococcus 

aureus) is not currently classified as a 

CC. Therefore, the commenters stated 

that MRSA does not lead to a higher 

reimbursement when the code is 

reported. 

<bullet≤ Serious preventable events. 

As stated earlier, some commenters 

representing injury prevention groups 

suggested including a broader group of 

conditions than hospital falls which 

should not be expected to occur during 

a hospital admission. Hey notes that 

these conditions are referred to as 

‘‘serious preventable events,’’ and 

include events such as the following: (a) 

Leaving an object in during surgery; (b) 

operating on the wrong body part or 

patient, or performing the wrong 

surgery; (c) air embolism as a result of 

surgery; and (d) providing incompatible 

blood or blood products. Other 

commenters indicated that serious 

preventable events are so rare that they 

should not be selected as a hospital 

condition that cannot result in a case 

being assigned to a higher paying DRG. 

5. Criteria for Selection of the HospitalAcquired Conditions 

CMS and CDC staff greatly appreciate 

the many comments and suggestions 

offered by organizations and groups that 

were interested in providing input into 

the selection of the initial hospitalacquired conditions. 

CMS and CDC staff evaluated each 

recommended condition under the three 

criteria established by section 

1886(d)(4)(D)(iv) of the Act. In order to 

meet the higher payment criterion, the 

condition selected must have an ICD–9– 

CM diagnosis code that clearly 

identifies the condition and is classified 

as a CC, or as an MCC as proposed for 

the MS–DRGs in this proposed rule. 

Some conditions recommended for 

inclusion among the initial hospitalacquired conditions did not have codes 

that clearly identified the conditions. 

Because there has not been national 

reporting of a POA indicator for each 

diagnosis, there is no Medicare data to 

determine the incidence of the reported 

secondary diagnoses occurring after 

admission. To the extent possible, we 

used information from the CDC on the 

incidence of these conditions. CDC’s 

data reflect the incidence of hospitalacquired conditions in 2002. We also 

examined FY 2006 Medicare data on the 

frequency that these conditions were 

reported as secondary diagnoses. We 

developed the following criteria to assist 

in our analysis of the conditions. The 

conditions described were those 

recommended for inclusion in the 

initial hospital-acquired infection 

provision. 

<bullet≤ Coding—Under section 

1886(d)(4)(D)(ii)(I) of the Act, a 

discharge is subject to the payment 

adjustment if ‘‘the discharge includes a 

condition identified by a diagnosis 

code’’ selected by the Secretary under 

section 1886(d)(4)(D)(iv) of the Act. We 

only selected conditions that have (or 

could have) a unique ICD–9–CM code 

that clearly describes the condition. 

Some conditions recommended by the 

commenters would require the use of 

two or more ICD–9–CM codes to clearly 

identify the conditions. Although we 

did not exclude these conditions from 

further consideration, the need to utilize 

multiple ICD–9–CM codes to identify 

them may present operational issues. 

For instance, below we describe in 

detail the complexities associated with 

selecting septicemia as a hospitalacquired condition that would be 

subject to section 5001(c) of the DRA. In 

some cases, septicemia may be a 

reasonably preventable condition with 

proper hospital care. However, in other 

cases, clinicians may argue that the 

condition arose from further 

development of another infection the 

patient did have upon admission and 

the septicemia was not preventable. As 

we indicate in detail below, there could 

be a significant variety of clinical 

scenarios and potential coding vignettes 

to describe situations where septicemia 

occurs. Although we could select 

septicemia, we would also have to 

identify many exclusions for situations 

where the septicemia is not preventable. 

The vast number of clinical scenarios 

that we would have to account for could 

complicate implementation of the 

provision. 

<bullet≤ Burden (High Cost/High 

Volume)—Under section 

1886(d)(4)(D)(iv)(I) of the act, we must 

select cases that have conditions that are 

high cost or high volume, or both. 

<bullet≤ Prevention guidelines— 

Under section 1886(d)(4)(D)(iv)(II) of the 

Act, we must select codes that describe 

conditions that could reasonably have 

been prevented through application of 

evidence-based guidelines. We 

evaluated whether there is information 

available for hospitals to follow to 

prevent the condition from occurring. 

<bullet≤ CC—Under section 

1886(d)(4)(D)(iv)(III) of the Act, we must 

select codes that result in assignment of 

the case to a DRG that has a higher 

payment when the code it present as a 

secondary diagnosis. The condition 

must be an MCC or a CC that would, in 

the absence of this provision, result in 

assignment to a higher paying DRG. 

<bullet≤ Considerations—We evaluate 

each condition above according to how 

it meets the statutory criteria in light of 

the potential difficulties that we would 

face if the condition were selected. 

6. Proposed Selection of HospitalAcquired Conditions 

We discuss below our analysis of each 

of the conditions that were raised as 

possible candidates for selection under 

section 5001(c) of Pub. L. 109–171 

according to the criteria described above 

in section II.D.5. of this preamble. We 

also discuss any considerations, which 

would include any administrative issues 

surrounding the selection of a proposed 

condition. For example, the condition 

may only be able to be identified by 

multiple codes, thereby requiring the 

development of special GROUPER logic 

to also exclude similar or related ICD– 

9–CM codes from being classified as a 

CC. Similarly, a condition acquired 

during a hospital stay may arise from 

another condition that the patient had 

prior to admission, making it difficult to 

determine whether the condition was 

reasonably preventable. Following a 

discussion of each condition, we 

provide a summary table that describes 

the extent to which each condition 

meets each of the above criteria. We 

present 13 conditions in rank order. In 

our view, the conditions listed at the top 

of the table best meet the statutory 

selection criteria, while the conditions 

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12 Foxman, B.: ‘‘Epidemiology of urinary tract 

infections: incidence, morbidity, and economic 

costs,’’ The American Journal of Medicine, 113 

Suppl. 1A, pp. 5s–13s, 2002. 

listed lower may meet the selection 

criteria but could present a particular 

challenge (that is, they may be 

preventable only in some circumstances 

but not in others). Therefore, we would 

submit that the first conditions listed 

should receive the highest consideration 

of selection among our initial group of 

hospital-acquired conditions. We 

encourage comments on whether or not 

we have ranked these conditions 

appropriately. We also encourage 

additional comments on clinical, 

coding, and prevention issues that may 

affect the conditions selected. While we 

have ranked these conditions, there may 

be compelling public health reasons for 

including conditions that are not at the 

top of our list. We ask commenters to 

recommend how many and which 

conditions should be selected for 

implementation on October 1, 2008, 

along with justifications for these 

selections. 

(a) Catheter-Associated Urinary Tract 

Infections 

<bullet≤ Coding—ICD–9–CM code 

996.64 (Infection and inflammatory 

reaction due to indwelling urinary 

catheter) clearly identifies this 

condition. The hospital would also 

report the code for the specific type of 

urinary infection. For instance, when a 

patient develops a catheter associated 

urinary tract infection during the 

inpatient stay, the hospital would report 

code 996.64 and 599.0 (Urinary tract 

infection, site not specified) to clearly 

identify the condition. There are also a 

number of other more specific urinary 

tract infection codes that could also be 

coded with code 996.64. These codes 

are classified as CCs. If we were to select 

catheter-associated urinary tract 

infections, we would implement the 

decision by not counting code 996.64 

and any of the urinary tract infection 

codes listed below when both codes are 

present and the condition was acquired 

after admission. If only code 996.64 

were coded on the claim as a secondary 

diagnosis, we would not count it as a 

CC. 

Burden (High Cost/High Volume)— 

CDC reports that there are 561,667 

catheter-associated urinary tract 

infections per year. For FY 2006, there 

were 11,780 reported cases of Medicare 

patients who had a catheter associated 

urinary tract infection as a secondary 

diagnosis. The cases had average 

charges of $40,347 for the entire 

hospital stay. According to a study in 

the American Journal of Medicine, 

catheter-associated urinary tract 

infection is the most common 

nosocomial infection, accounting for 

more than 1 million cases in hospitals 

and nursing homes nationwide.12

Approximately 11.3 million women in 

the United States had at least one 

presumed acute community-acquired 

urinary tract infection resulting in 

antimicrobial therapy in 1995, with 

direct costs estimated at $659 million 

and indirect costs totaling $936 million. 

Nosocomial urinary tract infection 

necessitates one extra hospital day per 

patient, or nearly 1 million extra 

hospital days per year. It is estimated 

that each episode of symptomatic 

urinary tract infection adds $676 to a 

hospital bill. In total, according to the 

study, the estimated annual cost of 

nosocomial urinary tract infection in the 

United States ranges between $424 and 

$451 million. 

Prevention guidelines—There are 

widely recognized guidelines for the 

prevention of catheter-associated 

urinary tract infections. Guidelines can 

be found at the following Web site: 

http://www.cdc.gov/ncidod/dhqp/gl— 

catheter—assoc.html. 

CC—Codes 996.64 and 599.0 are 

classified as CCs in the current CMS 

DRGs as well as in the proposed MS– 

DRGs. 

Considerations—The primary 

prevention intervention would be not 

using catheters or removing catheters as 

soon as possible, both of which are 

worthy goals because once catheters are 

in place for 3 to 4 days, most clinicians 

and infectious disease/infection control 

experts do not believe urinary tract 

infections are preventable. While there 

may be some concern about the 

selection of catheter associated urinary 

tract infections, it is an important public 

health goal to encourage practices that 

will reduce urinary tract infections. 

Approximately 40 percent of Medicare 

beneficiaries have a urinary catheter 

during hospitalization based on 

Medicare Patient Safety Monitoring 

System (MPSMS) data. As stated above in the Coding section, 

this condition is clearly identified 

through ICD–9–CM code 996.64. Code 

996.64 is classified as a CC. The hospital 

would also report the code for the 

specific type of urinary infection. For 

instance, when a patient develops a 

catheter associated urinary tract 

infection during the inpatient stay, the 

hospital would report codes 996.64 and 

599.0 or another more specific code that 

clearly identifies the condition. These 

codes are classified as CCs under the 

current CMS DRGs as well as the 

proposed MS–DRGs. To select catheterassociated urinary tract infections as 

one of the hospital-acquired conditions 

that would not be counted as a CC, we 

would not classify code 996.64 as a CC 

if the condition occurred after 

admission. Furthermore, we would also 

not classify any of the codes listed 

below as CCs if present on the claim 

with code 996.64 because these 

additional codes identify the same 

condition. The following codes 

represent specific types of urinary 

infections. We did not include codes for 

conditions that could be considered 

chronic urinary infections, such as code 

590.00 (Chronic pyelonephritis, without 

lesion or renal medullary necrosis). 

Chronic conditions may indicate that 

the condition was not acquired during 

the current stay. We would not count 

code 996.64 or any of the following 

codes representing acute urinary 

infections if they developed after 

admission and were coded together on 

the same claim. 

<bullet≤ 112.2 (Candidiasis of other 

urogenital sites) <bullet≤ 590.10 (Acute 

pyelonephritis, without lesion of renal 

medullary necrosis) <bullet≤ 590.11 (Acute 

pyelonephritis, with lesion of renal 

medullary necrosis) <bullet≤ 590.2 (Renal and perinephric 

abscess) 

<bullet≤ 590.3 (Pyeloureteritis 

cystica) <bullet≤ 590.80 (Pyelonephritis, 

unspecified) <bullet≤ 590.81 (Pyelitis or 

pyelonephritis in diseases classified 

elsewhere) 

<bullet≤ 590.9 (Infection of kidney, 

unspecified) <bullet≤ 595.0 (Acute cystitis) <bullet≤ 595.3 (Trigonitis) <bullet≤ 595.4 (Cystitis in diseases 

classified elsewhere) 

<bullet≤ 595.81 (Cystitis cystica) <bullet≤ 595.89 (Other specified type 

of cystitis, other) <bullet≤ 595.9 (Cystitis, unspecified) <bullet≤ 597.0 (Urethral abscess) 

<bullet≤ 597.80 (Urethritis, 

unspecified) <bullet≤ 599.0 (Urinary tract 

infection, site not specified) We believe the condition of catheterassociated urinary tract infection meets 

all of our criteria for selection as one of 

the initial hospital-acquired conditions. 

We can easily identify the cases with 

ICD–9–CM codes. The condition is a CC 

under both the current CMS DRGs and 

the proposed MS–DRGs that are 

discussed earlier in this proposed rule. 

The condition meets our burden 

criterion with its high cost and high 

frequency. There are prevention 

guidelines on which the medical 

community agrees. Of all 13 conditions 

discussed in this proposed rule, we 

believe this condition best meets the 

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criteria discussed. Therefore, we are 

proposing the selection of catheterassociated urinary tract infections as 

one of the initial hospital-acquired 

conditions. 

We encourage comments on both the 

selection of this condition and the 

related conditions that we are proposing 

to exclude from being counted as CCs. 

(b) Pressure Ulcers 

Coding—Pressure ulcers are also 

referred to as decubitus ulcers. The 

following codes clearly identify 

pressure ulcers. <bullet≤ 707.00 (Decubitus ulcer, 

unspecified site) <bullet≤ 707.01 (Decubitus ulcer, 

elbow) 

<bullet≤ 707.02 (Decubitus ulcer, 

upper back) <bullet≤ 707.03 (Decubitus ulcer, 

lower back) 

<bullet≤ 707.04 (Decubitus ulcer, hip) <bullet≤ 707.05 (Decubitus ulcer, 

buttock) 

<bullet≤ 707.06 (Decubitus ulcer, 

ankle) 

<bullet≤ 707.07 (Decubitus ulcer, 

heel) 

<bullet≤ 707.09 (Decubitus ulcer, 

other site) 

Burden (High Cost/High Volume)— 

This is both a high-cost and highvolume condition. For FY 2006, there 

were 322,946 reported cases of Medicare 

patients who had a pressure ulcer as a 

secondary diagnosis. These cases had 

average charges for the hospital stay of 

$40,381. 

Prevention guidelines—Prevention 

guidelines can be found at the following 

Web sites: http://www.npuap.org/ 

positn1.html. http:// 

www.ncbi.nlm.nih.gov/books/ 

bv.fcgi?rid=hstat2.chapter.4409 CC—Decubitus ulcer codes are 

classified as CCs under the current CMS 

DRGs. Codes 707.00, 707.01, and 707.09 

are CCs under the proposed MS–DRGs. 

Codes 707.02 through 707.07 are 

considered MCCs under the proposed 

MS–DRGs. As discussed earlier, MCCs 

result in even larger payments than CCs. Considerations—Pressure ulcers are 

an important hospital-acquired 

complication. Prevention guidelines 

exist (non-CDC) and can be 

implemented by hospitals. Clinicians 

may state that some pressure ulcers 

present on admission cannot be 

identified (skin is not yet broken (Stage 

I) but damage to tissue is already done 

and skin will eventually break down. 

However, by selecting this condition, 

we would provide hospitals the 

incentive to perform careful 

examination of the skin of patients on 

admission to identify decubitus ulcers. 

If the condition is present on admission, 

the provision will not apply. We are 

proposing to include pressure ulcers as 

one of our initial hospital-acquired 

conditions. This condition can be 

clearly identified through ICD–9–CM 

codes. These codes are classified as a CC 

under the current CMS DRGs and as a 

CC or MCC under the proposed MS– 

DRGs. Pressure ulcers meet the burden 

criteria because they are both high cost 

and high frequency cases. There are 

clear prevention guidelines. While there 

is some question as to whether all cases 

with developing pressure ulcers can be 

identified on admission, we believe the 

selection of this condition will result in 

a closer examination of the patient’s 

skin on admission. This will result in 

better quality of care. We welcome 

comments on the proposed inclusion of 

this condition. 

Serious Preventable Events 

Serious preventable events are events 

that should not occur in health care. 

The injury prevention community has 

developed information on serious 

preventable events. CMS reviewed the 

list of serious preventable events and 

identified those events for which there 

was an ICD–9–CM code that would 

assist in identifying them. We identified 

four types of serious preventable events 

to include in our evaluation. These 

include leaving an object in a patient; 

performing the wrong surgery (surgery 

on the wrong body part, wrong patient, 

or the wrong surgery); air embolism 

following surgery; and providing 

incompatible blood or blood products. 

Three of these serious preventable 

events have unique ICD–9–CM codes to 

identify them. There is not a clear and 

unique code for surgery performed on 

the wrong body part, wrong patient, or 

the wrong surgery. Each of these events 

is discussed separately. 

(c) Serious Preventable Event—Object 

Left in During Surgery 

Coding—Retention of a foreign object 

in a patient after surgery is identified 

through ICD–9–CM code 998.4 (Foreign 

body accidentally left during a 

procedure). 

Burden (High Cost/High Volume)— 

For FY 2006, there were 764 cases 

reported of Medicare patients who had 

an object left in during surgery reported 

as a secondary diagnosis. The average 

charges for the hospital stay were 

$61,962. This is a rare event. Therefore, 

it is not high volume. However, an 

individual case will likely have high 

costs, given that the patient will need 

additional surgery to remove the foreign 

body. Potential adverse events 

stemming from foreign body could 

further raise costs for an individual 

case. 

Prevention guidelines—There are 

widely accepted and clear guidelines for 

the prevention of this event. Prevention 

guidelines for avoiding leaving objects 

in during surgery are located at the 

following Web site: http:// 

www.qualityindicators.ahrq.gov/psi— 

download.htm. This event should not 

occur. 

CC—This code is a CC under the 

current CMS DRGs as well as under the 

proposed MS–DRGs. 

Considerations—There are no 

significant considerations for this 

condition. There is a unique ICD–9–CM 

code and wide agreement on the 

prevention guidelines. We are proposing 

to include this condition as one of our 

initial hospital-acquired conditions. The 

cases can be clearly identified through 

an ICD–9–CM. This code is a CC under 

both the current CMS DRGs and the 

proposed MS–DRGs. There are clear 

prevention guidelines. While the cases 

may not meet the high frequency 

criterion, they do meet the high-cost 

criterion. Individual cases can be high 

cost. We welcome comments on 

including this condition as one of our 

initial hospital-acquired conditions. 

(d) Serious Preventable Event—Air 

Embolism 

Coding—An air embolism is 

identified through ICD–9–CM code 

999.1 (Complications of medical care, 

NOS, air embolism). 

Burden (High Cost/High Volume)— 

This event is rare. For FY 2006, there 

were 45 reported cases of air embolism 

for Medicare patients. The average 

charges for the hospital stay were 

$66,007. 

Prevention guidelines—There are 

clear prevention guidelines for air 

embolisms. This event should not occur. 

Serious preventable event guidelines 

can be found at the following Web site: 

http://www.qualityindicators.ahrq.gov/ 

psi—download.htm. 

CC—This code is a CC under the 

current CMS DRGs and is an MCC under 

the proposed MS–DRGs. 

Considerations—There are no 

significant considerations for this 

condition. There is a unique ICD–9–CM 

code and wide agreement on the 

prevention guidelines. In addition, as 

stated earlier, the condition is a CC 

under the current CMS DRGs and an 

MCC under the proposed MS–DRGs. 

While the condition is rare, it does meet 

the cost burden criterion because 

individual cases can be expensive. 

Therefore, air embolism is a high-cost 

condition because average charges per 

case are high. We welcome comments 

on the proposal to include this 

condition. 

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(e) Serious Preventable Event—Blood 

Incompatibility 

Coding—Delivering ABO-incompatible 

blood or blood products is identified by 

ICM–9–CM code 999.6 (Complications 

of medical care, NOS, ABO 

incompatibility reaction). 

Burden (High Cost/High Volume)— 

This event is rare. Therefore, it is not 

high volume. For FY 2006, there were 

33 reported cases of blood 

incompatibility among Medicare 

patients, with average charges of 

$46,492 for the hospital stay. Therefore, 

individual cases have high costs. 

Prevention guidelines—There are 

prevention guidelines for avoiding the 

delivery of incompatible blood or blood 

products. The event should not occur. 

Serious preventable event guidelines 

can be found at the following Web site: 

http://www.qualityindicators.ahrq.gov/ 

psi—download.htm 

CC—This code is a CC under the 

current CMS DRGs as well as the 

proposed MS–DRGs. 

Considerations—There are no 

significant considerations for this 

condition. There is a unique ICD–9–CM 

code which is classified as a CC under 

the CMS DRGs as well as the proposed 

MS–DRGs. There is wide agreement on 

the prevention guidelines. While this 

may not be a high-volume condition, 

average charges per case are high. 

Therefore, we believe this condition is 

a high-cost condition and, therefore, 

meets our burden criterion. We are 

proposing to include this condition as 

one of our initial hospital-acquired 

conditions. 

(f) Staphylococcus Aureus Bloodstream 

Infection/Septicemia 

Coding—ICD–9–CM Code 038.11 

(Staphylococcus aureus septicemia) 

identifies this condition. However, the 

codes selected to identify septicemia are 

somewhat complex. The following ICD– 

9–CM codes may also be reported to 

identify septicemia: 

<bullet≤ 995.91 (Sepsis) and 995.92 ( 

Severe sepsis). These codes are reported 

as secondary codes and further define 

cases with septicemia. 

<bullet≤ 998.59 (Other postoperative 

infections). This code includes 

septicemia that develops 

postoperatively. 

<bullet≤ 999.3 (Other infection). This 

code includes but is not limited to 

sepsis/septicemia resulting from 

infusion, injection, transfusion, 

vaccination (ventilator-associated 

pneumonia also included here). 

Burden (High Cost/High Volume)— 

CDC reports that there are 290,000 cases 

of staphylococcus aureus infection 

annually in hospitalized patients of 

which approximately 25 percent are 

bloodstream infections or sepsis. For FY 

2006, there were 29,500 cases of 

Medicare patients who had 

staphylococcus aureus infection 

reported as a secondary diagnosis. The 

average charges for the hospital stay 

were $82,678. Inpatient staphylococcus 

aureus result in an estimated 2.7 million 

days in excess length of stay, $9.5 

billion in excess charges, and 

approximately 12,000 inpatient deaths 

per year. 

Prevention guidelines—CDC 

guidelines are located at the following 

Web site: http://www.cdc.gov/ncidod/ 

dhqp/gl—intravascular.html. 

CC—Codes 038.11, 995.91, 998.59, 

and 999.3 are classified as CCs under 

the current CMS DRGs and as MCCs 

under the proposed MS–DRGs. 

Considerations—Preventive health 

care associated bloodstream infections/ 

septicemia that are preventable are 

primarily those that are related to a 

central venous/vascular catheter, a 

surgical procedure (postoperative 

sepsis) or those that are secondary to 

another preventable infection (for 

example, sepsis due to catheterassociated urinary tract infection). 

Otherwise, physicians and other public 

health experts may argue whether 

septicemia is reasonably preventable. 

The septicemia may not be simply a 

hospital-acquired infection. It may 

simply be a progression of an infection 

that occurred prior to admission. 

Furthermore, physicians cannot always 

tell whether the condition was hospitalacquired. We examined whether it 

might be better to limit the septicemia 

cases to a specific organism (for 

example, code 038.11 (Staphylococcus 

aureus septicemia)). CDC staff 

recommended that we focus on 

staphylococcus aureus septicemia 

because this condition is a significant 

public health issue. As stated earlier, 

there is a specific code for 

staphylococcus aureus septicemia, code 

038.11. Therefore, the cases would be 

easy to identify. However, as stated 

earlier, while this type of septicemia is 

identified through code 038.11, coders 

may also provide sepsis code 995.91 or 

995.92 to more fully describe the 

staphylococcus aureus septicemia. 

Codes 995.91 and 995.92 are reported as 

secondary codes and further define 

cases with septicemia. Codes 995.91 and 

995.92 are CCs under the current CMS 

DRGs and MCCs under the proposed 

MS–DRGs. 

<bullet≤ 998.59 (Other postoperative 

infections). This code includes 

septicemia that develops 

postoperatively. 

<bullet≤ 999.3 (Other infection). This 

code includes but is not limited to 

sepsis/septicemia resulting from 

infusion, injection, transfusion, 

vaccination (ventilator-associated 

pneumonia also indexed here). 

To implement this condition as one of 

our initial ones, we would have to 

exclude the specific code for 

staphylococcus aureus septicemia, 

038.11, and the additional septicemia 

codes, 995.91, 995.92, 998.59, and 

999.3. 

We acknowledge that there are 

additional issues involved with the 

selection of this condition that may 

involve developing an exclusion list of 

conditions present on admission for 

which we would not apply a CC 

exclusion to staphylococcus aureus 

septicemia. For example, a patient may 

come into the hospital with a 

staphylococcus aureus infection such as 

pneumonia. The pneumonia might 

develop into staphylococcus aureus 

septicemia during the admission. It may 

be appropriate to consider excluding 

cases such as those of patients admitted 

with staphylococcus aureus pneumonia 

that subsequently develop 

staphylococcus aureus septicemia from 

the provision. In order to exclude cases 

that did not have a staphylococcus 

aureus infection prior to admission, we 

would have to develop a list of specific 

codes that identified all types of 

staphylococcus aureus infections such 

as code 482.41 (Pneumonia due to 

staphylococcus aureus). We likely 

would not apply the new provision to 

cases of staphylococcus aureus 

septicemia if a patient were admitted 

with staphylococcus aureus pneumonia. 

However, if the patient had other types 

of infections, not classified as being 

staphylococcus aureus, and then 

developed staphylococcus aureus 

septicemia during the admission, we 

would apply the provision and exclude 

the staphylococcus aureus septicemia as 

a CC. We were not able to identify any 

other specific ICD–9–CM codes that 

identify specific infections as being due 

to staphylococcus aureus. 

Other types of infections, such as 

urinary tract infections, would require 

the reporting of an additional code, 

041.11 (Staphylococcus aureus), to 

identify the staphylococcus aureus 

infection. This additional coding 

presents administrative issues, because 

it will not always be clear which 

condition code 041.11 (Staphylococcus 

aureus) is describing. We do not believe 

it would be appropriate to make code 

041.11, in combination with other 

codes, subject to the hospital-acquired 

conditions provision until we better 

understand how to address the 

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13 Safdar N.: Clinical and Economic 

Consequences of Ventilator-Associated Pneumonia: 

A Systematic Review, Critical Care Medicine, 2005, 

33(10), pp. 2184–2193. 

administrative issues that would be 

associated with their selection. 

Therefore, we would exclude 

staphylococcus aureus septicemia cases 

with code 482.41 reported as being 

subject to the hospital-acquired 

conditions provision. Stated conversely, 

we would allow staphylococcus aureus 

septicemia to count as a CC if the 

patient was admitted with 

staphylococcus aureus pneumonia. 

We recognize that there may be other 

conditions which we should consider 

for this type of exclusion. We are 

proposing to include staphylococcus 

aureus bloodstream infection/ 

septicemia (code 038.11) as one of our 

initial hospital-acquired conditions. We 

would also exclude codes 995.91, 

998.59, and 999.3 from counting as an 

MCC/CC when they are reported with 

code 038.11. The condition can be 

clearly identified through ICD–9–CM 

codes that are classified as CC under the 

current CMS DRGs and MCCs under the 

proposed MS–DRGs. The condition 

meets our burden criterion by being 

both high cost and high volume. There 

are prevention guidelines which we 

acknowledge are subject to some debate 

among the medical community. We also 

acknowledge that we would have to 

exclude this condition if a patient were 

admitted with a staphylococcus aureus 

infection of a more limited location, 

such as pneumonia. We encourage 

commenters to make suggestions on this 

issue and to recommend any other 

appropriate exclusion for 

staphylococcus aureus septicemia. We 

encourage comments on the 

appropriateness of selecting 

staphylococcus aureus septicemia as 

one of our proposed initial hospitalacquired conditions. 

(g) Ventilator Associated Pneumonia 

(VAP) and Other Types of Pneumonia 

Coding ‘‘ Pneumonia is identified 

through the following codes: 

<bullet≤ 073.0 (Ornithosis with 

pneumonia) 

<bullet≤ 112.4 (Candidiasis of lung) 

<bullet≤ 136.3 (Pneumocystosis) 

<bullet≤ 480.0 (Pneumonia due to 

adenovirus) 

<bullet≤ 480.1 (Pneumonia due to 

respiratory syncytial virus) 

<bullet≤ 480.2 (Pneumonia due to 

parainfluenza virus) 

<bullet≤ 480.3 (Pneumonia due to 

SARS-associated coronavirus) 

<bullet≤ 480.8 (Pneumonia due to 

other virus not elsewhere classified) 

<bullet≤ 480.9 (Viral pneumonia, 

unspecified) 

<bullet≤ 481 (Pneumococcal 

pneumonia [Streptococcus pneumoniae 

pneumonia]) 

<bullet≤ 482.0 (Pneumonia due to 

Klebsiella pneumoniae) 

<bullet≤ 482.1 (Pneumonia due to 

Pseudomonas) 

<bullet≤ 482.2 (Pneumonia due to 

Hemophilus influenzae [H. influenzae]) 

<bullet≤ 482.30 (Pneumonia due to 

Streptococcus, unspecified) 

<bullet≤ 482.31 (Pneumonia due to 

Streptococcus, Group A) 

<bullet≤ 482.32 (Pneumonia due to 

Streptococcus, Group B) 

<bullet≤ 482.39 (Pneumonia due to 

other Streptococcus) 

<bullet≤ 482.40 (Pneumonia due to 

Staphylococcus, unspecified) 

<bullet≤ 482.41 (Pneumonia due to 

Staphylococcus aureus) 

<bullet≤ 482.49 (Other 

Staphylococcus pneumonia) 

<bullet≤ 482.81 (Pneumonia due to 

Anaerobes) 

<bullet≤ 482.82 (Pneumonia due to 

Escherichia coli [E. coli]) 

<bullet≤ 482.83 (Pneumonia due to 

other gram-negative bacteria) 

<bullet≤ 482.84 (Pneumonia due to 

Legionnaires’ disease) 

<bullet≤ 482.89 (Pneumonia due to 

other specified bacteria) 

<bullet≤ 482.9 (Bacterial pneumonia 

unspecified) 

<bullet≤ 483.0 (Pneumonia due to 

Mycoplasma pneumoniae) 

There is not a unique code that 

identifies ventilator associated 

pneumonia. The creation of a code for 

ventilator associated pneumonia was 

discussed at the September 29, 2006 

meeting of the ICD–9–CM Coordination 

and Maintenance Committee meeting. 

Many issues and concerns were raised 

at the meeting concerning the creation 

of this proposed new code. It has been 

difficult to define ventilator-associated 

pneumonia. We plan to continue 

working closely with the CDC to 

develop a code that can accurately 

describe this condition for 

implementation in FY 2009. CDC will 

address the creation of a unique code for 

this condition at the September 28–29, 

2007 ICD–9–CM Coordination and 

Maintenance Committee meeting. 

While we list 27 pneumonia codes 

above, our clinical advisors do not 

believe that all of the codes mentioned 

could possibly be associated with 

ventilator-associated pneumonia. Our 

clinical advisors specifically question 

whether the following codes would ever 

represent cases of ventilator-associated 

pneumonia: 073.0, 480.0, 480.1, 480.2, 

480.3, 480.8, 480.9, and 483.0. 

Therefore, we have a range of 

pneumonia codes, all of which may not 

represent cases that could involve 

ventilator-associated pneumonia. In 

addition, we do not have a specific code 

that uniquely identifies cases of 

ventilator-associated pneumonia. 

Burden (High Cost/High Volume)— 

CDC reports that there are 250,205 

ventilator-associated pneumonias per 

year. Because there is not a unique ICD– 

9–CM code for ventilator-associated 

pneumonia, there is not accurate data 

for FY 2006 on the number of Medicare 

patients who had this condition as a 

secondary diagnosis. However, we did 

examine data for FY 2006 on the 

number of Medicare patients who listed 

pneumonia as a secondary diagnosis. 

There were 92,586 cases with a 

secondary diagnosis of pneumonia, with 

average charges of $88,781. According 

to the journal Critical Care Medicine, 

patients with ventilator-associated 

pneumonia have statistically 

significantly longer intensive care 

lengths of stay (mean = 6.10 days) than 

those who do not (mean = 5.32–6.87 

days). In addition, patients who develop 

ventilator-associated pneumonia incur, 

on average, greater than or equal to 

$10,019 in additional hospital costs 

compared to those who do not.13

Therefore, we believe that this is a highvolume condition. 

Prevention guidelines—Prevention 

guidelines are located at the following 

Web site: http://www.cdc.gov/ncidod/ 

dhqp/ gl—hcpneumonia.html. However, 

it is not clear how effective these 

guidelines are in preventing pneumonia. 

Ventilator-associated pneumonia may 

be particularly difficult to prevent. 

CC—All of the pneumonia codes 

listed above are CCs under the current 

CMS DRGs and under the proposed 

MS–DRGs, except for the following 

pneumonia codes which are non-CCs: 

073.0, 480.0, 480.1, 480.2, 480.3, 480.8, 

480.9, 483.0. However, as mentioned 

earlier, there is not a unique ICD–9–CM 

code for ventilator-associated 

pneumonia. Therefore, this condition 

does not currently meet the statutory 

criteria for being selected. 

Considerations—Hospital-acquired 

pneumonias, and specifically ventilator 

associated pneumonias, are an 

important problem. However, based on 

our work with the medical community 

to develop specific codes for this 

condition, we have learned that it is 

difficult to define what constitutes 

ventilator associated pneumonia. 

Although prevention guidelines exist, it 

is not clear how effective these are in 

preventing pneumonia. Clinicians 

cannot always tell which pneumonias 

are acquired in a hospital. In addition, 

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as mentioned above, there is not a 

unique code that identifies ventilatorassociated pneumonia. There are a 

number of codes that capture a range of 

pneumonia cases. It is not possible to 

specifically identify if these pneumonia 

cases are ventilator-associated or arose 

from other sources. Because we cannot 

identify cases with ventilator-associated 

pneumonia and there are questions 

about its preventability, we are not 

proposing to select this condition as one 

of our initial hospital-acquired 

conditions. However, we welcome 

public comments on how to create an 

ICD–9–CM code that identifies 

ventilator-associated pneumonia, and 

we encourage participation in our 

September 28–29, 2007 ICD–9–CM 

Coordination and Maintenance 

Committee meeting where this issue 

will be discussed. We will reevaluate 

the selection of this condition in FY 

2009. 

(h) Vascular Catheter-Associated 

Infections 

Coding—The code used to identify 

vascular catheter associated infections is 

ICD–9–CM code 996.62 (Infection due to 

other vascular device, implant, and 

graft). This code includes infections 

associated with all vascular devices, 

implants, and grafts. It does not 

uniquely identify a vascular catheter 

associated infections. Therefore, there is 

not a unique ICD–9–CM code for this 

infection. CDC and CMS staff requested 

that the ICD–9–CM Coordination and 

Maintenance Committee discuss the 

creation of a unique ICD–9–CM code for 

vascular catheter associated infections 

because the issue is important for public 

health. The proposal to create a new 

ICD–9–CM was discussed at the March 

22–23, 2007 meeting of the ICD–9–CM 

Coordination and Maintenance 

Committee. A summary of this meeting 

can be found at: http://www.cdc.gov/ 

nchs/icd9.htm. Coders would also 

assign an additional code for the 

infection such as septicemia. Therefore, 

a list of specific infection codes would 

have to be developed to go along with 

code 996.62. If the vascular catheter 

associated infection was hospitalacquired, the DRG logic would have to 

be modified so that neither the code for 

the vascular catheter associated 

infection along with the specific 

infection code would count as a CC. 

Burden (High Cost/High Volume)— 

CDC reports that there are 248,678 

central line associated bloodstream 

infections per year. It appears to be both 

high cost and high volume. However, 

we were not able to identify Medicare 

data on these cases because there is no 

existing unique ICD–9–CM code. 

Prevention guidelines—CDC 

guidelines are located at the following 

Web site: http://www.cdc.gov/ncidod/ 

dhqp/gl—intravascular.html. 

CC—Code 996.62 is a CC under the 

current CMS DRGs and the proposed 

MS–DRGs. However, as stated earlier, 

this code is broader than vascular 

catheter-associated infections. 

Therefore, there is not a unique ICD–9– 

CM code to identify the condition at this 

time, and it does not currently meet the 

statutory criteria to be selected. 

However, as indicated above, we will be 

creating a code(s) to identify this 

condition and may select it as a 

condition under the provision beginning 

in FY 2009. 

Considerations—There is not yet a 

unique ICD–9–CM code to capture this 

condition. If one is implemented on 

October 1, 2007, we would be able to 

specifically identify these cases. Some 

patients require long-term indwelling 

catheters, which are more prone to 

infections. Ideally catheters should be 

changed at certain time intervals. 

However, circumstances might prevent 

such practice (for example, the patient 

has a bleeding diathesis). In addition, a 

patient may acquire an infection from 

another source which can colonize the 

catheter. As mentioned earlier, coders 

would also assign an additional code for 

the infection, such as septicemia. 

Therefore, a list of specific infection 

codes would have to be developed to go 

along with code 996.62. If the vascular 

catheter-associated infection was 

hospital-acquired, the DRG logic would 

have to be modified so that neither the 

code for the vascular catheter-associated 

infection along with the specific 

infection code would count as a CC. 

Without a specific code for infections 

due to a catheter, it would be difficult 

to identify these patients. Given the 

current lack of an ICD–9–CM code for 

this condition, we are not proposing to 

include it as one of our initial hospitalacquired conditions at this time. 

However, we believe it shows merit for 

inclusion in future lists of hospitalacquired conditions once we have 

resolved the coding issues and are able 

to better identify the condition in the 

Medicare data. We will reevaluate the 

selection of this condition in FY 2009. 

We encourage comments on this 

condition which was identified as an 

important public health issue by several 

organizations that provided 

recommendations on hospital-acquired 

conditions. We are particularly 

interested in receiving comments on 

how we should handle additional 

associated infections that might develop 

along with the vascular catheterassociated infection. 

(i) Clostridium Difficile-Associated 

Disease (CDAD) 

Coding—This condition is identified 

by ICD–9–CM code 008.45 (Clostridium 

difficile). 

Burden (High Cost/High Volume)— 

CDC reports that there are 178,000 cases 

per year in U.S. hospitals. For FY 2006, 

there were 110,761 reported cases of 

Medicare patients with CDAD as a 

secondary diagnosis, with average 

charges for the hospital stay of $52,464. 

Therefore, this is a high-volume 

condition. 

Prevention guidelines—Prevention 

guidelines are not available. Therefore, 

we do not believe this condition can 

reasonably be prevented through the 

application of evidence-based 

guidelines. 

CC—Code 008.45 is a CC under the 

current CMS DRGs and the proposed 

MS–DRGs. 

Considerations—CDAD is an 

emerging problem with significant 

public health importance. If found early 

CDAD cases can easily be treated. 

However, cases not diagnosed early can 

be expensive and difficult to treat. 

CDAD occurs in patients on a variety of 

antibiotic regiments, many of which are 

unavoidable, and therefore 

preventability is an issue. We are not 

proposing to include CDAD as one of 

our initial hospital-acquired conditions 

at this time, given the lack of prevention 

guidelines. We welcome public 

comments on CDAD, specifically on its 

preventability and whether there is 

potential to develop guidelines to 

identify it early in the disease process 

and/or diminish its incidence. We will 

reevaluate the selection of this 

condition in FY 2009. 

(j) Methicillin-Resistant Staphylococcus 

Aureus (MRSA) 

Coding—MRSA is identified by ICD– 

9–CM code V09.0 (Infection with 

microorganisms resistant to penicillins). 

One would also assign a code(s) to 

describe the exact nature of the 

infection. 

Burden (High Cost/High Volume)— 

For FY 2006, there were 95,103 reported 

cases of Medicare patients who had 

MRSA as a secondary diagnosis. The 

average charges for these cases were 

$31,088. This condition is a high-cost 

and high-volume infection. MRSA has 

become a very common bacteria 

occurring both in and outside of the 

hospital environment. 

Prevention guidelines—CDC 

guidelines are located at the following 

Web site: http://www.cdc.gov/ncidod/ 

dhqp/pdf/ar/mdroGuideline2006.pdf. 

CC—Code V09.0 is not a CC under the 

current CMS DRGs and the proposed 

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MS–DRGs. The specific infection would 

be identified in a code describing the 

exact nature of the infection, which may 

be a CC. 

Considerations—As stated earlier, 

preventability may be hard to ascertain 

since the bacteria has become so 

common both inside and outside the 

hospital. There are also considerations 

in identifying MRSA infections because 

hospitals would report the code for 

MRSA along with additional codes that 

would describe the exact nature of the 

infection. We would have to develop a 

list of specific infections that could be 

the result of MRSA. We are not 

proposing to include MRSA as one of 

our initial hospital-acquired conditions 

because the condition is not a CC. We 

recognize that associated conditions 

may be a CC. We welcome comments on 

the proposal not to include this 

condition. Should there be support for 

including this condition, we request 

recommendations on what codes might 

be selected to identify the specific types 

of infections associated with MRSA. 

(k) Surgical Site Infections 

Coding—Surgical site infections are 

identified by ICD–9–CM code 998.59 

(Other postoperative infection). The 

code does not tell the exact location or 

nature of the postoperative wound 

infection. The code includes wound 

infections and additional types of 

postoperative infections such as 

septicemia. The coding guidelines 

instruct the coder to add an additional 

code to identify the type of infection. To 

implement this condition we would 

have to remove both code 998.59 and 

the specific infection from counting as 

a CC if they occurred after the 

admission. We would have to develop 

an extensive list of possible infections 

that would be subject to the provision. 

We may also need to recommend the 

creation of a series of new ICD–9–CM 

codes to identify various types of 

surgical site infections, should this 

condition merit inclusion among those 

that are subject to the proposed 

hospital-acquired conditions provision. 

Burden (High Cost/High Volume)— 

CDC reports that there are 290,485 

surgical sites infections each year. As 

stated earlier, there is not a unique code 

for surgical site infection. Therefore, we 

examined Medicare data on patients 

with any type of postoperative infection. 

For FY 2006, there were 38,763 reported 

cases of Medicare patients who had a 

postoperative infection. These patients 

had average charges for the hospital stay 

of $79,504. We are unable to determine 

how many of these patients had surgical 

site infections. 

Prevention guidelines—CDC 

guidelines are available at the following 

Web site: http://www.cdc.gov/ncidod/ 

dhqp/gl—surgicalsite.html 

CC—Code 998.59 is a CC under the 

current CMS DRGs and the proposed 

MS–DRGs. 

Considerations—As mentioned 

earlier, code 998.59 is not exclusive to 

surgical site infections. It includes other 

types of postoperative infections. 

Therefore, code 998.59 does not 

currently meet the statutory criteria for 

being subject to the provision because it 

does not uniquely identify surgical site 

infections. To identify surgical site 

infections, we would need new codes 

that provide more detail about the type 

of postoperative infection as well as the 

site of the infection. In addition, one 

would report both code 998.59 as well 

a more specific code for the specific 

type of infection, making 

implementation difficult. While there 

are prevention guidelines, it is not 

always possible to identify the specific 

types of surgical infections that are 

preventable. Therefore, we are not 

proposing to select surgical site 

infections as one of our proposed 

hospital-acquired conditions at this 

time. However, we welcome public 

comments on whether we can develop 

criteria and codes to identify 

preventable surgical site infections that 

would assist us in reducing their 

incidence. We are exploring ways to 

identify surgical site infections and will 

reevaluate this condition in FY 2009. 

(l) Serious Preventable Event—Surgery 

on Wrong Body Part, Patient, or Wrong 

Surgery 

Coding—Surgery performed on the 

wrong body part, wrong patient, or the 

wrong surgery would be identified by 

ICD–9–CM code E876.5 (Performance of 

inappropriate operation). This diagnosis 

code does not specifically identify 

which of these events has occurred. 

Burden (High Cost/High Volume)—As 

stated earlier, there are not unique ICD– 

9–CM codes which capture surgery 

performed on the wrong body part or 

the wrong patient, or the wrong surgery. 

Therefore, we examined Medicare data 

on the code for performance of an 

inappropriate operation. For FY 2006, 

there was one Medicare case reported 

with this code, and the patient had 

average charges for the hospital stay of 

$24,962. This event is rare. Therefore, it 

is not high volume. Individual cases 

could have high costs. However, we 

were unable to determine the impact 

with our limited data. 

Prevention guidelines—There are 

prevention guidelines for performing 

the correct surgery on the correct patient 

or correct patient’s body part. This event 

should not occur. 

CC—This code is not a CC under the 

current CMS DRGs and the proposed 

MS–DRGs. Therefore, it does not meet 

the criteria for selection under section 

1886(d)(4)(D)(iv) of the Act. However, 

Medicare does not pay for performing 

surgery on the wrong body part or 

patient, or performing the wrong 

surgery. These services are not 

considered to be reasonable and 

necessary and are excluded from 

Medicare coverage. 

Considerations—There are significant 

considerations for the selection of this 

condition. There is not a unique ICD–9– 

CM code that would describe the nature 

of the inappropriate operation. All types 

of inappropriate operations are included 

in code E876.5. Unlike other conditions, 

performance of an inappropriate 

operation is not a complication of a 

prior medical event that was medically 

necessary. Rather, in this case, there was 

a needed intervention but it was done 

to either the wrong body part or the 

wrong patient, or was not the correct 

operation. Thus, a service was 

completed that was not reasonable and 

necessary and Medicare does not pay for 

any inpatient service associated with 

the wrong surgery. It is not necessary for 

us to select this condition because 

Medicare does not pay for it under any 

circumstances. 

(m) Falls 

Coding—There is no single code that 

shows that a patient has suffered a fall 

in the hospital. Codes would be 

assigned to identify the nature of any 

resulting injury from the fall such as a 

fracture, contusion, concussion, etc. 

There is a code to indicate that a patient 

fell from bed, code E884.4 (Fall from 

bed). One would then assign a code that 

identifies the external cause of the 

injury (the fall from the bed) and an 

additional code(s) for any resulting 

injury (a fractured bone). 

Burden (High Cost/High Volume)—As 

stated earlier, there is not a code to 

capture all types of falls. Therefore, we 

examined Medicare data on the number 

of Medicare beneficiaries who fell out of 

bed. For FY 2006, there were 2,591 

cases reported of Medicare patients who 

fell out of bed. These patients had 

average charges of the hospital stay of 

$24,962. However, depending on the 

nature of the injury, costs may vary in 

specific cases. 

Prevention guidelines—Falls may or 

may not be preventable. Serious 

preventable event guidelines can be 

found at the following Web site: http:// 

www.qualityindicators.ahrq.gov/psi— 

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CC—Code E884.4 is not a CC under 

the current CMS DRGs or the proposed 

MS–DRGs. 

Considerations—There are not clear 

codes that identify all types of falls. 

Hospitals would also have to use 

additional codes for fractures and other 

injuries that result from the fall. In 

addition, depending on the 

circumstances, the falls may or may not 

be preventable. We are not proposing 

the inclusion of falls as one of our initial 

hospital-acquired conditions at this time 

because we can only identify a limited 

number of these cases, and they are not 

classified as a CC. However, we 

welcome public comments on how to 

develop codes or coding logic that 

would allow us to identify injuries that 

result from falls in the hospital so that 

Medicare would not recognize the 

higher costs associated with treating 

patients who acquire these conditions in 

the hospital. We will reevaluate this 

condition in FY 2009. 

The following table summarizes 

whether or not the potential conditions 

meet our criteria and if there are 

significant considerations with selecting 

the particular condition. As mentioned 

earlier, we have listed these conditions 

in the priority order according to how 

well they meet the statutory criteria. As 

discussed earlier, we are proposing to 

select the first six conditions (catheter 

associated urinary tract infections 

through Staphylococcus aureus 

septicemia) as our initial hospitalacquired conditions. We would not 

include the last seven conditions 

(ventilator-associated pneumonia 

through falls) as initial hospitalacquired conditions. We welcome 

comments on how appropriately we 

have evaluated and proposed the 

selection of the first six conditions. We 

also encourage specific comments on 

any additional conditions we should 

select for October 1, 2008 

implementation. We request 

commenters to include a rationale for 

selecting any suggested additional 

conditions, as well as an analysis of 

why each suggested additional 

condition meets the criteria under 

section 1886(d)(4)(D)(iv) of the Act and 

whether there would be coding issues or 

other considerations associated with 

selecting each condition. 

PROPOSED HOSPITAL-ACQUIRED CONDITIONS AND CRITERIA

Proposed hospital-acquired condition Coding—unique 

code? 

Burden—high cost 

and/or high volume? 

Prevention guidelines? CC? Considerations? 

1. Catheter associated urinary tract 

infections.

Yes ...................... Yes ...................... Yes ...................... Yes ...................... Minimal—additional 

infection codes. 

2. Pressure ulcers (Decubitus ulcers) Yes ...................... Yes ...................... Yes ...................... Yes ...................... No. 

3. Serious preventable event—Object 

left in surgery.

Yes ...................... Yes—high cost in 

specific circumstances.

Yes ...................... Yes ...................... No. 

4. Serious preventable event—air 

embolism.

Yes ...................... Yes—high cost in 

specific circumstances.

Yes ...................... Yes ...................... No . 

5. Serious preventable event—Blood 

incompatibility.

Yes ...................... Yes—high cost in 

specific circumstances.

Yes ...................... Yes ...................... No. 

6. Staphylococcus aureus septicemia Yes—multiple 

codes reported.

Yes ...................... Yes ...................... Yes ...................... Multiple codes. 

7. Ventilator associated pneumonia 

(VAP)/Pneumonia/.

No VAP code, 

multiple pneumonia codes.

Yes ...................... Yes ...................... No—no unique 

codes.

Preventability 

issues. VAPs— 

identification 

issues. 

8. Vascular catheter associated infections.No ........................ Yes ...................... Yes ...................... Yes—but code is 

too broad.

Preventability 

issues. 

9. Clostridium difficile-associated disease (CDAD).Yes ...................... Yes ...................... No ........................ Yes ...................... Preventability 

issues. 

10. Methicillin-resistant staphylococcus aureus (MRSA).Yes ...................... Yes ...................... Yes ...................... No ........................ Preventability 

issues. 

11. Surgical site infections ................ No ........................ Yes ...................... Yes ...................... Yes—but code is 

too broad.

Cannot identify. 

12. Serious preventable event— 

Wrong surgery.

Yes ...................... Yes—high cost in 

specific circumstances.

Yes ...................... No ........................ Not a CC. 

13. Falls ............................................. No—not for all 

types of falls.

Yes—high cost in 

specific circumstances.

No—for all types 

of falls.

No ........................ Cannot identify. 

As stated earlier, we are soliciting 

comments on the six conditions we 

proposed to include among the initial 

hospital-acquired conditions. We 

welcome any comments on the clinical 

aspects of the conditions and on which 

conditions should be selected for 

implementation on October 1, 2008. We 

also solicit comments on any 

problematic issues for specific 

conditions that may support not 

selecting them as one of the initial 

conditions. We encourage comments on 

how some of the administrative 

problems can be overcome if there is 

support for a particular condition. 

7. Other Issues 

Under section 1886(d)(4)(D)(vi) of the 

Act, ‘‘[a]ny change resulting from the 

application of this subparagraph shall 

not be taken into account in adjusting 

the weighting factors under 

subparagraph (C)(i) or in applying 

budget neutrality under subparagraph 

(C)(iii).’’ Subparagraph (C)(i) refers to 

DRG classifications and relative 

weights. Therefore, the statute requires 

the Secretary to continue counting the 

conditions selected under section 

5001(c) of the DRA as MCCs or CCs 

when updating the relative weights 

annually. Thus, the higher costs 

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associated with a case with a hospitalacquired MCC or CC will continue to be 

assigned to the MCC or CC DRG when 

calculating the relative weight but 

payment will not be made to the 

hospital at one of these higher-paying 

DRGs. Further, subparagraph (C)(iii) 

refers to the budget neutrality 

calculations that are done so aggregate 

payments do not increase as a result of 

changes to DRG classifications and 

relative weights. Again, the higher costs 

associated with the cases that have a 

hospital-acquired MCC or CC will be 

included in the budget neutrality 

calculation but Medicare will make a 

lower payment to the hospital for the 

specific case that include an MCC or CC. 

Thus, to the extent that the provision 

applies and cases with an MCC or CC 

are assigned to a lower-paying DRG, 

section 5001(c) of the DRA will result in 

cost savings to the Medicare program. 

We note that the provision will only 

apply when the selected conditions are 

the only MCCs and CCs present on the 

claim. Therefore, if a nonselected MCC 

or CC is on the claim, the case will 

continue to be assigned to the higher 

paying MCC or CC DRG, and there will 

be no savings to Medicare from the case. 

We believe the provision will apply in 

a small minority of cases because it is 

rare that one of the selected conditions 

will be the only MCC or CC present on 

the claim. We provide our estimate of 

the savings associated with this 

provision in the impact section of this 

proposed rule. 

G. Proposed Changes to Specific DRG 

Classifications 

1. Pre-MDC: Intestinal Transplantation 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Intestinal 

Transplantation’’ at the beginning of 

your comment.) 

In the FY 2005 IPPS final rule (69 FR 

48976), we reassigned intestinal 

transplant cases from CMS DRG 148 

(Major Small and Large Bowel 

Procedures with CC) and CMS DRG 149 

(Major Small and Large Bowel 

Procedures without CC) to CMS DRG 

480 (Liver Transplant and/or Intestinal 

Transplantation). In the FY 2006 IPPS 

final rule (70 FR 47286), we continued 

to evaluate these cases to see if a further 

DRG change was warranted. While we 

found that intestinal only transplants 

and combination liver-intestine 

transplants have higher average charges 

than other cases in CMS DRG 480, these 

cases are extremely rare (there were 

only 4 cases in FY 2004) and the 

insufficient number of cases does not 

warrant creating a separate DRG. 

For FY 2008, we examined the 

September 2006 update of the FY 2006 

MedPAR file and found 1,208 cases 

assigned to CMS DRG 480. In the 

proposed MS–DRGs described in 

section II.C. of the preamble of this 

proposed rule, we are proposing to split 

CMS DRG 480 into two severity levels: 

proposed MS–DRG 005 (Liver 

Transplant and/or Intestinal Transplant 

with MCC) and proposed MS–DRG 006 

(Liver Transplant and/or Intestinal 

Transplant without MCC). The 

following table displays our results: 

ROPOSED MS–DRG 

Proposed MS–DRG Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 006—All cases .............................................................................................................................. 446 10.05 $129,519 

MS–DRG 006—Intestinal transplant cases only ........................................................................................... 3 34 354,793 

MS–DRG 005—All cases .............................................................................................................................. 762 22.25 243,271 

MS–DRG 005—Intestinal transplant cases only ........................................................................................... 9 40.22 460,089 

MS–DRG 005—Intestinal and liver transplant .............................................................................................. 1 56 1,179,425 

Under the proposed MS–DRGs, 10 of 

13 intestinal transplant cases are 

assigned to proposed MS–DRG 005 

based on the secondary diagnosis of the 

patient. The three remaining intestinal 

transplant cases do not have an MCC 

and would have been assigned to 

proposed MS–DRG 006, absent further 

changes to the DRG logic. These three 

intestinal transplants have average 

charges of approximately $354,793 and 

an average length of stay of 34 days. 

Average charges and length of stay for 

these three cases are more comparable 

to the average charges of approximately 

$243,271 and average length of stay of 

40.22 days for all cases assigned to 

proposed MS–DRG 005. For this reason, 

we are proposing to move all intestinal 

transplant cases to proposed MS–DRG 

005. As part of this proposal, we would 

redefine proposed MS–DRG 005 as 

‘‘Liver Transplant with MCC or 

Intestinal Transplant.’’ The presence of 

a liver transplant with MCC or an 

intestinal transplant would assign a case 

to the higher severity level. Proposed 

MS–DRG would also be redefined as 

‘‘Liver Transplant without MCC.’’ 

2. MDC 1 (Diseases and Disorders of the 

Nervous System) 

a. Implantable Neurostimulators 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Neurostimulators’’ at 

the beginning of your comment.) 

We received a joint request from three 

manufacturers to review the DRG 

assignment for cases involving 

neurostimulators. The commenters are 

concerned that: 

<bullet≤ Neurostimulator cases may 

be assigned to 30 different DRGs in 12 

different MDCs depending upon the 

patient’s principal diagnosis. 

<bullet≤ Neurostimulator cases 

represent a small proportion of the total 

cases in their assigned DRG and have 

higher costs. 

<bullet≤ The 11 new ICD–9–CM codes 

created beginning in FY 2007 that 

identify pain are assigned to MDC 23 

(Factors Influencing Health Status and 

Other Contacts With Health Services) 

rather than MDC 1 (Diseases and 

Disorders of the Nervous System). The 

commenters are concerned that these 

pain codes will be a common principal 

diagnosis for patients who receive a 

neurostimulator and will be assigned to 

MDC 23, which contains a wide variety 

of dissimilar diagnoses. The new ICD– 

9–CM codes are: 338.0 (Central pain 

syndrome), 338.11 (Acute pain due to 

trauma), 338.12 (Acute postthoracotomy pain), 338.18 (Other acute 

postoperative pain), 338.19 (Other acute 

pain), 338.21 (Chronic pain due to 

trauma), 338.22 (Chronic postthoracotomy pain), 338.28 (Other 

chronic postoperative pain), 338.29 

(Other chronic pain), 338.3 (Neoplasm 

related pain (acute)(chronic)), and 338.4 

(Chronic pain syndrome) 

The commenters recommended that 

we: 

<bullet≤ Reroute all spinal and 

peripheral neurostimulator cases into a 

common set of base DRGs. 

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<bullet≤ Reclassify ICD–9–CM pain 

codes 338.0 through 338.4 currently 

assigned to MDC 23 into MDC 1 when 

reported as principal diagnosis. 

<bullet≤ Revise surgical CMS DRGs in 

MDC 1 based on whether the patient 

received a major device. 

<bullet≤ Split the single surgical CMS 

DRG in MDC 19 (Mental Diseases and 

Disorders) and MDC 23 into two CMS 

DRGs: one CMS DRG for minor 

procedures as defined by CMS DRGs 

477 (Non-Extensive O.R. Procedure 

Unrelated to Principal Diagnosis) and 

CMS DRG 468 (Extensive O.R. 

Procedure Unrelated to Principal 

Diagnosis) and one CMS DRG for major 

procedures. 

<bullet≤ Create a new CMS DRG in 

MDC 1 for major devices. 

The commenters recognize that 

implementing a re-routing feature in the 

CMS DRG system would be a major 

undertaking and, alternatively, 

suggested reassigning the pain codes to 

MDC 1 as an interim step. We agree 

with this suggestion as described further 

below. With respect to the suggestion to 

split the single surgical CMS DRG in 

MDCs 19 and 23 into two CMS DRGs 

and create a major device CMS DRG 

within MDC 1, we encourage the 

commenters to examine the assignment 

of neurostimulator cases under the MS– 

DRGs to determine whether the changes 

we are proposing to adopt to better 

recognize severity in the CMS DRG 

system would address these concerns. 

The implantation of a neurostimulator 

requires two types of procedures. First, 

the surgeons implant leads containing 

electrodes into the targeted section of 

the brain, spine, or peripheral nervous 

system. Second, a neurostimulator pulse 

generator is implanted into the pectoral 

region and extensions from the 

neurostimulator pulse generator are 

tunneled under the skin and connected 

with the proximal ends of the leads. 

Hospitals stage the two procedures 

required for a full system 

neurostimulator implant. 

There are separate ICD–9–CM 

procedure codes that identify the 

implant of the leads and the insertion of 

the pulse generator. The three codes for 

the leads insertion are: 02.93 

(Implantation or replacement of 

intracranial neurostimulator lead(s)); 

03.93 (Implantation or replacement of 

spinal neurostimulator lead(s)); and 

code 04.92 (Implantation or replacement 

of peripheral neurostimulator lead(s). 

The five codes for the insertion of the 

pulse generator are: 86.94 (Insertion or 

replacement of single array 

neurostimulator pulse generator, not 

specified as rechargeable); 86.95 

(Insertion or replacement of dual array 

neurostimulator pulse generator, not 

specified as rechargeable); 86.96 

(Insertion or replacement of other 

neurostimulator pulse generator); 86.97 

(Insertion or replacement of single array 

rechargeable neurostimulator pulse 

generator); and 86.98 (Insertion or 

replacement of dual array rechargeable 

neurostimulator pulse generator). 

The patient’s principal diagnosis 

determines the MDC assignment. 

Implant of a cranial, spinal or peripheral 

neurostimulator will result in 

assignment of the case to a surgical DRG 

within that MDC. Although the 

commenters are correct that 

neurostimulator cases can potentially be 

assigned to many different CMS DRGs 

based on the patient’s principal 

diagnosis, they also provided data that 

showed that nearly 90 percent are 

assigned to 6 different CMS DRGs that 

cross two MDCs. In MDC 1, 

neurostimulator cases are assigned to 

four CMS DRGs: CMS DRG 7 (Peripheral 

and Cranial Nerve and Other Nervous 

System Procedures With CC); CMS DRG 

8 (Peripheral and Cranial Nerve and 

Other Nervous System Procedures 

Without CC); CMS DRG 531 (Spinal 

Procedures With CC); and CMS DRG 

532 (Spinal Procedures Without CC). In 

MDC 8 (Disease and Disorders of the 

Musculoskeletal System and Connective 

Tissue), neurostimulator cases are 

assigned to two CMS DRGs: CMS DRG 

499 (Back and Neck Procedures Except 

Spinal Fusion With CC); and CMS DRG 

500 (Back and Neck Procedures Except 

Spinal Fusion Without CC). 

With very limited exceptions, such as 

tracheostomies and certain types of 

transplants, the principal diagnosis is 

fundamental to the assignment of a case 

to an MDC within the DRG system. By 

relying on the patient’s principal 

diagnosis, the DRG system will group 

together patients who are clinically 

similar. For this reason, we are 

concerned about adopting the 

suggestion that all neurostimulator cases 

be rerouted to a common DRG 

irrespective of the patient’s principal 

diagnosis. We believe such a step would 

be fundamentally inconsistent with the 

idea of creating common groups of 

patients who are clinically similar based 

on diagnosis and procedures. For this 

reason, we do not believe that a 

rerouting step should be adopted that 

would group together all 

neurostimulator cases. 

However, we do agree with the 

commenters’ suggestion that the new 

ICD–9–CM codes created in FY 2007 for 

central and chronic pain syndrome and 

chronic pain (codes 338.0, 338.21 

through 338.29, and 338.4) should be 

assigned to MDC 1 when present as the 

principal diagnosis. The commenters 

requested that we reclassify the pain 

codes (338.0 through 338.4) from MDC 

23 to MDC 1. Our medical consultants 

advised that the acute pain codes (codes 

338.11 through 338.19) should remain 

in MDC 23 because the acute pain is not 

a neurological condition. According to 

the commenters, the National Center for 

Health Statistics’ (NCHS) choice in 

locating the pain codes within ICD–9– 

CM’s Nervous System chapter has much 

clinical validity, particularly for chronic 

pain. The commenters further noted that 

acute pain is typically self-limited, a 

symptomatic response to an immediate 

insult that serves the body as a warning 

sign. However, chronic pain is 

unrelenting and serves no warning or 

protective function. It is a disease 

process of its own accord, according to 

the commenters. 

The commenters described pain as 

follows. Broadly, there are two main 

categories of pain: nociceptive and 

neuropathic. Nociceptive pain is caused 

by sensory neurons, called nociceptors, 

responding to tissue damage. This type 

of pain is the body’s normal response to 

injury. The pain is usually localized and 

time-limited. That is, when the tissue 

damage heals, the pain typically 

resolves. Acute pain is typically 

nociceptive. In general, nociceptive pain 

is typically treated with antiinflammatories and, in more severe 

cases, with opioids via a morphine 

pump for example. 

In contrast, neuropathic pain is 

caused by malfunctioning or 

pathologically altered nervous pathways 

stemming from injury to the nervous 

system, either as a direct result of 

trauma to a nerve (phantom limb 

syndrome, reflex sympathetic 

dystrophy/complex regional pain 

syndrome after injury) or due to other 

medical conditions that cause damage to 

the nerve such as herpes (postherpetic 

neuralgia), diabetes (diabetic 

neuropathy), and peripheral vascular 

disease (critical limb ischemia). Failed 

back surgery syndrome (FBSS) is 

another common source of neuropathic 

pain. Typically, neuropathic pain is 

chronic and may persist for months or 

years beyond the healing of damaged 

tissue. Because the nerves themselves 

have been damaged, neuropathic pain 

can be considered its own disease 

process. Neuropathic pain may be more 

difficult to treat than nociceptive pain 

and has been shown to be more 

responsive to neurostimulation. 

The pain codes, created effective 

October 1, 2006, are currently assigned 

to MDC 23. The neurostimulator cases 

with a principal diagnosis using the 

pain codes were assigned to CMS DRG 

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461 (O.R. Procedure With Diagnoses of 

Other Contact With Health Services) for 

the first time in FY 2007. As explained 

above, prior to our adoption of the new 

pain codes in FY 2007, these cases had 

historically been assigned to CMS DRGs 

7 and 8 (Peripheral and Cranial Nerve 

and Other Nervous System Procedure 

With and Without CC, respectively) tin 

MDC 1. Adopting the commenters’ 

recommendation would result in the 

neurostimulator cases being assigned to 

their historic CMS DRGs. 

Our medical officers agree that cases 

that use the new pain diagnosis codes 

for central and chronic pain syndrome 

and chronic pain (codes 338.0, 338.21 

through 338.29, and 338.4) as a 

principal diagnosis should be assigned 

to MDC 1. For this reason, we are 

proposing to assign cases with a 

principal diagnosis of central pain 

syndrome (code 338.0), chronic pain 

due to trauma (code 338.21), chronic 

post-thoracotomy pain (code 338.22), 

other chronic postoperative pain (code 

338.28), other chronic pain (code 

338.29), or chronic pain syndrome (code 

338.4) to MDC 1, although we plan to 

monitor their use and may reassign 

them if needed. 

b. Intracranial Stents 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Intracranial Stents’’ at 

the beginning of your comment.) 

Effective October 1, 2004, the ICD–9– 

CM Coordination and Maintenance 

Committee created procedure code 

00.62 (Percutaneous angioplasty or 

atherectomy of intracranial vessel(s)). At 

the same time, we created code 00.65 

(Percutaneous insertion of intracranial 

vascular stent(s)). It is our customary 

practice to assign new codes to the same 

DRG as their predecessor codes. Code 

00.62 was removed from code 39.50 

(Angioplasty or atherectomy of other 

noncoronary vessel(s)), which is 

assigned to CMS DRG 533 (Extracranial 

Procedures with CC) and CMS DRG 534 

(Extracranial Procedures Without CC) 

(proposed MS–DRGs 37, 38, and 39 

(Extracranial Procedures With MCC, 

With CC, and Without CC/MCC, 

respectively)) when the patient has 

principal diagnosis in MDC 1. 

Therefore, we assigned code 00.62 to 

CMS DRGs 533 and 534 in MDC 1 

beginning in FY 2005. In addition, we 

made code 00.65 a non-O.R. procedure 

for DRG assignment. We also assigned 

code 00.62 to the Non-Covered 

Procedure edit of the MCE, as Medicare 

had a national noncoverage 

determination for intracranial 

angioplasty and atherectomy with 

stenting. 

Effective November 7, 2006, Medicare 

covers percutaneous transluminal 

angioplasty (PTA) and stenting of 

intracranial arteries for the treatment of 

cerebral artery stenosis in cases in 

which stenosis is 50 percent or greater 

in patients with intracranial 

atherosclerotic disease when furnished 

in accordance with FDA-approved 

protocols governing Category B 

Investigational Device Exemption (IDE) 

clinical trials. CMS determined that 

coverage of intracranial PTA and 

stenting is reasonable and necessary 

under these circumstances. All other 

indications for PTA without stenting to 

treat obstructive lesions of the vertebral 

and cerebral arteries remain 

noncovered. This decision can be found 

online in the CMS Coverage Manual: 

http://www.cms.hhs.gov/Manuals/IOM/ 

itemdetail.asp at section 20.7.B.5. 

A manufacturer recently met with 

CMS to request that code 00.62 be 

reassigned to CMS DRGs 1 and 2 

(Craniotomy Age ≤ 17 With and Without 

CC, respectively) (proposed MS–DRGs 

37 (Extracranial Procedures With MCC), 

38 (Extracranial Procedures With CC), 

and 39 (Extracranial Procedures 

Without CC/MCC)) and CMS DRG 543 

(Craniotomy with Major Device Implant 

or Acute Complex Central Nervous 

System Principal Diagnosis) (proposed 

MS–DRGs 23 and 24 (Craniotomy With 

Major Device Implant or Acute Complex 

Central Nervous System Principal 

Diagnosis With MCC and Without MCC, 

respectively). The manufacturer noted 

that other similar endovascular 

intracranial procedures that treat a 

cerebrovascular blockage are currently 

assigned to the craniotomy CMS DRGs. 

These endovascular-approach cases 

already assigned to the craniotomy CMS 

DRGs are identified by procedure codes 

39.72 (Endovascular repair or occlusion 

of head and neck vessels), 39.74 

(Endovascular removal of obstruction 

from head and neck vessel(s)), and 39.79 

(Other endovascular repair (of 

aneurysm) of other vessels). Under the 

proposed MS–DRGs, we are proposing 

to assign procedure codes 39.72, 39.74, 

and 39.79 to MS–DRGs 011 through 013 

and MS–DRG 543. Although we are 

concerned about the assignment of 

additional endovascular procedures to 

an open surgical DRG, we agree that 

there is clinical consistency between 

procedure codes 39.72, 39.74, and 39.79 

and procedure code 00.62. For this 

reason, we agree that procedure code 

00.62 should be assigned to CMS DRGs 

1, 2, and 543 (proposed MS–DRGs 37, 

38, and 39 and 243 and 24, respectively, 

that are divided by the presence or 

absence of specific CCs). 

For FY 2008, we are proposing to 

remove code 00.62 from CMS DRGs 533 

and 534 and assign them to proposed 

MS–DRGs 37, 38, and 39, as well as to 

proposed MS–DRGs 23 and 24. 

In order to assure appropriate DRG 

assignment as described above, we are 

proposing to make conforming changes 

to the MCE by removing code 00.62 

from the Non-Covered Procedure edit. 

However, as intracranial PTA is only 

covered when performed in conjunction 

with insertion of a stent, we are 

proposing to redefine the edit by 

specifying that code 00.62 must be 

accompanied by code 00.65 

(Percutaneous insertion of intracranial 

vascular stent(s)). Should code 00.65 not 

be reported on the claim, the case would 

fail the MCE edit. For a full discussion 

of this proposed change, we refer 

readers to the MCE discussion in section 

II.F.6. of the preamble of this proposed 

rule. 

Although we are proposing to assign 

endovascular intracranial procedures to 

the same DRG as craniotomy, we remain 

concerned that endovascular 

intracranial procedures are clinically 

different than open craniotomy surgical 

procedures and may have very different 

resource requirements. At the current 

time, there are an insufficient number of 

cases to warrant creation of a separate 

base DRG for endovascular intracranial 

procedures. However, we intend to 

revisit the assignment of intracranial 

endovascular procedures at a later date 

when more data are available to analyze 

these cases. 

3. MDC 3 (Diseases and Disorders of the 

Ear, Nose, Mouth, and Throat)— 

Cochlear Implants 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Cochlear Implants’’ at 

the beginning of your comment.) 

Cochlear implants were first covered 

by Medicare in 1986 and were assigned 

to CMS DRG 49 (Major Head and Neck 

Procedures) in MDC 3 (Diseases and 

Disorders of the Ear, Nose, Mouth, and 

Throat). CMS DRG 49 is the highest 

weighted DRG in that MDC. However, 

two manufacturers of cochlear implants 

contend that this DRG assignment is 

clinically and economically 

inappropriate and have requested that 

cochlear implant cases be reassigned 

from CMS DRG 49 to CMS DRG 543 

(Craniotomy With Major Device Implant 

or Acute Complex Central Nervous 

System Principal Diagnosis). 

The manufacturers stated that 

procedures assigned to CMS DRG 49 are 

performed mostly for diseases such as 

head and neck cancers, while 

procedures in CMS DRG 543 include 

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operations on and inside the skull and 

implantation of complex devices, 

including intracranial neurostimulators. 

The manufacturers described the 

cochlear implant procedure as requiring 

incisions behind the ear to remove a 

section of the temporal bone, followed 

by microscopic neurotologic surgery 

under general anesthesia, and is 

typically completed in 2 to 4 hours to 

restore hearing to the profoundly deaf. 

For these reasons, these manufacturers 

believe cochlear implant procedures are 

similar to open craniotomies. 

Based on their analysis of the FY 2005 

MedPAR data, the manufacturers 

identified a total of 139 cochlear 

implant cases using ICD–9–CM 

procedure codes 20.96 (Implantation or 

replacement of cochlear prosthetic 

device NOS), 20.97 (Implantation or 

replacement of cochlear prosthetic 

device, single channel), and 20.98 

(Implantation or replacement of 

cochlear prosthetic device, multiple 

channel). The manufacturers reported 

121 out of 139 cochlear implant cases 

were assigned to CMS DRG 49 with 

average standardized charges of 

approximately $58,078. 

When we reviewed the FY 2006 

MedPAR data, we identified 104 

cochlear implant cases assigned to CMS 

DRG 49. In the proposed MS–DRGs, 

CMS DRG 49 is subdivided into two 

severity levels: Proposed MS–DRG 129 

(Major Head and Neck Procedures With 

CC or MCC) and proposed MS–DRG 130 

(Major Head and Neck Procedures 

Without CC). The following table 

displays our results: 

Proposed MS–DRG Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 130—All cases ........................................................................................................................ 1,095 3.04 $23,928 

MS–DRG 130—Code 20.96 cases only .................................................................................................. 38 1.63 51,740 

MS–DRG 130—Code 20.97 only ............................................................................................................ 2 1.50 38,855 

MS–DRG 130—Code 20.98 only ............................................................................................................ 45 1.24 50,219 

MS–DRG 129—All cases ........................................................................................................................ 1,244 5.35 34,169 

MS–DRG 129—Code 20.96 only ............................................................................................................ 10 2.70 81,351 

MS–DRG 129—Code 20.97 only ............................................................................................................ 1 5.00 95,441 

MS–DRG 129—Code 20.98 only ............................................................................................................ 8 3.13 53.510 

Under the proposed MS–DRGs, 19 out 

of 104 cochlear implant cases are 

assigned to proposed MS–DRG 129 

based on the secondary diagnosis of the 

patient. The 85 remaining cochlear 

implant cases do not have a CC or MCC 

and would be assigned to proposed MS– 

DRG 130, absent further changes to the 

DRG logic. 

The average charges of approximately 

$54,238 for cochlear implant cases are 

higher than the average charges of 

approximately $29,375 for the other 

cases in CMS DRG 49. However, the 

average charges are not as high as the 

average charges of approximately 

$78,118 for cases assigned to CMS DRG 

543. Further, our medical advisors do 

not believe that surgery to implant a 

cochlear implant is clinically similar to 

an open craniotomy in MDC 1 because 

typically a craniotomy involves 

removing and then replacing a section 

of the skull in order to perform a 

procedure on or within the brain, 

whereas a cochlear implant involves 

drilling a hole in the mastoid bone in 

order to insert the implant into the inner 

ear. 

We have been unable to address this 

issue under the current DRGs because 

there are not enough inpatient cochlear 

implant cases to warrant creation of a 

separate DRG. Although these cases will 

continue to have higher charges than 

other cases in their assigned DRG, we 

are proposing to move the cochlear 

implant cases to the higher DRG severity 

level within CMS DRG 49. As part of 

this proposal, we would redefine 

proposed MS–DRG 129 as ‘‘Major Head 

and Neck Procedures With CC or MCC 

or Major Device’’. The presence of a 

major head and neck procedure with a 

CC or MCC or major device would 

assign the case to the higher severity 

level within CMS DRG 49. 

4. MDC 8 (Diseases and Disorders of the 

Musculoskeletal System and Connective 

Tissue) 

a. Hip and Knee Replacements 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Hip and Knee 

Replacements’’ at the beginning of your 

comment.) 

In the FY 2006 IPPS final rule (70 FR 

47303), we deleted DRG 209 (Major 

Joint and Limb Reattachment 

Procedures of Lower Extremity) and 

created two new DRGs: 544 (Major Joint 

Replacement or Reattachment of Lower 

Extremity) and 545 (Revision of Hip or 

Knee Replacement). The two new DRGs 

were created to identify that revisions of 

joint replacement procedures are 

significantly more resource intensive 

than original hip and knee replacements 

procedures. DRG 544 includes the 

following procedure code assignments: 

<bullet≤ 81.51, Total hip replacement 

<bullet≤ 81.52, Partial hip 

replacement 

<bullet≤ 81.54, Total knee 

replacement 

<bullet≤ 81.56, Total ankle 

replacement 

<bullet≤ 84.26, Foot reattachment 

<bullet≤ 84.27, Lower leg or ankle 

reattachment 

<bullet≤ 84.28, Thigh reattachment 

DRG 545 includes the following 

procedure code assignments: <bullet≤ 00.70, Revision of hip 

replacement, both acetabular and 

femoral components <bullet≤ 00.71, Revision of hip 

replacement, acetabular component <bullet≤ 00.72, Revision of hip 

replacement, femoral component <bullet≤ 00.73, Revision of hip 

replacement, acetabular liner and/or 

femoral head only <bullet≤ 00.80, Revision of knee 

replacement, total (all components) <bullet≤ 00.81, Revision of knee 

replacement, tibial component <bullet≤ 00.82, Revision of knee 

replacement, femoral component <bullet≤ 00.83, Revision of knee 

replacement, patellar component <bullet≤ 00.84, Revision of knee 

replacement, tibial insert (liner) <bullet≤ 81.53, Revision of hip 

replacement, not otherwise specified <bullet≤ 81.55, Revision of knee 

replacement, not otherwise specified Further, we created a number of new 

ICD–9–CM procedure codes effective 

October 1, 2005, that better distinguish 

the many different types of joint 

replacement procedures that are 

currently being performed. In the FY 

2006 IPPS final rule (70 FR 47305), we 

indicated that a commenter had 

requested that, once we receive claims 

data using the new procedure codes, we 

closely examine data from the use of the 

codes under the two new DRGs to 

determine if future additional DRG 

modifications are needed. 

Further, the American Association of 

Hip & Knee Surgeons (AAHKS) 

recommended that we make further 

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refinements to the DRGs for knee and 

hip arthroplasty procedures. AAHKS 

previously presented data to CMS on 

the important differences in clinical 

characteristics and resource utilization 

between primary and revision total joint 

arthroplasty procedures. AAHKS stated 

that CMS’ decision to create a separate 

DRG for revision of total joint 

arthroplasty (TJA) in October 2005 

resulted in more equitable 

reimbursement for hospitals that 

perform a disproportionate share of 

complex revision of TJA procedures, 

recognizing the higher resource 

utilization associated with these cases. 

AAHKS stated that this important 

payment policy change led to increased 

access to care for patients with failed 

total joint arthroplasties, and ensured 

that high volume TJA centers could 

continue to provide a high standard of 

care for these challenging patients. AAHKS further stated that the 

addition of new, more descriptive ICD– 

9–CM diagnosis and procedure codes 

for TJA in October 2005 gave it the 

opportunity to further analyze 

differences in clinical characteristics 

and resource intensity among TJA 

patients and procedures. Inclusive of 

the preparatory work to submit its 

recommendations, the AAHKS 

compiled, analyzed, and reviewed 

detailed clinical and resource utilization 

data from over 6,000 primary and 

revision TJA procedure codes from 4 

high volume joint arthroplasty centers 

located within different geographic 

regions of the United States: University 

of California, San Francisco, CA; Mayo 

Clinic, Rochester, MN; Massachusetts 

General Hospital, Boston, MA; and the 

Hospital for Special Surgery, New York, 

NY. Based on its analysis, AAHKS 

recommended that CMS examine 

Medicare claims data and consider the 

creation of separate DRGs for total hip 

and total knee arthroplasty procedures. 

DRG 545 currently contains revisions of 

both hip and knee replacement 

procedures. AAHKS stated that based 

on the differences between patient 

characteristics, procedure 

characteristics, resource utilization, and 

procedure code payment rates between 

total hip and total knee replacements, 

separate DRGs were warranted. 

Furthermore, AAHKS recommended 

that CMS create separate base DRGs for 

routine versus complex joint revision or 

replacement procedures as shown 

below. 

Routine Hip Replacements 

<bullet≤ 00.73, Revision of hip 

replacement, acetabular liner and/or 

femoral heal only <bullet≤ 00.85, Resurfacing hip, total, 

acetabulum and femoral head 

<bullet≤ 00.86, Resurfacing hip, 

partial, femoral head <bullet≤ 00.87, Resurfacing hip, 

partial, acetabulum <bullet≤ 81.51, Total hip replacement <bullet≤ 81.52, Partial hip 

replacement <bullet≤ 81.53, Revision of hip 

replacement, not otherwise specified 

Complex Hip Replacements 

<bullet≤ 00.70, Revision of hip 

replacement, both acetabular and 

femoral components <bullet≤ 00.71, Revision of hip 

replacement, acetabular component <bullet≤ 00.72, Revision of hip 

replacement, femoral component 

Routine Knee Replacements and Ankle 

Procedures 

<bullet≤ 00.83, Revision of knee 

replacement, patellar component <bullet≤ 00.84, Revision of knee 

replacement, tibial insert (liner) <bullet≤ 81.54, Revision of knee 

replacement, not otherwise specified <bullet≤ 81.55, Revision of knee 

replacement, not otherwise specified <bullet≤ 81.56, Total ankle 

replacement 

Complex Knee Replacements and other 

reattachments 

<bullet≤ 00.80, Revision of knee 

replacement, total (all components) <bullet≤ 00.81, Revision of knee 

replacement, tibial component <bullet≤ 00.82, Revision of knee 

replacement, femoral component <bullet≤ 84.26, Foot reattachment 

<bullet≤ 84.27, Lower leg or ankle 

reattachment 

<bullet≤ 84.28, Thigh reattachment AAHKS also recommended the 

continuation of DRG 471 (Bilateral or 

Multiple Major Joint Procedures of 

Lower Extremity) without 

modifications. DRG 471 includes any 

combination of two or more of the 

following procedure codes: 

<bullet≤ 00.70, Revision of hip 

replacement, both acetabular and 

femoral components 

<bullet≤ 00.80, Revision of knee 

replacement, total (all components) 

<bullet≤ 00.85, Resurfacing hip, total, 

acetabulum and femoral head 

<bullet≤ 00.86, Resurfacing hip, 

partial, femoral head 

<bullet≤ 00.87, Resurfacing hip, 

partial, acetabulum 

<bullet≤ 81.51, Total hip replacement 

<bullet≤ 81.52, Partial hip 

replacement 

<bullet≤ 81.54, Total knee 

replacement 

<bullet≤ 81.56, Total ankle 

replacement 

As discussed in section II.C. of the 

preamble of this proposed rule, we are 

proposing to adopt MS–DRGs to better 

recognize severity of illness for FY 2008. 

The proposed MS–DRGs include two 

new severity of illness levels under the 

current base DRG 544. We are also 

proposing to add three new severity of 

illness levels to the base DRG for 

Revision of Hip or Knee Replacement 

(currently DRG 545). The new MS– 

DRGs are as follows: 

<bullet≤ Proposed MS–DRG 466 

(Revision of Hip or Knee Replacement 

with MCC) 

<bullet≤ Proposed MS–DRG 467 

(Revision of Hip or Knee Replacement 

with CC) 

<bullet≤ Proposed MS–DRG 468 

(Revision of Hip or Knee Replacement 

without CC) 

<bullet≤ Proposed MS–DRG 483 

(Major Joint Replacement or 

Reattachment of Lower Extremity with 

CC/MCC) 

<bullet≤ Proposed MS–DRG 484 

(Major Joint Replacement or 

Reattachment of Lower Extremity 

without CC/MCC) 

We found that the proposed MS– 

DRGs greatly improved our ability to 

identify joint procedures with higher 

resource costs. The following table 

indicates the average charges for each 

new proposed MS–DRG for the joint 

procedures. 

PROPOSED MS–DRGS THAT REPLACE DRGS 544 AND 535 WITH NEW SEVERITY LEVELS

Proposed MS–DRG Number of 

cases 

Average 

length of stay 

Average 

charges 

MS–DRG 466 .............................................................................................................................. 390,344 4.03 $33,465.85 

MS–DRG 467 .............................................................................................................................. 28,211 8.46 53,676.09 

MS–DRG 468 .............................................................................................................................. 26,718 4.06 38,720.28 

MS–DRG 483 .............................................................................................................................. 10,078 6.06 48,575.01 

MS–DRG 484 .............................................................................................................................. 3,886 9.55 69,649.08 

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AAHKS analyzed Medicare data 

under the current DRG system and was 

unaware of how its analysis would 

change under the proposed MS–DRGs. 

Under the current DRGs, the AAHKS 

recommendation would replace 2 DRGs 

with 4 new ones. However, under the 

proposed MS–DRGs, the AAHKS 

recommendation would result in 5 

DRGs becoming 12. Because AAHKS is 

recommending four new joint 

replacement DRGs (two for knees and 

two for hips), each would need to be 

subdivided into severity levels under 

our proposed MS–DRG system. 

Therefore, the four new joint DRGs 

could be subdivided into three levels 

each, leading to 12 new DRGs. At this 

time, we believe that the changes we are 

proposing to make to adopt the 

proposed MS–DRGs are sufficiently 

better for recognizing severity of illness 

among the hip and knee replacement 

cases. We do not believe that there 

would be significant improvements in 

the proposed MS–DRGs recognition of 

severity of illness from creating an 

additional 7 DRGs. However, we 

acknowledge the valuable assistance the 

AAHKS has provided to CMS in 

creating the new joint replacement 

procedure codes and modifying the joint 

replacement DRGs beginning in FY 

2006. These efforts greatly improved our 

ability to categorize significantly 

different groups of patients according to 

severity of illness. We welcome 

comments from AAHKS on whether the 

proposed MS–DRGs recognize patient 

complexity and severity of illness in the 

hip and knee replacement DRGs 

consistent with the concerns it 

expressed to us in previous comments. 

We also welcome public comments from 

others as well on whether the proposed 

changes to the hip and knee 

replacement DRGs better recognize 

severity of illness and complexity of 

these operations in the Medicare patient 

population. 

b. Spinal Fusions 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Spinal Procedures’’ at 

the beginning of your comment.) 

In the FY 2007 final rule (71 FR 

47947), we discussed a request that 

urged CMS to consider applying a 

severity concept to all of the back and 

spine surgical cases, similar to the 

approach that was used in the FY 2006 

final rule in refining the cardiac DRGs 

with an MCV. Specifically, the 

commenter recommended that the use 

of spinal devices be uniquely identified 

within the spine DRGs. The 

commenter’s suggestion involved the 

development of 10 new spine DRGs as 

well as additional modifications. One of 

these modifications included revising 

DRG 546 (Spinal Fusions Except 

Cervical with Curvature of the Spine or 

Malignancy). The commenter stated 

DRG 546 did not adequately recognize 

clinical severity or the resource 

differences among spinal fusion patients 

whose surgeries include fusing multiple 

levels of their spinal vertebrae. 

We agreed with the commenter that it 

was important to recognize severity 

when classifying groups of patients into 

specific DRGs. In addition, in response 

to recommendations from MedPAC’s 

March 2005 Report to Congress, we 

stated that we were conducting a 

comprehensive analysis of the entire 

DRG system to determine if we could 

better identify severity of illness. We 

further stated that until results from our 

analysis were available, it would be 

premature to implement a severity 

concept for the spine DRGs. Therefore, 

we did not make any adjustments to 

those DRGs at that time. 

Under the proposed MS–DRGs 

described in section II.D. of the 

preamble of this proposed rule, we are 

proposing a number of refinements that 

would better recognize severity for FY 

2008. The proposed MS–DRGs include 

several refinements to the spine DRGs. 

These refinements are described in 

detail below. 

In the FY 2006 IPPS final rule, we 

noted that there are numerous 

innovations occurring in spinal surgery 

such as artificial spinal disc prostheses, 

kyphoplasty, vertebroplasty and the use 

of spine decompression devices. As part 

of our analysis of the DRG system for 

this proposed rule, we did a 

comprehensive review of the DRGs for 

spinal fusion and other back and neck 

procedures to determine whether 

additional refinements beyond the 

proposed MS–DRGs were necessary. We 

studied data from the FY 2006 MedPAR 

file for the entire group of spine DRGs. 

This group included DRG 496 

(Combined Anterior/Posterior Spinal 

Fusion), DRGs 497 and 498 (Spinal 

Fusion Except Cervical With and 

Without CC, respectively), DRGs 499 

and 500 (Back and Neck Procedures 

Except Spinal Fusion With and Without 

CC, respectively), DRGs 519 and 520 

(Cervical Spinal Fusion With and 

Without CC, respectively), and DRG 546 

(Spinal Fusion Except Cervical with 

Curvature of the Spine or Malignancy). 

As indicated earlier, we are proposing 

a two or three-way split for each of these 

spine DRGs to better recognize severity 

of illness, complexity of service, and 

resource utilization. In addition, we 

examined the procedure codes that 

identify multiple fusion or refusion of 

the vertebrae (codes 81.62 through 

81.64) to determine if the data 

supported further refinement when a 

greater number of vertebrae are fused. 

In applying the proposed MS–DRG 

logic, CMS DRG 497 and 498 were 

collapsed and the result is a split with 

two severity levels: proposed MS–DRG 

459 (Spinal Fusion Except Cervical 

With MCC) and proposed MS–DRG 460 

(Spinal Fusion Except Cervical Without 

MCC). There were a total of 51,667 cases 

in proposed MS–DRGs 459 and 460. We 

identified 288 cases where nine or more 

noncervical vertebrae were fused (code 

81.64) that currently are assigned to 

proposed MS–DRGs 459 and 460. The 

average charges and length of stay for 

cases in these MS–DRGs are closer to 

the average charges and length of stay 

for cases in proposed MS–DRGs 456 

through 458 (Spinal Fusion Except 

Cervical With Curvature of the Spine or 

Malignancy With MCC, With CC, and 

Without CC, respectively). For example, 

in proposed MS–DRG 460, there were 

238 cases with an average length of stay 

of 6.20 days and average charges of 

$110,908 when nine or more 

noncervical vertebrae are fused. There 

are an additional 50 cases where nine or 

more vertebrae were fused in proposed 

MS–DRG 459 with average charges of 

$171,839. Without any further 

modification to the proposed MS–DRGs, 

these cases would be assigned to 

proposed MS–DRGs 459 and 460 that 

have average charges of $59,698, and 

$99,298, respectively. The average 

charges for these cases are more 

comparable to $142,871, $95,489, and 

$77,528, respectively, for proposed MS– 

DRGs 456 through 458. We believe these 

data support assigning cases where nine 

or more noncervical vertebrae are fused 

from proposed MS–DRG 459 and 460 

into proposed MS–DRG 456 through 

458. The table below represents our 

findings. 

Proposed MS–DRG Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 459 (Spinal Fusion Except Cervical With MCC)—All Cases .................................................. 3,186 10.10 $99,298 

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Proposed MS–DRG Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 459 (Spinal Fusion Except Cervical With MCC)—Cases with Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) .............................................................................................. 50 13.00 171.839 

MS–DRG 460 (Spinal Fusion Except Cervical Without MCC)—All Cases ............................................. 48,481 4.36 59,698

MS–DRG 460 (Spinal Fusion Except Cervical Without MCC)—Cases with Procedure Code 81.64 

(Fusion or refusion of 9 or more vertebrae) ........................................................................................ 238 6.20 110,908 

MS–DRG 456 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With 

MCC)—All Cases ................................................................................................................................. 548 14.79 142,871 

MS–DRG 456 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With 

MCC)—Cases With Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) .................. 61 13.34 170,655 

MS–DRG 457 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With 

CC)—All Cases .................................................................................................................................... 1,500 8.14 95,489 

MS–DRG 457 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With 

CC)—Cases With Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) ..................... 146 8.88 125,722 

MS–DRG 458 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy Without 

CC—All Cases ..................................................................................................................................... 1,340 4.58 77,528 

MS–DRG 458 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy Without 

CC)—Cases With Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) ..................... 81 6.21 123,823 

Therefore, we are proposing to move 

those cases that include fusing or 

refusing nine or more vertebrae from 

proposed MS–DRGs 459 and 460 into 

proposed MS–DRGs 456 through 458. 

This proposed modification would 

include revising the MS–DRG title to 

reflect the fusion of nine or more 

vertebrae. The revised titles for 

proposed MS–DRGs 456 through 458 

would be as follows: 

<bullet≤ Proposed MS–DRG 456 

(Spinal Fusion Except Cervical with 

Spinal Curvature or Malignancy or 9+ 

Fusions With MCC) 

<bullet≤ Proposed MS–DRG 457 

(Spinal Fusion Except Cervical with 

Spinal Curvature or Malignancy or 9+ 

Fusions With CC) 

<bullet≤ Proposed MS–DRG 458 

(Spinal Fusion Except Cervical with 

Spinal Curvature or Malignancy or 9+ 

Fusions Without CC/MCC) 

We invite public comment on this 

topic as well as on the additional 

changes we are proposing to the spine 

MS–DRGs discussed below. 

Further analysis demonstrates that 

spinal fusion cases with a principal 

diagnosis of tuberculosis or 

osteomyelitis also have higher average 

charges than other cases in CMS DRG 

497 (proposed MS–DRGs 459 and 460) 

that are more similar to the cases 

assigned to CMS DRG 546 (proposed 

MS–DRGs 456 through 458). Although 

the volume of cases is relatively low, the 

data show very high average charges for 

these patients. The following tables 

display our results: 

Proposed MS–DRG Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 459 (Spinal Fusion Except Cervical With MCC) ..................................................................... 3,186 10.10 $99,298 

MS–DRG 460 (Spinal Fusion Except Cervical Without MCC) ................................................................ 48,481 4.36 59,698 

Proposed MS–DRG Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 456 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions 

With MCC) ............................................................................................................................................ 548 14.79 $142,870 

MS–DRG 457 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions 

With CC) ............................................................................................................................................... 1,500 8.14 95,489 

MS–DRG 458 (Spinal Fusion Except Cervical With Spinal Curvature or Malignancy or 9+ Fusions 

Without CC/MCC) ................................................................................................................................ 1,340 4.58 77,528 

Tuberculosis and Osteomyelitis 

Principal diagnosis Number of 

cases 

Average 

length of 

stay 

Average 

charges 

Codes 015.02, 015.04, 015.05, 730.08, 730.18 and 730.28 .................................................................. 194 24.8 $128,073 

For this reason, we are proposing to 

add the following diagnoses to the 

principal diagnosis list for proposed 

MS–DRGs 456 through 458: 

<bullet≤ 015.02, Tuberculosis of 

bones and joints, vertebral column, 

bacteriological or histological 

examination unknown (at present) 

<bullet≤ 015.04, Tuberculosis of 

bones and joints, vertebral column, 

tubercle bacilli not found (in sputum) 

by microscopy, but found by bacterial 

culture 

<bullet≤ 015.05, Tuberculosis of 

bones and joints, vertebral column, 

tubercle bacilli not found by 

bacteriological examination, but 

tuberculosis confirmed histologically 

<bullet≤ 730.08, Acute osteomyelitis 

of other specified sites 

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<bullet≤ 730.18, Chronic 

osteomyelitis of other specified sites 

<bullet≤ 730.28, Unspecified 

osteomyelitis of other specified sites 

For the complete list of principal 

diagnosis codes that lead to assignment 

of CMS DRG 546 (proposed MS–DRGs 

496 through 498), we refer readers to 

section II.D.4.b. of the preamble of the 

FY 2007 IPPS final rule (71 FR 47947). 

c. Spinal Disc Devices 

Over the past several years, 

manufacturers of spinal disc devices 

have requested reassignment of DRGs 

for their products and applied for new 

technology add-on payments. 

CHARITETM is one of these devices. 

CHARITETM is a prosthetic 

intervertebral disc. On October 26, 2004, 

the FDA approved the CHARITETM

Artificial Disc for single level spinal 

arthroplasty in skeletally mature 

patients with degenerative disc disease 

between L4 and S1. On October 1, 2004, 

we created new procedure codes for the 

insertion of spinal disc prostheses 

(codes 84.60 through 84.69). We 

provided the CMS DRG assignments for 

these new codes in Table 6B of the FY 

2005 IPPS proposed rule (69 FR 28673). 

We received comments on the FY 2005 

proposed rule recommending that we 

change the assignments for these codes 

from CMS DRG 499 (Back and Neck 

Procedures Except Spinal Fusion With 

CC) and CMS DRG 500 (Back and Neck 

Procedures Except Spinal Fusion 

Without CC) to the CMS DRGs for spinal 

fusion, CMS DRG 497 (Spinal Fusion 

Except Cervical With CC) and CMS DRG 

498 (Spinal Fusion Except Cervical 

Without CC) for procedures on the 

lumbar spine and to CMS DRGs 519 and 

520 for procedures on the cervical 

spine. In the FY 2005 IPPS final rule (69 

FR 48938), we indicated that CMS DRGs 

497 and 498 are limited to spinal fusion 

procedures. Because the surgery 

involving the CHARITETM Artificial 

Disc is not a spinal fusion, we decided 

not to include this procedure in these 

CMS DRGs. However, we stated that we 

would continue to analyze this issue 

and solicited further public comments 

on the DRG assignment for spinal disc 

prostheses. 

In the FY 2006 final rule (70 FR 

47353), we noted that, if a product 

meets all of the criteria for Medicare to 

pay for the product as a new technology 

under section 1886(d)(5)(K) of the Act, 

there is a clear preference expressed in 

the statute for us to assign the 

technology to a DRG based on similar 

clinical or anatomical characteristics or 

costs. However, for FY 2006, we did not 

find that the CHARITETM Artificial Disc 

met the substantial clinical 

improvement criterion and, thus, did 

not qualify as a new technology. 

Consequently, we did not address the 

DRG classification request made under 

the authority of this provision of the 

Act. 

We did evaluate whether to reassign 

the CHARITETM Artificial Disc to 

different CMS DRGs using the 

Secretary’s authority under section 

1886(d)(4) of the Act (70 FR 47308). We 

indicated that we did not have Medicare 

charge information to evaluate CMS 

DRG changes for cases involving an 

implant of a prosthetic intervertebral 

disc like the CHARITETM and did not 

make a change in its CMS DRG 

assignments. We stated that we would 

consider whether changes to the CMS 

DRG assignments for the CHARITETM

Artificial Disc were warranted for FY 

2007, once we had information from 

Medicare’s data system that would 

assist us in evaluating the costs of these 

patients. 

As we discussed in the FY 2007 IPPS 

proposed rule (71 FR 24036), we 

received correspondence regarding the 

CMS DRG assignments for the 

CHARITETM Artificial Disc, code 84.65 

(Insertion of total spinal disc prosthesis, 

lumbosacral). The commenter had 

previously submitted an application for 

the CHARITETM Artificial Disc for new 

technology add-on payments for FY 

2006 and had requested a reassignment 

of cases involving CHARITETM

implantation to CMS DRGs 497 and 498. 

The commenter asked that we examine 

claims data for FY 2005 and reassign 

procedure code 84.65 from CMS DRGs 

499 and 500 into CMS DRGs 497 and 

498. The commenter again stated the 

view that cases with the CHARITETM

Artificial Disc reflect comparable 

resource use and similar clinical 

indications as do those in CMS DRGs 

497 and 498. If CMS were to reject 

reassignment of the CHARITETM

Artificial Disc to CMS DRGs 497 and 

498, the commenter suggested creating 

two separate DRGs for lumbar disc 

replacements. 

On February 15, 2006, we posted a 

proposed national coverage 

determination (NCD) on the CMS Web 

site seeking public comment on our 

proposed finding that the evidence is 

not adequate to conclude that lumbar 

artificial disc replacement with the 

CHARITETM Artificial Disc is reasonable 

and necessary. The proposed NCD 

stated that lumbar artificial disc 

replacement with the CHARITETM

Artificial Disc is generally not indicated 

in patients over 60 years old. Further, it 

stated that there is insufficient evidence 

among either the aged or disabled 

Medicare population to make a 

reasonable and necessary determination 

for coverage. With an NCD pending to 

make spinal arthroplasty with the 

CHARITETM Artificial Disc noncovered, 

we indicated in the FY 2007 IPPS 

proposed rule that we did not believe it 

was appropriate at that time to reassign 

procedure code 84.65 from CMS DRGs 

499 and 500 to CMS DRGs 497 and 498. 

After considering the public 

comments and additional evidence 

received, we made a final NCD on May 

16, 2006, that Medicare would not cover 

the CHARITETM Artificial Disc for the 

Medicare population over 60 years of 

age. For Medicare beneficiaries 60 years 

of age and under, local Medicare 

contractors have the discretion to 

determine coverage for lumbar artificial 

disc replacement procedures involving 

the CHARITETM Artificial Disc. The 

final NCD can be found on the CMS 

Web site at: http://www.cms.hhs.gov/ 

mcd/ viewncd.asp:ncd-id 150.10&ncd— 

version1& basket=ncd%3A150 

%2E10%3A1%3ALumbar+ 

Artificial+Disc+Replacement 

%280ADR%29. 

We agreed with a commenter on the 

FY 2007 IPPS proposed rule that it was 

not appropriate to consider a DRG 

revision at that time for the CHARITETM

Artificial Disc, given the recent decision 

to limit coverage for surgical procedures 

involving this device. Although we had 

reviewed the Medicare charge data, we 

were concerned that there were a very 

small number of cases for patients under 

60 years of age who had received the 

CHARITETM Artificial Disc. We believed 

it appropriate to base the decision of a 

DRG change on charge data only on the 

population for which the procedure is 

covered. We had an extremely small 

number of cases for Medicare 

beneficiaries under 60 on which to base 

such a decision. For this reason, we did 

not believe it was appropriate to modify 

the CMS DRGs in FY 2007 for 

CHARITETM cases. 

For FY 2008, we collapsed CMS DRGs 

499 and 500 (Back and Neck Procedures 

Except Spinal Fusion With and Without 

CC, respectively) and identified a total 

of 74,989 cases. Under the proposed 

MS–DRGs, the result of the analysis of 

the data supports that these CMS DRGs 

split into two severity levels: proposed 

MS–DRG 490 (Back and Neck 

Procedures Except Spinal Fusion with 

CC or MCC) and proposed MS–DRG 491 

(Back and Neck Procedures Except 

Spinal Fusion Without CC or MCC). We 

found a total of 53 cases that used the 

CHARITETM Artificial Disc. Without any 

further modification to the proposed 

MS–DRGs, average charges are $26,481 

for 6 cases with a CC or MCC and 

$37,324 for 47 CHARITETM cases 

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without a CC or MCC. (We find it 

counterintuitive that average charges for 

cases in the higher severity level are 

lower but checked our data and found 

it to be correct). 

We also analyzed data for other spinal 

disc devices. Average charges for the X 

Stop Interspinous Process 

Decompression Device (code 84.58) are 

$31,400 for cases with a CC or MCC and 

$28,821 for cases without a CC or MCC. 

Average charges for other specified 

spinal devices described by code 84.59 

(Coflex, Dynesys, M-Brace) are $34,002 

for 18 cases with a CC or MCC and 

$33,873 for 65 cases without a CC or 

MCC. We compared these average 

charges to data in the proposed spinal 

fusion MS–DRGs 453 (Combined 

Anterior/Posterior Spinal Fusion With 

MCC), 454 (Combined Anterior/ 

Posterior Spinal Fusion With CC), 455 

(Combined Anterior/Posterior Spinal 

Fusion Without CC/MCC), 459 (Spinal 

Fusion Except Cervical With MCC), and 

460 (Spinal Fusion Except Cervical 

Without MCC). These cases have lower 

average charges than the spinal fusion 

MS–DRGs. The following tables display 

the results: 

Proposed MS–DRGs 490 and 491 Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 490—All Cases ....................................................................................................................... 17,493 5.13 $29,656 

MS–DRG 490—Cases with Procedure Code 84.65 (CHARITETM) ........................................................ 6 3.33 26,481 

MS–DRG 491—All Cases ....................................................................................................................... 57,496 2.27 17,789 

MS–DRG 491—Cases with Procedure Code 84.65 (CHARITETM) ........................................................ 47 2.43 37,324 

MS–DRG 491—Cases without Procedure Code 84.65 (CHARITETM) ................................................... 57,449 2.27 17,773 

Proposed MS–DRGs 490 and 491 Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 490—All Cases ....................................................................................................................... 17,493 5.13 $29,656 

MS–DRG 490—Cases with Procedure Code 84.58 (X Stop) ................................................................. 179 2.65 31,400 

MS–DRG 490—Cases without Procedure Code 84.58 (X Stop) ............................................................ 17,314 5.15 29,638 

MS–DRG 491—All Cases ....................................................................................................................... 57,496 2.27 17,789 

MS–DRG 491—Cases with Procedure Code 84.58 (X Stop) ................................................................. 1,174 1.34 28,821 

MS–DRG 491—Cases without Procedure Code 84.58 (X-Stop) ............................................................ 56,322 2.29 17,559 

Proposed MS–DRGs 490 and 491 Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 490—All Cases ....................................................................................................................... 17,493 5.13 $29,656 

MS–DRG 490—Cases with Procedure Code 84.59 (Coflex/Dynesys/M-Brace) .................................... 18 5.56 34,002 

MS–DRG 490—Cases without Procedure Code 84.59 (Coflex/Dynesys/M-Brace) ............................... 17,475 5.13 29,651 

MS–DRG 491—All Cases ....................................................................................................................... 57,496 2.27 17,789 

MS–DRG 491—Cases with Procedure Code 84.59 (Coflex/Dynesys/M-Brace) .................................... 65 2.35 33,873 

MS–DRG 491—Cases without Procedure Code 84.59 (Coflex/Dynesys/M-Brace) ............................... 57,431 2.27 17,770 

Proposed MS–DRGs 453, 454, 455, 459 and 460 Number of 

cases 

Average 

length of 

stay 

Average 

charges 

MS–DRG 453—Combined Anterior/Posterior Spinal Fusion With MCC ................................................ 792 15.84 $180,658

MS–DRG 454—Combined Anterior/Posterior Spinal Fusion With CC ................................................... 1,411 8.69 116,402 

MS–DRG 455—Combined Anterior/Posterior Spinal Fusion Without CC/MCC ..................................... 1,794 4.84 85,927 

MS–DRG 459—Spinal Fusion Except Cervical with MCC ..................................................................... 3,186 10.10 99,298 

MS–DRG 460—Spinal Fusion Except Cervical Without MCC ................................................................ 48,481 4.36 59,698 

The data demonstrate that the average 

charges for CHARITETM and the other 

devices are higher than other cases in 

proposed MS–DRGs 490 and 491 but 

lower than proposed MS–DRGs 453 

through 55 and 459 and 460. For this 

reason, we do not believe that any of the 

cases that use these spine devices 

should be assigned to the spinal fusion 

MS–DRGs. However, we do believe that 

the average charges for cases using these 

spine devices are more similar to the 

higher severity level in MS–DRG 490. 

As such, we are proposing to move 

cases with procedure codes 84.58, 

84.59, and 84.65 into proposed MS– 

DRG 490 and revise the title to reflect 

disc devices. The proposed modified 

MS–DRG title would be: MS–DRG 490 

(Back and Neck Procedures Except 

Spinal Fusion with CC or MCC or Disc 

Devices). 

We believe these proposed changes to 

the spine DRGs are appropriate to 

recognize the similar utilization of 

resources, differences in levels of 

severity, and complexity of the services 

performed for various types of spinal 

procedures described above. We 

encourage commenters to provide input 

on this approach to better recognize the 

types of patients these procedures are 

being performed upon and their 

outcomes. 

d. Other Spinal DRGs 

We did not identify any data to 

support moving cases in or out of CMS 

DRGs 496 (Combined Anterior/Posterior 

Spinal Fusion), 519 (Cervical Spinal 

Fusion With CC), or 520 (Cervical 

Spinal Fusion Without CC)). Under the 

proposed MS–DRG system, CMS DRG 

496 would be split into three severity 

levels: proposed MS–DRG 453 

(Combined Anterior/Posterior Spinal 

Fusion With MCC), proposed MS–DRG 

454 (Combined Anterior/Posterior 

Spinal Fusion With CC), and proposed 

MS–DRG 455 (Combined Anterior/ 

Posterior Spinal Fusion Without CC). 

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CMS DRG 519 would also be split into 

three severity levels: proposed MS–DRG 

471 (Cervical Fusion With MCC), 

proposed MS–DRG 472 (Cervical Fusion 

With CC), and proposed MS–DRG 473 

(Cervical Fusion Without CC). We are 

not proposing changes to these DRGs at 

this time. 

5. MDC 17 (Myeloproliferative Diseases 

and Disorders, Poorly Differentiated 

Neoplasm): Endoscopic Procedures 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Endoscopy’’ at the 

beginning of your comment.) 

We received a request from a 

manufacturer to review the DRG 

assignment of codes 33.71 (Endoscopic 

insertion or replacement of bronchial 

valve(s)), 33.78 (Endoscopic removal of 

bronchial device(s) or substances), and 

33.79 (Endoscopic insertion of other 

bronchial device or substances) with the 

intent of moving these three codes out 

of CMS DRG 412 (History of Malignancy 

With Endoscopy) (proposed MS–DRGs 

843, 844, and 845). The requestor has 

noted that CMS DRG 412 is titled to be 

a DRG for cases with a history of 

malignancy, and none of the three codes 

(33.71, 33.78, or 33.79) necessarily 

involve treatment for malignancies. In 

addition, the requestor believed the 

integrity of the DRG is compromised 

because the other endoscopy codes 

assigned to CMS DRG 412 are all 

diagnostic in nature, while codes 33.71, 

33.78, and 33.79 represent therapeutic 

procedures. 

The requestor also stated that while 

the diagnostic endoscopies in CMS DRG 

412 do not have significant costs for 

equipment or pharmaceutical agents 

beyond the basic endoscopy, the 

therapeutic procedures described by 

codes 33.71, 33.78, and 33.79 involve 

substantial costs for devices or 

substances in relation to the cost of the 

endoscopic procedure itself. The 

requestor was concerned that, if these 

three codes continue to be assigned to 

CMS DRG 412, payment will be so 

inadequate as to constitute a substantial 

barrier to Medicare beneficiaries for 

these treatments. 

ICD–9–CM procedure codes 33.71, 

33.78, and 33.79 were all created for use 

beginning October 1, 2006. As these 

codes have been in use only for a few 

months, we have no data to make a 

different DRG assignment. We assigned 

these codes based on the advice of our 

medical officers to a DRG that includes 

similar clinical procedures. 

On the matter of codes 33.71, 33.78, 

and 33.79 being therapeutic in nature 

while all other endoscopies assigned to 

CMS DRG 412 are diagnostic, we 

disagree with the commenter. CMS DRG 

412 includes procedure codes for 

therapeutic endoscopic destruction of 

lesions of the bronchus, lung, stomach, 

anus, and duodenum, as well as codes 

for polypectomy of the intestine and 

rectum. In addition, we note that there 

are codes for insertion of therapeutic 

devices currently located in this DRG. 

We believe it would be premature to 

assign these codes to another DRG 

without any supporting data. We will 

reconsider our decision for these codes 

if we have data suggesting that a DRG 

reassignment is warranted. Therefore, 

aside from the proposed changes to the 

MS–DRGs, we are not proposing to 

change the current DRG assignment for 

codes 33.71, 33.78, and 33.79 at this 

time. 

6. Medicare Code Editor (MCE) Changes 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Medicare Code Editor’’ at the 

beginning of your comment.) 

As explained under section II.B.1. of 

this preamble, the Medicare Code Editor 

(MCE) is a software program that detects 

and reports errors in the coding of 

Medicare claims data. Patient diagnoses, 

procedure(s), discharge status, and 

demographic information go into the 

Medicare claims processing systems and 

are subjected to a series of automated 

screens. The MCE screens are designed 

to identify cases that require further 

review before classification into a DRG. 

For FY 2008, we are proposing to 

make the following changes to the MCE 

edits. 

a. Non-Covered Procedure Edit: Code 

00.62 (Percutaneous angioplasty or 

atherectomy of intracranial vessel(s)) 

As discussed in II.G.2. of the 

preamble of this proposed rule, under 

MDC 1, code 00.62 is a covered service 

when performed in conjunction with 

code 00.65 (Percutaneous insertion of 

intracranial vascular stent(s)). Effective 

November 6, 2006, Medicare covers 

PTA and stenting of intracranial arteries 

for the treatment of cerebral artery 

stenosis in cases in which stenosis is 50 

percent or greater in patients with 

intracranial atherosclerotic disease 

when furnished in accordance with the 

FDA-approved protocols governing 

Category B Investigational Device 

Exemption (IDE) clinical trials. CMS 

determines that coverage of intracranial 

PTA and stenting is reasonable and 

necessary under these circumstances. 

Therefore, we are proposing to make a 

conforming change and to add the 

following language to this edit: 

Procedure code 00.62 (PTA of 

intracranial vessel(s)) is identified as a 

noncovered procedure except when it is 

accompanied by procedure code 00.65 

(Intracranial stent). 

b. Non-Specific Principal Diagnosis Edit 

7 and Non-Specific O.R. Procedures Edit 

10 

When MCE Non-Specific Principal 

Diagnosis Edit 7 and Non-Specific O.R. 

Procedures Edit 10 were created at the 

beginning of the IPPS, it was with the 

intent that they were to encourage 

hospitals to code as specifically as 

possible. While the codes on both edits 

are valid according to the ICD–9–CM 

coding scheme, more precise codes are 

preferable to give a more complete 

understanding of the services provided 

on the Medicare claims. When the MCE 

was created, we had intended that these 

specific edits would allow educational 

contact between the provider and the 

contractor. It was never the intention 

that these edits would be used to deny/ 

reject or return-to-provider claims 

submitted with non-specific codes. 

However, we found these two edits to be 

misunderstood, and found that claims 

were erroneously being denied, rejected, 

or returned. On November 11, 2006, 

CMS issued a Joint Signature 

Memorandum which instructed all 

fiscal intermediaries and all Part A and 

Part B Medicare Administrative 

Contractors (A/B MACs) to deactivate 

the Fiscal Intermediary Shared System 

Edits W1436 through W1439 and 

W1489 through W1491 which edited for 

Non-Specific Diagnoses and the NonSpecific Procedures. 

Therefore, we are proposing to make 

a conforming change to the MCE by 

removing the following codes from Edit 

7: 

00320 1109 1543 

01590 1129 1579 

01591 1149 1589 

01592 1279 1590 

01593 129 1609 

01594 1309 1619 

01596 13100 1629 

0369 1319 1639 

0399 1329 1649 

0528 1369 1709 

05310 1370 1719 

0538 1371 1729 

05440 1372 1739 

0548 1373 1749 

0558 1374 1769 

05600 138 179 

0568 1390 1809 

06640 1391 1839 

07070 1398 1874 

07071 1409 1879 

0728 1419 1889 

0738 1429 1899 

07420 1439 1909 

08240 1449 1929 

0979 1469 1949 

09810 1479 1969 

09830 1509 1991 

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09950 1519 20490 

0999 1529 20491 

1009 1539 20590 

20591 2779 36910 

20690 2793 36911 

20691 2799 

20890 28730 36912 

20891 28800 36913 

2129 28850 36914 

2139 28860 36915 

2149 28950 36916 

2159 3239 36917 

2169 3249 36918 

2189 326 36920 

2199 32700 36921 

2229 32710 36922 

2239 32720 36923 

2249 32730 36924 

2259 32740 36925 

2279 3309 3693 

22800 3319 3694 

2299 3349 36960 

2306 3359 36961 

2319 34120 36962 

2329 3419 36963 

2349 3439 36964 

23690 3449 36965 

23770 34690 36966 

23875 34691 36967 

2390 3489 36968 

2391 3499 36969 

2392 3509 36970 

2393 3519 36971 

2394 3529 36972 

2396 3539 36973 

2397 3569 36974 

2398 3579 36975 

2399 3589 36976 

2469 3599 3698 

2519 3609 3699 

25200 3619 3709 

2529 3629 3719 

2539 3639 3729 

2549 3649 3739 

25510 3659 3749 

2569 3669 3759 

2579 3679 3769 

2589 3689 3779 

2681 36900 3789 

2709 36901 37960 

2719 36902 3809 

2729 36903 3819 

2739 36904 3829 

27540 36905 3839 

2759 36906 3849 

27650 36907 3859 

27730 36908 3879 

38800 52140 6089 

38810 5219 6109 

38830 52320 6169 

38840 52330 6170 

38860 52340 61800 

38870 5239 6184 

3889 52400 6189 

38900 52420 6199 

38910 52430 6209 

3897 52450 62130 

3899 52460 6219 

41090 52470 62210 

41091 5249 6229 

41092 52520 6239 

412 52540 6249 

4149 52550 6269 

4179 52560 6279 

42650 5259 62920 

4275 5269 63390 

4279 5279 63391 

42820 52800 64090 

42830 5299 64091 

42840 5309 64093 

4289 53640 64100 

4299 5379 64110 

4329 5539 64120 

43390 56400 64130 

43490 5649 64180 

4379 5679 64190 

4389 5689 64191 

4419 56960 64193 

4429 5699 64200 

4449 5739 64210 

44620 57510 64220 

4479 5759 64230 

4519 5769 64240 

45340 5779 64250 

4539 5799 64260 

4579 5859 64270 

4599 5889 64290 

4619 5890 64300 

46450 5891 64310 

46451 5899 64320 

4749 5909 64380 

4919 5959 64390 

5169 5969 64400 

51900 5989 64410 

5199 59960 64420 

5209 5999 64600 

52100 60090 64610 

60091 64620 

52110 6019 64630 

52120 6029 64640 

52130 60820 64650 

64660 65290 65820 

64670 65291 65830 

64680 65293 65840 

64690 65300 65880 

64700 65310 65890 

64710 65320 65891 

64720 65330 65893 

64730 65340 65900 

64740 65350 65910 

64750 65360 65920 

64760 65370 65930 

64780 65380 65940 

64790 65390 65950 

64791 65391 65960 

64792 65393 65980 

64793 65400 65990 

64794 65410 65991 

64800 65420 65993 

64810 65430 66000 

64820 65440 66010 

64830 65450 66020 

64840 65460 66030 

64850 65470 66040 

64860 65480 66050 

64870 65490 66060 

64880 65491 66070 

64890 65492 66080 

64900 65493 66090 

64910 65494 66100 

64920 65500 66110 

64930 65510 66120 

64940 65520 66130 

64950 65530 66140 

64960 65540 66190 

65100 65550 66191 

65110 65560 66193 

65120 65570 66200 

65130 65580 66210 

65140 65590 66220 

65150 65591 66230 

65160 65593 66300 

65180 65600 66310 

65190 65610 66320 

65191 65620 66330 

65193 65630 66340 

65200 65640 66350 

65210 65650 66360 

65220 65660 66380 

65230 65670 66390 

65240 65680 66391 

65250 65690 66393 

65260 65700 66400 

65270 65800 66410 

65280 65810 66420 

66430 67110 7059 

66440 67120 7069 

66441 67130 70700 

66444 67140 70710 

66450 67150 7079 

66480 67180 7149 

66490 67190 71590 

66491 67191 7179 

66494 67192 71849 

66500 67193 71850 

66510 67194 71870 

66520 67200 72230 

66530 67300 72270 

66540 67310 72280 

66550 67320 72290 

66560 67330 7239 

66570 67380 7244 

66580 67400 7289 

66590 67410 73000 

66591 67420 73010 

66592 67430 73020 

66593 67440 73030 

66594 67450 73090 

66600 67480 73091 

66610 67490 73092 

66620 67492 73093 

66630 67494 73094 

66700 67500 73095 

66710 67510 73096 

66800 67520 73097 

66810 67580 73098 

66820 67590 73099 

66880 67600 73310 

66890 67610 73340 

66891 67620 73390 

66892 67630 7359 

66893 67640 73600 

66894 67650 73620 

66900 67660 73630 

66910 67680 73670 

66920 67690 7369 

66930 67691 73810 

66940 67692 7389 

66950 67693 74100 

66960 67694 74190 

66970 677 7429 

66980 6809 7439 

66990 6819 7449 

66991 6829 7459 

66992 68600 7469 

66993 6869 74760 

66994 6949 7489 

67000 7019 74900 

67100 7049 74910 

7509 7769 9009 

7529 7789 9029 

75310 7799 9039 

75312 78031 9048 

75320 78051 9049 

7539 78052 9050 

7559 78053 9051 

75670 78054 9052 

7579 78055 9053 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24737 

7599 78057 9054 

7600 78058 9055 

7601 78079 9056 

7602 7825 9057 

7603 78261 9058 

7604 78262 9059 

7605 78340 9060 

7606 78830 9061 

76070 78900 9062 

76072 78930 9063 

76073 78940 9064 

76074 78960 9065 

76079 79009 9066 

7608 7901 9067 

7609 7904 9068 

7610 7905 9069 

7611 7906 9070 

7612 79091 9071 

7613 79092 9072 

7614 79099 9073 

7615 7929 9074 

7616 79380 9075 

7617 79500 9079 

7618 7954 9080 

7619 7964 9081 

7629 7969 9082 

7630 7993 9083 

7631 79989 9084 

7632 7999 9085 

7633 8290 9086 

7634 ...................... 9089 

7635 8291 9090 

7636 8398 9091 

7637 8399 9092 

76383 8409 9093 

7639 8419 9094 

76520 8439 9095 

7679 8469 9099 

7689 8479 9219 

77010 8489 9229 

7709 8678 9239 

77210 8679 9249 

7729 86800 9269 

7759 86810 9279 

9289 94404 9659 

9299 94405 9679 

9349 94406 9699 

9399 94407 9709 

94100 94408 9739 

94101 94500 9769 

94102 94501 9779 

94103 94502 9809 

94104 94503 9849 

94105 94504 9859 

94106 94505 9889 

94107 94506 9899 

94108 94509 9929 

94109 9460 9939 

94200 9479 99520 

94201 9490 99522 

94202 9491 99523 

94203 9492 99529 

94204 9493 99550 

94205 9494 99580 

94209 9495 99590 

94300 9519 99600 

94301 9529 99630 

94302 9539 99640 

94303 9549 99660 

94304 9559 99670 

94305 9569 99680 

94306 9579 99690 

94309 95890 99700 

94400 9599 99760 

94401 9609 9989 

94402 9639 ......................

94403 9649 ......................

In addition, we are proposing to make 

a conforming change to the MCE by 

removing the following codes from Edit 

10: 

0650 3770 4400 

0700 3800 4440 

0763 3810 4500 

0769 3830 4590 

0780 3840 4610 

2630 3850 4620 

3500 3860 4640 

3510 3880 4650 

3520 4040 4660 

3550 4050 4680 

3560 4100 5300 

3570 4210 5310 

3610 4240 5640 

3710 ...................... 7550 

7670 7880 8070 

7700 7890 8080 

7720 7910 8090 

7760 7920 8100 

7770 7930 8120 

7780 7940 8130 

7790 7950 8153 

7800 7960 8155 

7810 7980 8400 

7820 7990 8440 

7830 8000 8460 

7840 8010 8469 

7850 8020 8660 

7870 8040 8670 

c. Limited Coverage Edit 17 

Edit 17 in the MCE contains ICD–9– 

CM procedure codes describing 

medically complex procedures, 

including lung volume reduction 

surgery, organ transplants, and 

implantable heart assist devices which 

are to be performed only in certain 

preapproved medical centers. CMS has 

established, through a regulation (CMS– 

3835–F: Medicare Conditions of 

Participation: Requirements for 

Approval and Reapproval of Transplant 

Centers to Perform Organ Transplants, 

published in the Federal Register on 

March 30, 2007 (72 FR 15198)), a survey 

and certification process for organ 

transplant programs. The organs 

covered in this regulation are heart, 

heart and lung combined, intestine, 

kidney, liver, lung, pancreas, and 

multivisceral. Historically, kidney 

transplants have been regulated under 

the End-Stage Renal Disease (ESRD) 

conditions for coverage. Other types of 

organ transplant facilities have been 

regulated under various NCDs. 

The regulation becomes effective on 

June 28, 2007. Organ transplant 

programs will have 180 days from the 

June 28, 2007 effective date of the 

regulation to apply for participation in 

the Medicare program under the new 

survey and certification process. After 

these programs apply, we will survey 

and approve programs that meet the 

new Medicare conditions of 

participation. Until transplant facilities 

are surveyed and approved, kidney 

transplant facilities will continue to be 

regulated under the ESRD conditions for 

coverage, and other types of organ 

transplant facilities will continue to be 

regulated under the NCDs. 

In this proposed rule, we are 

proposing to add conforming Medicare 

Part A payment edits to the MCE, 

consistent with the requirements of the 

organ transplant regulation (CMS–3835– 

F), to ensure that Medicare covers only 

those organ transplants performed in 

Medicare-approved facilities. We are 

proposing to add the following 

procedure codes to the existing list of 

limited coverage procedures under Edit 

17: 

<bullet≤ 55.69, Other kidney 

transplantation 

<bullet≤ 52.80, Pancreatic transplant, 

not otherwise specified 

<bullet≤ 52.82, Homotransplant of 

pancreas 

7. Surgical Hierarchies 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Surgical Hierarchies’’ at the 

beginning of your comment.) 

Some inpatient stays entail multiple 

surgical procedures, each one of which, 

occurring by itself, could result in 

assignment of the case to a different 

DRG within the MDC to which the 

principal diagnosis is assigned. 

Therefore, it is necessary to have a 

decision rule within the GROUPER by 

which these cases are assigned to a 

single DRG. The surgical hierarchy, an 

ordering of surgical classes from most 

resource-intensive to least resourceintensive, performs that function. 

Application of this hierarchy ensures 

that cases involving multiple surgical 

procedures are assigned to the DRG 

associated with the most resourceintensive surgical class. 

Because the relative resource intensity 

of surgical classes can shift as a function 

of DRG reclassification and 

recalibrations, we reviewed the surgical 

hierarchy of each MDC, as we have for 

previous reclassifications and 

recalibrations, to determine if the 

ordering of classes coincides with the 

intensity of resource utilization. 

A surgical class can be composed of 

one or more DRGs. For example, in 

MDC 11, the surgical class ‘‘kidney 

transplant’’ consists of a single DRG 

(DRG 302) and the class ‘‘kidney, ureter 

and major bladder procedures’’ consists 

of three DRGs (DRGs 303, 304, and 305). 

Consequently, in many cases, the 

surgical hierarchy has an impact on 

more than one DRG. The methodology 

for determining the most resourceintensive surgical class involves 

weighting the average resources for each 

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24738 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

14 See the FY 1989 final rule (53 FR 38485, 

September 30, 1988), for the revision made for the 

discharges occurring in FY 1989; the FY 1990 final 

rule (54 FR 36552, September 1, 1989), for the FY 

1990 revision; the FY 1991 final rule (55 FR 36126, 

September 4, 1990), for the FY 1991 revision; the 

FY 1992 final rule (56 FR 43209, August 30, 1991) 

for the FY 1992 revision; the FY 1993 final rule (57 

FR 39753), September 1, 1992), for the FY 1993 

revision; the FY 1994 final rule (58 FR 46278, 

September 1, 1993), for the FY 1994 revisions; the 

FY 1995 final rule (59 FR 45334, September 1, 

1994), for the FY 1995 revisions; the FY 1996 final 

rule (60 FR 45782, September 1, 1995), for the FY 

1996 revisions; the FY 1997 final rule (61 FR 46171, 

August 30, 1996), for the FY 1997 revisions; the FY 

1998 final rule (62 FR 45966, August 29, 1997) for 

the FY 1998 revisions; the FY 1999 final rule (63 

FR 40954, July 31, 1998), for the FY 1999 revisions; 

the FY 2001 final rule (65 FR 47064, August 1, 

2000), for the FY 2001 revisions; the FY 2002 final 

rule (66 FR 39851, August 1, 2001), for the FY 2002 

revisions; the FY 2003 final rule (67 FR 49998, 

August 1, 2002), for the FY 2003 revisions; the FY 

2004 final rule (68 FR 45364, August 1, 2003), for 

the FY 2004 revisions; the FY 2005 final rule (69 

FR 49848, August 11, 2004), for the FY 2005 

revisions; the FY 2006 final rule (70 FR 47640, 

August 12, 2005), for the FY 2006 revisions; and the 

FY 2007 final rule (71 FR 47870) for the FY 2007 

revisions. In the FY 2000 final rule (64 FR 41490, 

July 30, 1999), we did not modify the CC Exclusions 

List because we did not make any changes to the 

ICD–9–CM codes for FY 2000. 

DRG by frequency to determine the 

weighted average resources for each 

surgical class. For example, assume 

surgical class A includes DRGs 1 and 2 

and surgical class B includes DRGs 3, 4, 

and 5. Assume also that the average 

charge of DRG 1 is higher than that of 

DRG 3, but the average charges of DRGs 

4 and 5 are higher than the average 

charge of DRG 2. To determine whether 

surgical class A should be higher or 

lower than surgical class B in the 

surgical hierarchy, we would weight the 

average charge of each DRG in the class 

by frequency (that is, by the number of 

cases in the DRG) to determine average 

resource consumption for the surgical 

class. The surgical classes would then 

be ordered from the class with the 

highest average resource utilization to 

that with the lowest, with the exception 

of ‘‘other O.R. procedures’’ as discussed 

below. 

This methodology may occasionally 

result in assignment of a case involving 

multiple procedures to the lowerweighted DRG (in the highest, most 

resource-intensive surgical class) of the 

available alternatives. However, given 

that the logic underlying the surgical 

hierarchy provides that the GROUPER 

search for the procedure in the most 

resource-intensive surgical class, in 

cases involving multiple procedures, 

this result is sometimes unavoidable. 

We note that, notwithstanding the 

foregoing discussion, there are a few 

instances when a surgical class with a 

lower average charge is ordered above a 

surgical class with a higher average 

charge. For example, the ‘‘other O.R. 

procedures’’ surgical class is uniformly 

ordered last in the surgical hierarchy of 

each MDC in which it occurs, regardless 

of the fact that the average charge for the 

DRG or DRGs in that surgical class may 

be higher than that for other surgical 

classes in the MDC. The ‘‘other O.R. 

procedures’’ class is a group of 

procedures that are only infrequently 

related to the diagnoses in the MDC, but 

are still occasionally performed on 

patients in the MDC with these 

diagnoses. Therefore, assignment to 

these surgical classes should only occur 

if no other surgical class more closely 

related to the diagnoses in the MDC is 

appropriate. A second example occurs when the 

difference between the average charges 

for two surgical classes is very small. 

We have found that small differences 

generally do not warrant reordering of 

the hierarchy because, as a result of 

reassigning cases on the basis of the 

hierarchy change, the average charges 

are likely to shift such that the higherordered surgical class has a lower 

average charge than the class ordered 

below it. 

For FY 2008, we are not proposing 

any revisions of the surgical hierarchy 

for any MDC. In general, the MS–DRGs 

that are being proposed for use in FY 

2008 and discussed in section II.D. of 

the preamble of this proposed rule 

follow the same hierarchical order as 

the CMS DRGs they are to replace, 

except for DRGs that were deleted and 

consolidated. 

8. CC Exclusion List Proposed for FY 

2008 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘CC Exclusion List’’ at the 

beginning of your comment.) 

a. Background 

As indicated earlier in this preamble, 

under the IPPS DRG classification 

system, we have developed a standard 

list of diagnoses that are considered 

complications or comorbidities (CCs). 

Historically, we developed this list 

using physician panels that classified 

each diagnosis code based on whether 

the diagnosis, when present as a 

secondary condition, would be 

considered a substantial complication or 

comorbidity. A substantial complication 

or comorbidity was defined as a 

condition that, because of its presence 

with a specific principal diagnosis, 

would cause an increase in the length of 

stay by at least 1 day in at least 75 

percent of the patients. We refer readers 

to section II.D.2. and 3. of the preamble 

of this proposed rule for a discussion of 

the refinement of CCs in relation to the 

MS–DRGs we are proposing to adopt for 

FY 2008. 

b. Proposed CC Exclusions List for FY 

2008 

In the September 1, 1987 final notice 

(52 FR 33143) concerning changes to the 

DRG classification system, we modified 

the GROUPER logic so that certain 

diagnoses included on the standard list 

of CCs would not be considered valid 

CCs in combination with a particular 

principal diagnosis. We created the CC 

Exclusions List for the following 

reasons: (1) To preclude coding of CCs 

for closely related conditions; (2) to 

preclude duplicative or inconsistent 

coding from being treated as CCs; and 

(3) to ensure that cases are appropriately 

classified between the complicated and 

uncomplicated DRGs in a pair. As we 

indicated above, we developed a list of 

diagnoses, using physician panels, to 

include those diagnoses that, when 

present as a secondary condition, would 

be considered a substantial 

complication or comorbidity. In 

previous years, we have made changes 

to the list of CCs, either by adding new 

CCs or deleting CCs already on the list. 

In the May 19, 1987 proposed notice 

(52 FR 18877) and the September 1, 

1987 final notice (52 FR 33154), we 

explained that the excluded secondary 

diagnoses were established using the 

following five principles: 

<bullet≤ Chronic and acute 

manifestations of the same condition 

should not be considered CCs for one 

another. 

<bullet≤ Specific and nonspecific 

(that is, not otherwise specified (NOS)) 

diagnosis codes for the same condition 

should not be considered CCs for one 

another. 

<bullet≤ Codes for the same condition 

that cannot coexist, such as partial/total, 

unilateral/bilateral, obstructed/ 

unobstructed, and benign/malignant, 

should not be considered CCs for one 

another. 

<bullet≤ Codes for the same condition 

in anatomically proximal sites should 

not be considered CCs for one another. 

<bullet≤ Closely related conditions 

should not be considered CCs for one 

another. 

The creation of the CC Exclusions List 

was a major project involving hundreds 

of codes. We have continued to review 

the remaining CCs to identify additional 

exclusions and to remove diagnoses 

from the master list that have been 

shown not to meet the definition of a 

CC.14

For FY 2008, we are proposing to 

make limited revisions to the CC 

Exclusions List to take into account the 

changes that will be made in the ICD– 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24739 

15 The original list of the ICD–9–CM procedure 

codes for the procedures we consider nonextensive 

procedures, if performed with an unrelated 

principal diagnosis, was published in Table 6C in 

section IV. of the Addendum to the FY 1989 final 

rule (53 FR 38591). As part of the FY 1991 final rule 

(55 FR 36135), the FY 1992 final rule (56 FR 43212), 

the FY 1993 final rule (57 FR 23625), the FY 1994 

final rule (58 FR 46279), the FY 1995 final rule (59 

FR 45336), the FY 1996 final rule (60 FR 45783), 

the FY 1997 final rule (61 FR 46173), and the FY 

1998 final rule (62 FR 45981), we moved several 

other procedures from DRG 468 to DRG 477, and 

some procedures from DRG 477 to DRG 468. No 

procedures were moved in FY 1999, as noted in the 

final rule (63 FR 40962); in FY 2000 (64 FR 41496); 

in FY 2001 (65 FR 47064); or in FY 2002 (66 FR 

39852). In the FY 2003 final rule (67 FR 49999) we 

did not move any procedures from DRG 477. 

However, we did move procedure codes from DRG 

468 and place them in more clinically coherent 

DRGs. In the FY 2004 final rule (68 FR 45365), we 

moved several procedures from DRG 468 to DRGs 

476 and 477 because the procedures are 

nonextensive. In the FY 2005 final rule (69 FR 

48950), we moved one procedure from DRG 468 to 

477. In addition, we added several existing 

procedures to DRGs 476 and 477. In the FY 2006 

(70 FR 47317), we moved one procedure from DRG 

468 and assigned it to DRG 477. In FY 2007, we 

moved one procedure from DRG 468 and assigned 

it to DRGs 479, 553, and 554. 

9–CM diagnosis coding system effective 

October 1, 2007. (See section II.G.10. of 

this preamble for a discussion of ICD– 

9–CM changes.) We are proposing to 

make these changes in accordance with 

the principles established when we 

created the CC Exclusions List in 1987. 

In addition, as discussed in section 

II.D.3. of the preamble of this proposed 

rule, we are proposing to indicate on the 

CC Exclusion List some updates to 

reflect the proposed exclusion of a few 

codes from being an MCC under the 

MS–DRG system that we are proposing 

to adopt for FY 2008. 

Table 6I (which is available through 

the Internet on the CMS Web site at: 

http://www.cms.hhs.gov/ 

AcuteInpatientPPS) contains the 

complete CC Exclusions List that will be 

effective for discharges occurring on or 

after October 1, 2007. Table 6I shows 

the principal diagnoses for which there 

is a CC exclusion. Each of these 

principal diagnoses is shown with an 

asterisk, and the conditions that will not 

count as a CC, are provided in an 

indented column immediately following 

the affected principal diagnosis. Tables 

6G and 6H, Additions to and Deletions 

from the CC Exclusion List, 

respectively, are also available through 

the Internet on the CMS Web site at: 

http://www.cms.hhs.gov/ 

AcuteInpatientPPS.) 

Beginning with discharges on or after 

October 1, 2007, the indented diagnoses 

will not be recognized by the GROUPER 

as valid CCs for the asterisked principal 

diagnosis. 

Alternatively, the complete 

documentation of the GROUPER logic, 

including the current CC Exclusions 

List, is available from 3M/Health 

Information Systems (HIS), which, 

under contract with CMS, is responsible 

for updating and maintaining the 

GROUPER program. The current DRG 

Definitions Manual, Version 24.0, is 

available for $225.00, which includes 

$15.00 for shipping and handling. 

Version 25.0 of this manual, which will 

include the final FY 2008 DRG changes, 

will be available in hard copy for 

$250.00. Version 25.0 of the manual is 

also available on a CD for $200.00; a 

combination hard copy and CD is 

available for $400.00. These manuals 

may be obtained by writing 3M/HIS at 

the following address: 100 Barnes Road, 

Wallingford, CT 06492; or by calling 

(203) 949–0303. Please specify the 

revision or revisions requested. 

9. Review of Procedure Codes in CMS 

DRGs 468, 476, and 477 

Each year, we review cases assigned 

to CMS DRG 468 (Extensive O.R. 

Procedure Unrelated to Principal 

Diagnosis), CMS DRG 476 (Prostatic 

O.R. Procedure Unrelated to Principal 

Diagnosis), and CMS DRG 477 

(Nonextensive O.R. Procedure Unrelated 

to Principal Diagnosis) to determine 

whether it would be appropriate to 

change the procedures assigned among 

these CMS DRGs. Under the MS–DRGs 

that we are proposing to adopt for FY 

2008, discussed in section II.D. of the 

preamble of this proposed rule, CMS 

DRG 468 would have a three-way split 

and would become proposed MS–DRGs 

981, 982, and 983 (Extensive O.R. 

Procedure Unrelated to Principal 

Diagnosis with MCC, with CC, and 

without CC/MCC). CMS DRG 476 would 

become proposed MS–DRGs 984, 985, 

and 986 (Prostatic O.R. Procedure 

Unrelated to Principal Diagnosis with 

MCC, with CC, and Without CC/MCC). 

CMS DRG 477 would become proposed 

MS–DRGs 987, 988, and 989 

(Nonextensive O.R. Procedure Unrelated 

to Principal Diagnosis with MCC, with 

CC, and without CC/MCC). 

Proposed MS–DRGs 981 through 983, 

984 through 986, and 987 through 989 

(formerly CMS DRGs 468, 476, and 477, 

respectively) are reserved for those cases 

in which none of the O.R. procedures 

performed are related to the principal 

diagnosis. These CMS DRGs are 

intended to capture atypical cases, that 

is, those cases not occurring with 

sufficient frequency to represent a 

distinct, recognizable clinical group. 

Proposed MS–DRGs 984 through 986 

(previously CMS DRG 476) are assigned 

to those discharges in which one or 

more of the following prostatic 

procedures are performed and are 

unrelated to the principal diagnosis: <bullet≤ 60.0, Incision of prostate <bullet≤ 60.12, Open biopsy of 

prostate <bullet≤ 60.15, Biopsy of periprostatic 

tissue 

<bullet≤ 60.18, Other diagnostic 

procedures on prostate and periprostatic 

tissue 

<bullet≤ 60.21, Transurethral 

prostatectomy <bullet≤ 60.29, Other transurethral 

prostatectomy <bullet≤ 60.61, Local excision of 

lesion of prostate <bullet≤ 60.69, Prostatectomy, not 

elsewhere classified 

<bullet≤ 60.81, Incision of 

periprostatic tissue 

<bullet≤ 60.82, Excision of 

periprostatic tissue 

<bullet≤ 60.93, Repair of prostate 

<bullet≤ 60.94, Control of 

(postoperative) hemorrhage of prostate 

<bullet≤ 60.95, Transurethral balloon 

dilation of the prostatic urethra 

<bullet≤ 60.96, Transurethral 

destruction of prostate tissue by 

microwave thermotherapy 

<bullet≤ 60.97, Other transurethral 

destruction of prostate tissue by other 

thermotherapy 

<bullet≤ 60.99, Other operations on 

prostate 

All remaining O.R. procedures are 

assigned to proposed MS–DRGs 981 

through 983 and 987 through 989 

(previously CMS DRGs 468 and 477), 

with proposed MS–DRGs 987 through 

989 (previously CMS DRG 477) assigned 

to those discharges in which the only 

procedures performed are nonextensive 

procedures that are unrelated to the 

principal diagnosis.15

For FY 2008, we are not proposing to 

change the procedures assigned among 

these CMS DRGs. 

a. Moving Procedure Codes From CMS 

DRG 468 (Proposed MS–DRGs 981 

Through 983) or CMS DRG 477 

(Proposed MS–DRGs 987 Through 989) 

to MDCs 

We annually conduct a review of 

procedures producing assignment to 

CMS DRG 468 (proposed MS–DRGs 981 

through 983) or CMS DRG 477 

(proposed MS–DRGs 987 through 989) 

on the basis of volume, by procedure, to 

see if it would be appropriate to move 

procedure codes out of these DRGs into 

one of the surgical DRGs for the MDC 

into which the principal diagnosis falls. 

The data are arrayed in two ways for 

comparison purposes. We look at a 

frequency count of each major operative 

procedure code. We also compare 

procedures across MDCs by volume of 

procedure codes within each MDC. 

We identify those procedures 

occurring in conjunction with certain 

principal diagnoses with sufficient 

frequency to justify adding them to one 

of the surgical DRGs for the MDC in 

which the diagnosis falls. Based on this 

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24740 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

year’s review, we are not proposing to 

remove any procedures from CMS DRG 

477 or CMS DRG 468 with assignment 

to one of the surgical DRGs. 

b. Reassignment of Procedures Among 

CMS DRGs 468, 476, and 477 (Proposed 

MS–DRGs 981 Through 983, 984 

Through 986, and 987 Through 989) 

We also annually review the list of 

ICD–9–CM procedures that, when in 

combination with their principal 

diagnosis code, result in assignment to 

CMS DRGs 468, 476, and 477 (proposed 

MS–DRGs 981 through 983, 984 through 

986, and 987 through 989, respectively), 

to ascertain whether any of those 

procedures should be reassigned from 

one of these three DRGs to another of 

the three DRGs based on average charges 

and the length of stay. We look at the 

data for trends such as shifts in 

treatment practice or reporting practice 

that would make the resulting DRG 

assignment illogical. If we find these 

shifts, we would propose to move cases 

to keep the DRGs clinically similar or to 

provide payment for the cases in a 

similar manner. Generally, we move 

only those procedures for which we 

have an adequate number of discharges 

to analyze the data. 

We are not proposing to move any 

procedure codes from CMS DRG 476 

(proposed MS–DRGs 984, 985, and 986) 

to CMS DRG 468 (proposed MS–DRGs 

981, 982, and 983) or to CMS DRG 477 

(proposed MS–DRGs 987, 988, and 989), 

or from CMS DRG 477 (proposed MS– 

DRGs 987, 988, and 989) to CMS DRGs 

468 (proposed MS–DRGs 981, 982, and 

983) or to CMS DRG 476 (proposed MS– 

DRGs 984, 985, and 986) for FY 2008. 

c. Adding Diagnosis or Procedure Codes 

to MDCs 

Based on our review this year, we are 

not proposing to add any diagnosis 

codes to MDCs for FY 2008. 

10. Changes to the ICD–9–CM Coding 

System 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘ICD–9–CM Coding System’’ at 

the beginning of your comment.) 

As described in section II.B.1. of this 

preamble, the ICD–9–CM is a coding 

system used for the reporting of 

diagnoses and procedures performed on 

a patient. In September 1985, the ICD– 

9–CM Coordination and Maintenance 

Committee was formed. This is a 

Federal interdepartmental committee, 

co-chaired by the National Center for 

Health Statistics (NCHS), the Centers for 

Disease Control and Prevention, and 

CMS, charged with maintaining and 

updating the ICD–9–CM system. The 

Committee is jointly responsible for 

approving coding changes, and 

developing errata, addenda, and other 

modifications to the ICD–9–CM to 

reflect newly developed procedures and 

technologies and newly identified 

diseases. The Committee is also 

responsible for promoting the use of 

Federal and non-Federal educational 

programs and other communication 

techniques with a view toward 

standardizing coding applications and 

upgrading the quality of the 

classification system. 

The Official Version of the ICD–9–CM 

contains the list of valid diagnosis and 

procedure codes. (The Official Version 

of the ICD–9–CM is available from the 

Government Printing Office on CD– 

ROM for $25.00 by calling (202) 512– 

1800.) The Official Version of the ICD– 

9–CM is no longer available in printed 

manual form from the Federal 

Government; it is only available on CD– 

ROM. Users who need a paper version 

are referred to one of the many products 

available from publishing houses. 

The NCHS has lead responsibility for 

the ICD–9–CM diagnosis codes included 

in the Tabular List and Alphabetic 

Index for Diseases, while CMS has lead 

responsibility for the ICD–9–CM 

procedure codes included in the 

Tabular List and Alphabetic Index for 

Procedures. 

The Committee encourages 

participation in the above process by 

health-related organizations. In this 

regard, the Committee holds public 

meetings for discussion of educational 

issues and proposed coding changes. 

These meetings provide an opportunity 

for representatives of recognized 

organizations in the coding field, such 

as the American Health Information 

Management Association (AHIMA), the 

American Hospital Association (AHA), 

and various physician specialty groups, 

as well as individual physicians, health 

information management professionals, 

and other members of the public, to 

contribute ideas on coding matters. 

After considering the opinions 

expressed at the public meetings and in 

writing, the Committee formulates 

recommendations, which then must be 

approved by the agencies. 

The Committee presented proposals 

for coding changes for implementation 

in FY 2008 at a public meeting held on 

September 28–29, 2006, and finalized 

the coding changes after consideration 

of comments received at the meetings 

and in writing by December 4, 2006. 

Those coding changes are announced in 

Tables 6A through 6F in the Addendum 

to this proposed rule. The Committee 

held its 2007 meeting on March 22–23, 

2007. Proposed new codes for which 

there was a consensus of public support 

and for which complete tabular and 

indexing changes can be made by May 

2007 will be included in the October 1, 

2007 update to ICD–9–CM. Code 

revisions that were discussed at the 

March 22–23, 2007 Committee meeting 

could not be finalized in time to include 

them in the Addendum to this proposed 

rule. These additional codes will be 

included in Tables 6A through 6F of the 

final rule and are marked with an 

asterisk (*). 

Copies of the minutes of the 

procedure codes discussions at the 

Committee’s September 28–29, 2006 

meeting can be obtained from the CMS 

Web site at: http://cms.hhs.gov/ 

ICD9ProviderDiagnosticCodes/03— 

meetings.asp. The minutes of the 

diagnosis codes discussions at the 

September 28–29, 2006 meeting are 

found at: http://www.cdc.gov/nchs/ 

icd9.htm. Paper copies of these minutes 

are no longer available and the mailing 

list has been discontinued. These Web 

sites also provide detailed information 

about the Committee, including 

information on requesting a new code, 

attending a Committee meeting, and 

timeline requirements and meeting 

dates. 

We encourage commenters to address 

suggestions on coding issues involving 

diagnosis codes to: Donna Pickett, CoChairperson, ICD–9–CM Coordination 

and Maintenance Committee, NCHS, 

Room 2402, 3311 Toledo Road, 

Hyattsville, MD 20782. Comments may 

be sent by E-mail to: dfp4@cdc.gov. 

Questions and comments concerning 

the procedure codes should be 

addressed to: Patricia E. Brooks, CoChairperson, ICD–9–CM Coordination 

and Maintenance Committee, CMS, 

Center for Medicare Management, 

Hospital and Ambulatory Policy Group, 

Division of Acute Care, C4–08–06, 7500 

Security Boulevard, Baltimore, MD 

21244–1850. Comments may be sent by 

E-mail to: 

patricia.brooks2@cms.hhs.gov. 

The ICD–9–CM code changes that 

have been approved will become 

effective October 1, 2007. The new ICD– 

9–CM codes are listed, along with their 

DRG classifications, in Tables 6A and 

6B (New Diagnosis Codes and New 

Procedure Codes, respectively) in the 

Addendum to this proposed rule. As we 

stated above, the code numbers and 

their titles were presented for public 

comment at the ICD–9–CM 

Coordination and Maintenance 

Committee meetings. Both oral and 

written comments were considered 

before the codes were approved. In this 

proposed rule, we are only soliciting 

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comments on the proposed 

classification of these new codes. 

For codes that have been replaced by 

new or expanded codes, the 

corresponding new or expanded 

diagnosis codes are included in Table 

6A. New procedure codes are shown in 

Table 6B. Diagnosis codes that have 

been replaced by expanded codes or 

other codes or have been deleted are in 

Table 6C (Invalid Diagnosis Codes). 

These invalid diagnosis codes will not 

be recognized by the GROUPER 

beginning with discharges occurring on 

or after October 1, 2007. Table 6D 

contains invalid procedure codes. These 

invalid procedure codes will not be 

recognized by the GROUPER beginning 

with discharges occurring on or after 

October 1, 2007. Revisions to diagnosis 

code titles are in Table 6E (Revised 

Diagnosis Code Titles), which also 

includes the DRG assignments for these 

revised codes. Table 6F includes revised 

procedure code titles for FY 2008. 

In the September 7, 2001 final rule 

implementing the IPPS new technology 

add-on payments (66 FR 46906), we 

indicated we would attempt to include 

proposals for procedure codes that 

would describe new technology 

discussed and approved at the Spring 

meeting as part of the code revisions 

effective the following October. As 

stated previously, ICD–9–CM codes 

discussed at the March 22–23, 2007 

Committee meeting that received 

consensus and that were finalized by 

May 2007, will be included in Tables 

6A through 6F of the Addendum to the 

final rule. 

Section 503(a) of Pub. L. 108–173 

included a requirement for updating 

ICD–9–CM codes twice a year instead of 

a single update on October 1 of each 

year. This requirement was included as 

part of the amendments to the Act 

relating to recognition of new 

technology under the IPPS. Section 

503(a) amended section 1886(d)(5)(K) of 

the Act by adding a clause (vii) which 

states that the ‘‘Secretary shall provide 

for the addition of new diagnosis and 

procedure codes on April 1 of each year, 

but the addition of such codes shall not 

require the Secretary to adjust the 

payment (or diagnosis-related group 

classification) * * * until the fiscal year 

that begins after such date.’’ This 

requirement improves the recognition of 

new technologies under the IPPS system 

by providing information on these new 

technologies at an earlier date. Data will 

be available 6 months earlier than 

would be possible with updates 

occurring only once a year on October 

1. 

While section 1886(d)(5)(K)(vii) of the 

Act states that the addition of new 

diagnosis and procedure codes on April 

1 of each year shall not require the 

Secretary to adjust the payment, or DRG 

classification, under section 1886(d) of 

the Act until the fiscal year that begins 

after such date, we have to update the 

DRG software and other systems in 

order to recognize and accept the new 

codes. We also publicize the code 

changes and the need for a mid-year 

systems update by providers to identify 

the new codes. Hospitals also have to 

obtain the new code books and encoder 

updates, and make other system changes 

in order to identify and report the new 

codes. 

The ICD–9–CM Coordination and 

Maintenance Committee holds its 

meetings in the spring and fall in order 

to update the codes and the applicable 

payment and reporting systems by 

October 1 of each year. Items are placed 

on the agenda for the ICD–9–CM 

Coordination and Maintenance 

Committee meeting if the request is 

received at least 2 months prior to the 

meeting. This requirement allows time 

for staff to review and research the 

coding issues and prepare material for 

discussion at the meeting. It also allows 

time for the topic to be publicized in 

meeting announcements in the Federal 

Register as well as on the CMS Web site. 

The public decides whether or not to 

attend the meeting based on the topics 

listed on the agenda. Final decisions on 

code title revisions are currently made 

by March 1 so that these titles can be 

included in the IPPS proposed rule. A 

complete addendum describing details 

of all changes to ICD–9–CM, both 

tabular and index, is publicized on CMS 

and NCHS Web sites in May of each 

year. Publishers of coding books and 

software use this information to modify 

their products that are used by health 

care providers. This 5-month time 

period has proved to be necessary for 

hospitals and other providers to update 

their systems. 

A discussion of this timeline and the 

need for changes are included in the 

December 4–5, 2005 ICD–9–CM 

Coordination and Maintenance 

Committee minutes. The public agreed 

that there was a need to hold the fall 

meetings earlier, in September or 

October, in order to meet the new 

implementation dates. The public 

provided comment that additional time 

would be needed to update hospital 

systems and obtain new code books and 

coding software. There was considerable 

concern expressed about the impact this 

new April update would have on 

providers. 

In the FY 2005 IPPS final rule, we 

implemented section 1886(d)(5)(K)(vii) 

of the Act, as added by section 503(a) 

of Pub. L. 108–173, by developing a 

mechanism for approving, in time for 

the April update, diagnosis and 

procedure code revisions needed to 

describe new technologies and medical 

services for purposes of the new 

technology add-on payment process. We 

also established the following process 

for making these determinations. Topics 

considered during the Fall ICD–9–CM 

Coordination and Maintenance 

Committee meeting are considered for 

an April 1 update if a strong and 

convincing case is made by the 

requester at the Committee’s public 

meeting. The request must identify the 

reason why a new code is needed in 

April for purposes of the new 

technology process. The participants at 

the meeting and those reviewing the 

Committee meeting summary report are 

provided the opportunity to comment 

on this expedited request. All other 

topics are considered for the October 1 

update. Participants at the Committee 

meeting are encouraged to comment on 

all such requests. There were no 

requests for an expedited April l, 2007 

implementation of an ICD–9–CM code 

at the September 28–29, 2006 

Committee meeting. Therefore, there 

were no new ICD–9–CM codes 

implemented on April 1, 2007. 

We believe that this process captures 

the intent of section 1886(d)(5)(K)(vii) of 

the Act. This requirement was included 

in the provision revising the standards 

and process for recognizing new 

technology under the IPPS. In addition, 

the need for approval of new codes 

outside the existing cycle (October 1) 

arises most frequently and most acutely 

where the new codes will identify new 

technologies that are (or will be) under 

consideration for new technology addon payments. Thus, we believe this 

provision was intended to expedite data 

collection through the assignment of 

new ICD–9–CM codes for new 

technologies seeking higher payments. 

Current addendum and code title 

information is published on the CMS 

Web site at: http://www.cms.hhs.gov/ 

icd9ProviderDiagnosticCodes/01— 

overview.asp#TopofPage. Information 

on ICD–9–CM diagnosis codes, along 

with the Official ICD–9–CM Coding 

Guidelines, can be found on the Web 

site at: http://www.cdc.gov/nchs/ 

icd9.htm. Information on new, revised, 

and deleted ICD–9–CM codes is also 

provided to the AHA for publication in 

the Coding Clinic for ICD–9–CM. AHA 

also distributes information to 

publishers and software vendors. 

CMS also sends copies of all ICD–9– 

CM coding changes to its contractors for 

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use in updating their systems and 

providing education to providers. 

These same means of disseminating 

information on new, revised, and 

deleted ICD–9–CM codes will be used to 

notify providers, publishers, software 

vendors, contractors, and others of any 

changes to the ICD–9–CM codes that are 

implemented in April. The code titles 

are adopted as part of the ICD–9–CM 

Coordination and Maintenance 

Committee process. Thus, although we 

publish the code titles in the IPPS 

proposed and final rules, they are not 

subject to comment in the proposed or 

final rules. We will continue to publish 

the October code updates in this manner 

within the IPPS proposed and final 

rules. For codes that are implemented in 

April, we will assign the new procedure 

code to the same DRG in which its 

predecessor code was assigned so there 

will be no DRG impact as far as DRG 

assignment. This mapping was specified 

by section 1886(d)(5)(K)(vii) of the Act 

as added by section 503(a) of Pub. L. 

108–173. Any midyear coding updates 

will be available through the Web sites 

indicated above and through the Coding 

Clinic for ICD–9–CM. Publishers and 

software vendors currently obtain code 

changes through these sources in order 

to update their code books and software 

systems. We will strive to have the April 

1 updates available through these Web 

sites 5 months prior to implementation 

(that is, early November of the previous 

year), as is the case for the October 1 

updates. 

11. Other Issues 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘DRGs: Headaches and 

Seizures’’ at the beginning of your 

comment.) 

a. Seizures and Headaches 

After publication of the FY 2007 IPPS 

final rule (71 FR 47928), we received 

correspondence expressing concerns 

about the revisions we made to the 

seizure and headache DRGs effective on 

October 1, 2006. We created new DRGs 

562 (Seizure Age ≤17 With CC), DRG 

563 (Seizure Age ≤17 Without CC), and 

DRG 564 (Headaches Age ≤17) as an 

interim step to better recognize severity 

of illness among seizure and headache 

patients for FY 2007. Although national 

Medicare utilization data supported the 

revised DRGs, the commenter indicated 

that the change did not appropriately 

recognize hospital resources associated 

with the patients treated in the 

hospital’s inpatient headache program. 

The commenter stated that patients who 

are admitted to the hospital’s inpatient 

headache program suffer from chronic 

headache pain and require inpatient 

treatment that can last up to 12 days. 

The commenter noted that these 

patients are referred from around the 

country after several months of 

unsuccessful pain relief and treatment. 

The commenter indicated that the 

majority of patients treated at the 

hospital’s inpatient headache program 

are drug dependent from being 

administered increasing dosages of pain 

relievers that have been unsuccessful in 

resolving chronic headache pain. 

Further, the commenter noted that the 

patients require detoxification before 

any headache treatment begins. The 

commenter urged CMS to subdivide the 

headache DRG to better recognize the 

higher level of severity associated with 

treating chronic headache patients in 

the hospital’s program. 

Although we are sympathetic to the 

commenter, it is not feasible to design 

a DRG system that addresses concerns 

that may be unique to one facility. Other 

than this one commenter, we did not 

receive any concern about our decision 

to create separate DRGs for seizures and 

headaches. However, we agreed to 

review this issue as part of our effort to 

redesign the DRG system to better 

recognize severity of illness for FY 2008. 

As discussed in section II.C. of the 

preamble of this proposed rule, we are 

proposing to adopt MS–DRGs for FY 

2008. While our current DRG structure 

did not support splitting the headache 

DRG based on the presence or absence 

of a CC, the proposed MS–DRGs support 

the creation of a split for the headache 

DRGs based on whether the patient has 

an MCC as shown below: 

Proposed MS–DRG Number of 

cases 

Average 

length of stay 

Average 

charges 

MS–DRG 102 (Headaches with MCC) ........................................................................................ 1,268 5.04 19,077.33 

MS–DRG 103 (Headaches without MCC) ................................................................................... 14,277 3.22 11,989.43 

(The criteria for determining whether 

to subdivide a DRG are described in 

detail earlier in section II.D. of the 

preamble of this proposed rule.) Thus, 

we are proposing to create two MS– 

DRGs for headaches under the MS– 

DRGs as shown below: 

<bullet≤ Proposed MS–DRG 102 

(Headaches With MCC) 

<bullet≤ Proposed MS–DRG 103 

(Headaches Without MCC) 

We believe this proposed structure 

would better recognize those headaches 

patients who are severely ill and require 

more resources as described by the 

commenter. We refer the readers to 

section II.D. of the preamble of this 

proposed rule for a detailed discussion 

of the MS–DRG proposal. 

b. Devices That Are Replaced Without 

Cost or Where Credit for a Replaced 

Device Is Furnished to the Hospital 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Replaced Devices’’ at the 

beginning of your comment.) 

(1) Background 

We addressed the topic of Medicare 

payment for devices that are replaced 

without costs or where credit for a 

replaced device is furnished to the 

hospital in the FY 2007 IPPS final rule 

(71 FR 47962). In that final rule, we 

included the following background 

information: 

In recent years, there have been 

several field actions and recalls with 

regard to failure of implantable cardiac 

defibrillators (ICDs) and pacemakers. In 

many of these cases, the manufacturers 

have offered replacement devices 

without cost to the hospital or credit for 

the device being replaced if the patient 

required a more expensive device. In 

some circumstances, manufacturers 

have also offered, through a warranty 

package, to pay specified amounts for 

unreimbursed expenses to persons who 

had replacement devices implanted. 

Nonetheless, we believe that incidental 

device failures that are covered by 

manufacturer warranties occur 

routinely. While we understand that 

some device malfunctions may be 

inevitable as medical technology grows 

increasingly sophisticated, we believe 

that early recognition of problems 

would reduce the number of people 

who would be potentially adversely 

affected by these device problems. The 

medical community needs heightened 

and early awareness of patterns of 

device failures, voluntary field actions, 

and recalls so that it can take 

appropriate corrective action to care for 

patients. Systematic efforts must be 

undertaken by all interested and 

involved parties, including 

manufacturers, insurers, and the 

medical community, to ensure that 

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device problems are recognized, and are 

addressed as early as possible so that 

patients’ quality of health care is 

protected and high quality medical care, 

equipment, and technologies are 

provided. We are taking several steps to 

assist in the early recognition and 

analysis of patterns of device problems 

to minimize the potential for harm from 

device-related defects to Medicare 

beneficiaries and the public in general. 

In recent years, CMS has recognized 

the importance of data collection as a 

condition of Medicare coverage for 

selected services. In 2005, we issued an 

NCD that expanded coverage of ICDs 

and also required registry participation 

when the devices were implanted for 

certain clinical indications. The NCD 

included this requirement in order to 

ensure that the medical care received by 

Medicare beneficiaries was reasonable 

and necessary and, therefore, that the 

provider or supplier would be 

appropriately paid. Presently, the 

American College of Cardiology— 

National Cardiovascular Data Registry 

(ACC–NCDR) collects these data and 

maintains the registry. 

In addition to ensuring appropriate 

payment of claims, collection, and 

ongoing analysis of ICD implantation, 

registry data can facilitate public 

response to the quality of health care 

issues in the event of future device 

recalls. Analysis of registry data may 

uncover patterns of device malfunction, 

device-related infection, or early battery 

depletion that would trigger a more 

specific investigation. Patterns found in 

registry data may identify problems in 

patient outcomes earlier than the 

currently available mechanisms, which 

do not systematically collect detailed 

information about each patient who 

receives an ICD. 

We encourage the medical community 

to work to develop additional registries 

for implantable devices, so that timely 

and comprehensive information is 

available regarding devices, recipients 

of those devices, and patients’ quality of 

health care status and medical 

outcomes. While participation in an ICD 

registry is required as a Medicare 

condition of coverage for ICD 

implantation for certain clinical 

conditions, we believe that the potential 

benefits of other data collection extend 

well beyond their application in 

Medicare’s specific NCDs. As medical 

technology continues to advance 

swiftly, data collection regarding the 

short-term and long-term medical 

outcomes of new technologies, 

especially concerning implanted 

devices that may remain in the bodies 

of patients for their lifetimes, will be 

essential to the timely recognition of 

any specific device-related problems, 

patterns of complications, and healthrelated outcomes. This information will 

facilitate early interventions to mitigate 

any harm potentially imposed upon 

Medicare beneficiaries and the public, 

and to improve the quality and 

efficiency of health care services 

provided. 

Moreover, published data from 

registries may further help the 

development of high quality, evidencebased clinical practice guidelines for the 

care of patients who may receive device 

implants. In turn, widespread use of 

evidence-based guidelines may reduce 

variation in medical practice, leading to 

improved personal care and overall 

public health. Registry information may 

also contribute to the development of 

more comprehensive and refined quality 

metrics that may be used to 

systematically assess the collected data, 

and then improve the safety and quality 

of health care provided to Medicare 

beneficiaries. Such improvements in the 

quality of care that result in better 

personal health will require the 

sustained commitment of industry, 

payers, health care providers, and others 

to progressively work towards that goal, 

and to ensure excellent and open 

communication and rapid systemwide 

responses. 

One strategy for this data collection 

involves adding information to the 

claims forms. CMS has a long history of 

collecting hemoglobin or hematocrit 

data from ESRD patients on the claims 

form. Modification of claims forms was 

necessary to do that. CMS is exploring 

the use of claims data to collect other 

types of clinical or technical data such 

as device manufacturer and model 

number. The systematic recording of 

model numbers can enhance knowledge 

of device-related outcomes and 

complications. We look forward to 

further discussions with the public 

about new strategies to both recognize 

device-related problems early as well as 

recognize health-related outcomes of 

new technologies. 

In addition, we believe that the 

routine identification of Medicare 

claims for certain device implantation 

procedures in situations where a 

payment adjustment is appropriate may 

enhance the medical community’s 

recognition of device-related problems, 

potentially leading to more timely 

improvements in medical device 

technologies. This systematic approach, 

which enables hospitals to identify and 

then appropriately report selected 

services when devices are replaced 

without cost to the hospital, or with full 

or partial credit to the hospital for the 

cost of the replaced device, should 

provide comprehensive information 

regarding the hospitals’ experiences 

with Medicare beneficiaries who have 

specific medical devices that are being 

replaced. Because Medicare 

beneficiaries are common recipients of 

implanted devices, the claims 

information may be particularly helpful 

in identifying patterns of device-related 

problems early in their natural history, 

so that appropriate strategies to reduce 

future problems may be developed. One 

possible strategy would be for the 

Medicare program to use information 

obtained through the use of bar coding 

of medical devices. The FDA issued a 

final rule in the Federal Register on 

February 26, 2004 (69 FR 9119), that 

required bar codes for human drugs and 

biological product labels effective April 

26, 2006. In the final rule, FDA deferred 

action on requiring bar codes for 

medical devices, noting the difficulty in 

standardizing medical devices, as 

compared to drugs and biologicals, 

which have the unique NDC numbering 

system. This rule can be reviewed on 

the Federal Register’s Web site at: 

http://www.docket.access.gpo.gov/2004/ 

04-4249.htm. 

We intend to monitor FDA’s work in 

this area to determine how this 

technology could help CMS promote 

higher quality through better clinical 

decision making and, as discussed 

below, assist in improving the accuracy 

of the Medicare payment system. 

In addition to our concern for overall 

public health, we also have a fiduciary 

responsibility to the Medicare Trust 

Fund to ensure that Medicare pays only 

for covered services. Therefore, in the 

FY 2007 IPPS final rule, we indicated 

that we believe we need to consider 

whether it is appropriate to reduce the 

Medicare payment in cases in which an 

implanted device is replaced at reduced 

or no cost to the hospital or with partial 

or full credit for the removed device. 

Such consideration could cover certain 

devices for which credit for the replaced 

medical device is given, or medical 

devices that are replaced as a result of 

or pursuant to a warranty, field action, 

voluntary recall, or involuntary recall, 

and medical devices that are provided 

free of charge. We indicated that 

conveying this information to the 

Medicare beneficiary could provide for 

a reduction in the IPPS payment if we 

determine that the device is replaced 

without cost to the provider or 

beneficiary or when the provider 

receives full credit for the cost of a 

replaced device. 

In FY 2007 IPPS final rule, we 

indicated a need to develop a 

methodology to determine the amount 

of the reduction to the otherwise 

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24744 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

payable IPPS payment for medical 

devices furnished to Medicare 

beneficiaries. We believe that this policy 

is appropriate because, in these cases, 

the full cost of the replaced device is not 

incurred and, therefore, an adjustment 

to the payment is necessary to remove 

the cost of the device. 

(2) Current and Proposed Policies 

In the CY 2007 OPPS final rule (71 FR 

68071 through 68077), we adopted a 

policy that requires a reduced payment 

to a hospital or ambulatory surgical 

center when a device is provided to 

them at no cost. From our experience 

with the OPPS, we understand that a 

manufacturer will often provide a credit 

or partial credit for the recalled device 

rather than a free replacement. In other 

situations, a manufacturer will provide 

either a full or partial credit for a device 

that needs to be replaced only during 

the manufacturer’s warranty period. In 

either of these situations, the original 

implantation of the device was paid for 

either by Medicare, another third party 

on behalf of the beneficiary by making 

payment directly to the hospital, or the 

implantation was paid for directly by 

the beneficiary. Therefore, we believe 

that Medicare should not pay the 

hospital for the full cost of the 

replacement if the hospital is receiving 

a partial or full credit, either due to a 

recall or service during the warranty 

period. The device was already paid for 

at the time of initial implantation, and 

Medicare should retain the credit that is 

being provided to the hospital for 

service to a Medicare beneficiary. 

Moreover, we also believe that a 

proposed adjustment is consistent with 

section 1862(a)(2) of the Act, which 

excludes from Medicare coverage an 

item or service for which neither the 

beneficiary, nor anyone on his or her 

behalf, has an obligation to pay. 

Payment of the full IPPS payment 

amount in cases in which the device 

was replaced under warranty or in 

which there was a full or partial credit 

for the price of the recalled or failed 

device effectively results in Medicare 

payment for a noncovered item. 

Therefore, we are proposing to adjust 

the IPPS payment amount in these 

circumstances under the authority of 

section 1886(d)(5)(I) of the Act, which 

permits the Secretary to make 

‘‘exceptions and adjustments to such 

payment amounts * * * as the Secretary 

deems appropriate.’’ 

Under the OPPS, we currently only 

apply the reduced payment amount in 

situations where the hospital received a 

replacement device at no cost or at full 

credit for the replacement device. 

Unlike the current OPPS policy, we are 

proposing for purposes of the IPPS to 

apply the policy for partial as well as 

full credit for a replacement device. As 

we indicated above, our experience with 

the OPPS suggests that the policy 

should be applied beyond full 

replacement of a recalled device. We are 

proposing to reduce the amount of the 

Medicare IPPS payment when a full or 

partial credit towards a replacement 

device is made or the device is replaced 

without cost to the hospital or with full 

credit for the removed device. However, 

we do not believe that the IPPS policy 

should apply to all DRGs and all 

situations in which a device is replaced 

without cost to the hospital for the 

device or with full or partial credit for 

the removed device. We recognize that, 

in many cases, the cost of the device is 

a relatively modest part of the IPPS 

payment. In other situations, we believe 

the amount of the credit will also be 

nominal. In these cases, we believe that 

the averaging nature of payments under 

the IPPS would incorporate any 

significant savings from a warranty 

replacement, field action, or recall into 

the payment rate for the associated DRG, 

and that no specific adjustment would 

be necessary or appropriate. For this 

reason, we are proposing to apply the 

policy only to those DRGs under the 

IPPS where the implantation of the 

device determines the base DRG 

assignment and situations where the 

hospital received a credit equal to 20 

percent or more of the cost of the 

device. We believe a credit that is equal 

to or more than this percentage is 

substantial, and Medicare should not 

pay for the full cost of these 

replacement devices because hospitals 

have received significant savings from 

the manufacturer for its replacement 

costs. We are seeking comment on the 

application of this percentage amount. 

We further believe that it is appropriate 

to limit application of the policy only to 

those DRGs where implantation of the 

device determines the DRG assignment. 

In making a decision to assign a case 

based on whether a device was 

implanted, we recognized that the 

device cost was a significant portion of 

the overall costs faced by the hospital 

that treats the case. Therefore, we 

believe that Medicare should not make 

full payment for those DRGs where the 

assignment of the case is made based on 

implantation of the device when the 

hospital is receiving either a full or 

significant partial credit for the device. 

We have listed the CMS DRGs that 

would be subject to this proposed policy 

below. We have also listed, in 

parentheses after the CMS DRG title, the 

proposed new MS–DRG title to which 

these cases would be assigned. 

CMS DRGS SUBJECT TO PROPOSED POLICY

MDC CMS 

DRG Narrative Description of DRG 

PRE ..... 103 Heart Transplant or Implant of Heart Assist System (Proposed MS–DRGs 1 and 2, Heart Transplant or Implant of Heart 

Assist System With and Without MCC, respectively). 

1 ........... 1 Craniotomy Age ≤ 17 With CC (Proposed MS–DRG 25 and 26, Craniotomy and Endovascular Intracranial Procedure 

With MCC or Without CC, respectively). 

1 ........... 2 Craniotomy Age ≤ 17 Without CC (Proposed MS–DRGs 26 and 27, Craniotomy and Endovascular Intracranial Procedure 

Without CC/MCC). 

1 ........... 7 Peripheral & Cranial Nerve & Other Nervous System Procedures With CC (Proposed MS–DRGs 40 and 41, Peripheral & 

Cranial Nerve & Other Nervous System Procedure With MCC or With CC, respectively). 

1 ........... 8 Peripheral & Cranial Nerve & Other Nervous System Procedures Without CC (Proposed MS–DRG 42, Peripheral & Cranial Nerve & Other Nervous System Procedure Without CC/MCC). 

1 ........... 543 Craniotomy With Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis (Proposed MS– 

DRGs 23 and 24, Craniotomy with Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis With and Without MCC, respectively). 

3 ........... 49 Major Head & Neck Procedures (Proposed MS–DRGs 129 and 130, Major Head & Neck Procedures With CC/MCC or 

Major Device or Without CC/MCC, respectively). 

5 ........... 104 Cardiac Valve & Other Major Cardiothoracic Procedures with Cardiac Catheterization (Proposed MS–DRGs 216, 217, 

and 218, Cardiac Valve & Other Major Cardiothoracic Procedure With Cardiac Catheterization With MCC, or Without 

CC, or Without CC/MCC, respectively). 

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CMS DRGS SUBJECT TO PROPOSED POLICY—Continued 

MDC CMS 

DRG Narrative Description of DRG 

5 ........... 105 Cardiac Valve & Other Major Cardiothoracic Procedures Without Cardiac Catheterization (Proposed MS–DRGs 219, 220, 

and 221, Cardiac Valve & Other Major Cardiothoracic Procedure Without Cardiac Catheterization With MCC, or With 

CC, or Without CC/MCC, respectively). 

5 ........... 110 Major Cardiovascular Procedures With CC (Proposed MS–DRG 237, Major Cardiovascular Procedures With MCC). 

5 ........... 111 Major Cardiovascular Procedures Without CC (Proposed MS–DRG 238, Major Cardiovascular Procedures Without MCC). 

5 ........... 117 Cardiac Pacemaker Revision Except Device Replacement (Proposed MS–DRGs 260, 261, and 262, Cardiac Pacemaker 

Revision Except Device Replacement With MCC, or With CC, or Without CC/MCC, respectively). 

5 ........... 118 Cardiac Pacemaker Device Replacement (Proposed MS–DRGs 258 and 259, Cardiac Pacemaker Device Replacement 

With MCC, and Without MCC, respectively). 

5 ........... 515 Cardiac Defibrillator Implant Without Cardiac Catheterization (Proposed MS–DRGs 226 and 227, Cardiac Defibrillator Implant Without Cardiac Catheterization With MCC and Without MCC, respectively). 

5 ........... 525 Other Heart Assist System Implant (Proposed MS–DRG 215, Other Heart Assist System Implant). 

5 ........... 535 Cardiac Defibrillator Implant With Cardiac Catheterization With Acute Myocardial Infarction/Heart Failure/Shock (Proposed 

MS–DRGs 222 and 223, Cardiac Defibrillator Implant With Cardiac Catheterization With Acute Myocardial Infarction/ 

Heart Failure/Shock With MCC and Without MCC, respectively). 

5 ........... 536 Cardiac Defibrillator Implant With Cardiac Catheterization Without Acute Myocardial Infarction/Heart Failure/Shock (Proposed MS–DRGs 224 and 225, Cardiac Defibrillator Implant With Cardiac Catheterization Without Acute Myocardial Infarction/Heart Failure/Shock With MCC and Without MCC, respectively). 

5 ........... 551 Permanent Cardiac Pacemaker Implant With Major Cardiovascular Diagnosis or AICD Lead or Generator (Proposed MS–

DRGs 242, 243, and 244, Permanent Cardiac Pacemaker Implant With MCC, With CC, and Without CC/MCC, respectively). 

5 ........... 552 Other Permanent Cardiac Pacemaker Implant Without Major Cardiovascular Diagnosis (Proposed MS–DRGs 242, 243, 

and 244, Permanent Cardiac Pacemaker Implant With MCC, With CC, and Without CC/MCC, respectively). 

8 ........... 471 Bilateral or Multiple Major Joint Procedures of Lower Extremity (Proposed MS–DRGs 461 and 462, Bilateral or Multiple 

Major Joint Procedures of Lower Extremity With MCC, or Without MCC, respectively). 

8 ........... 544 Major Joint Replacement or Reattachment of Lower Extremity (Proposed MS–DRGs 469 and 470, Major Joint Replacement or Reattachment of Lower Extremity With MCC or Without MCC, respectively). 

8 ........... 545 Revision of Hip or Knee Replacement (Proposed MS–DRGs 466, 467, and 468, Revision of Hip or Knee Replacement 

With MCC, With CC, or Without CC/MCC, respectively). 

CMS has requested and received new 

condition codes from the National 

Uniform Billing Committee to describe 

claims where a provider has received a 

device or product without cost. We will 

use these condition codes to reduce 

payment when the hospital used a 

device for which full or partial credit is 

given, or the item was replaced as a 

result of or under a warranty, field 

action, voluntary recall, involuntary 

recall, or otherwise provided free of 

charge. On November 4, 2005, we issued 

Change Request 4058, Transmittal 741, 

in the Medicare Claims Processing 

Manual. The effective date of this 

transmittal was April 1, 2006, and the 

implementation date was April 3, 2006. 

This transmittal specifies that the 

following two new condition codes have 

been created. They are defined below: 

<bullet≤ Condition Code 49—Product 

Replacement within Product Lifecycle. 

Replacement of a product earlier than 

the anticipated lifecycle due to an 

indication that the product is not 

functioning properly. 

<bullet≤ Condition Code 50—Product 

Replacement for Known Recall of a 

Product. The manufacturer or the FDA 

has identified the product for recall and 

therefore replacement. 

Hospitals must report these codes on 

any claim for IPPS services that 

includes a replacement device or 

product for which they received full or 

partial credit. Hospital billing offices 

would report one of these condition 

codes in addition to the specific code 

for the type of procedure performed (for 

example, replacement of a defibrillator). 

When this code is received by Medicare 

and the discharge is assigned to a DRG 

that is subject to this policy, we are 

proposing to suspend the claim so that 

it does not automatically process and 

the fiscal intermediary (or, if applicable, 

the MAC) makes a manual payment 

determination. We are proposing to 

require the hospital to provide invoices 

or other information indicating its 

normal cost of the device and the 

amount of the credit it received. 

This transmittal can be accessed at the 

following Web site: http:// 

www.cms.hhs.gov/Transmittals/ 

downloads/R741CP.pdf. 

Under our policy, the fiscal 

intermediary (or, if applicable, the 

MAC) would manually process claims 

involving DRGs that are subject to this 

policy that include a device that is 

replaced without cost to the hospital for 

the device or with full or partial credit 

for the removed device as identified by 

condition codes 49 or 50. For a device 

provided to the hospital without cost, 

the fiscal intermediary (or, if applicable, 

the MAC) would subtract the cost of the 

device from the DRG payment. For a 

device for which the hospital received 

a full or partial credit, the fiscal 

intermediary (or, if applicable, the 

MAC) would subtract the amount 

credited from the DRG payment. We are 

proposing to require the hospital to 

provide invoices or other information 

indicating the cost of the device and the 

amount of credit it received. We are 

seeking comment on the best approach 

to making this payment adjustment and 

what types of documentation hospitals 

should provide to the fiscal 

intermediary or MAC. 

We are proposing to invoke our 

special exceptions and adjustment 

authority under section 1886(d)(5)(I)(i) 

of the Act to make this adjustment. The 

special exceptions and adjustment 

authority authorizes us to provide ‘‘for 

such other exceptions and adjustments 

to [IPPS] payment amounts* * *as the 

Secretary deems appropriate.’’ We 

believe it would be appropriate to adjust 

payments for surgical procedures to 

replace certain devices by providing 

payments to hospitals only for the 

nondevice-related procedural costs 

when such a device is replaced without 

cost to the hospital for the device or 

with full credit for the removed device. 

To codify in regulations the proposed 

policies for the IPPS discussed above, 

we are proposing to add a new 

paragraph (g) to § 412.2 and a new 

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§ 412.89 to 42 CFR Part 412, Subpart F. 

We are also proposing to make a 

technical, conforming change to the 

heading of Subpart F and to add an 

uncoded center heading before the 

proposed new § 412.89. 

H. Recalibration of DRG Weights 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Recalibration of DRG Weights’’ 

at the beginning of your comment.) In section II.D.3. of the preamble of 

this proposed rule, we stated that we are 

proposing to continue to implement the 

cost-based DRG relative weights under a 

3-year transition period such that, in FY 

2008, year two of the transition, the 

relative weights would be recalibrated 

using a blend of 67 percent of the cost 

relative weight and 33 percent of the 

charge relative weight. By FY 2009, the 

relative weights will be 100 percent 

cost-based. We are proposing a few 

minor changes to the cost-weighting 

methodology that we adopted in the FY 

2007 IPPS final rule (71 FR 47962 

through 47971). However, in section 

II.E.2. of the preamble of this proposed 

rule, we request public comments about 

whether to adopt any of the short-term 

recommendations to the cost relative 

weighting methodology for FY 2008 

made by RTI. Therefore, if we were to 

adopt any of the RTI recommendations 

based on public comment, our 

description of the cost-weighting 

methodology shown below would be 

modified accordingly in the IPPS final 

rule. 

In developing the FY 2008 proposed 

system of weights, we used two data 

sources: claims data and cost report 

data. As in previous years, the claims 

data source is the MedPAR file. This file 

is based on fully coded diagnostic and 

procedure data for all Medicare 

inpatient hospital bills. The FY 2006 

MedPAR data used in this proposed rule 

include discharges occurring on October 

1, 2005, through September 30, 2006, 

based on bills received by CMS through 

December 2006, from all hospitals 

subject to the IPPS and short-term acute 

care hospitals in Maryland (which are 

under a waiver from the IPPS under 

section 1814(b)(3) of the Act). The FY 

2006 MedPAR file used in calculating 

the relative weights includes data for 

approximately 11,748,387 Medicare 

discharges from IPPS providers. 

Discharges for Medicare beneficiaries 

enrolled in a Medicare Advantage 

managed care plan are excluded from 

this analysis. The data exclude CAHs, 

including hospitals that subsequently 

became CAHs after the period from 

which the data were taken. The second 

data source used in the cost relative 

weight methodology is the FY 2005 

Medicare cost report data files from 

HCRIS, which represents the most 

recent full set of cost report data 

available. We used the December 31, 

2006 update of the HCRIS cost report 

files for FY 2005 in setting the proposed 

relative cost based weights. Because we are implementing the 

relative weights on a transitional basis, 

it is necessary to calculate both chargebased and cost-based relative weights. 

The charge-based methodology used to 

calculate the DRG relative weights from 

the MedPAR data is the same 

methodology that was in place for FY 

2006 and FY 2007 and was applied as 

follows: 

<bullet≤ To the extent possible, all the 

claims were regrouped using the MS– 

DRGs being proposed for FY 2008, as 

discussed in section II.D. of this 

preamble. <bullet≤ The transplant cases that 

were used to establish the relative 

weight for heart and heart-lung, liver 

and/or intestinal, and lung transplants 

(proposed MS–DRGs 001, 002, 005, 006, 

and 007, respectively; previously CMS 

DRGs 103, 480, and 495) were limited 

to those Medicare-approved transplant 

centers that have cases in the FY 2005 

MedPAR file. (Medicare coverage for 

heart, heart-lung, liver and/or intestinal, 

and lung transplants is limited to those 

facilities that have received approval 

from CMS as transplant centers.) <bullet≤ Organ acquisition costs for 

kidney, heart, heart-lung, liver, lung, 

pancreas, and intestinal (or 

multivisceral organs) transplants 

continue to be paid on a reasonable cost 

basis. Because these acquisition costs 

are paid separately from the IPPS rates, 

it was necessary to subtract the 

acquisition charges from the total 

charges on each transplant bill that 

showed acquisition charges before 

computing the average charge for the 

DRG and before eliminating statistical 

outliers. 

<bullet≤ Total charges were 

standardized to remove the effects of 

differences in area wage levels, indirect 

medical education and disproportionate 

share payments, and, for hospitals in 

Alaska and Hawaii, the applicable costof-living adjustment. <bullet≤ Statistical outliers were 

eliminated by removing all cases that 

were beyond 3.0 standard deviations 

from the mean of the log distribution of 

both the standardized charges per case 

and the standardized charges per day for 

each DRG. 

<bullet≤ The average charge for each 

DRG was then recomputed (excluding 

the statistical outliers). To compute the 

average DRG charge, we sum the 

standardized charges by DRG and divide 

by the transfer adjusted case count. A 

transfer case is counted as a fraction of 

a case based on the ratio of its transfer 

payment under the per diem payment 

methodology to the full DRG payment 

for nontransfer cases. That is, a transfer 

case receiving payment under the 

transfer methodology equal to half of 

what the case would receive as a 

nontransfer would be counted as 0.5 of 

a total case. The average charge per DRG 

is then divided by the national average 

standardized charge per case to 

determine the relative weight. The new charge-based weights were 

then normalized by an adjustment factor 

of 1.50808 so that the average case 

weight after recalibration was equal to 

the average case weight before 

recalibration. This normalization 

adjustment is intended to ensure that 

recalibration by itself neither increases 

nor decreases total payments under the 

IPPS as required by section 

1886(d)(4)(C)(iii) of the Act. 

The methodology we used to calculate 

the DRG cost-based weights from the FY 

2006 MedPAR claims data and FY 2005 

Medicare cost report data is as follows: <bullet≤ To the extent possible, all the 

claims were regrouped using the FY 

2008 proposed MS–DRG classifications 

discussed in section II.D. of this 

preamble. <bullet≤ The transplant cases that 

were used to establish the relative 

weight for heart and heart-lung, liver 

and/or intestinal, and lung transplants 

(proposed MS–DRGs 001, 002, 005, 006, 

and 007, respectively; previously CMS 

DRGs 103, 480, and 495) were limited 

to those Medicare-approved transplant 

centers that have cases in the FY 2006 

MedPAR file. (Medicare coverage for 

heart, heart-lung, liver and/or intestinal, 

and lung transplants is limited to those 

facilities that have received approval 

from CMS as transplant centers.) <bullet≤ Organ acquisition costs for 

kidney, heart, heart-lung, liver, lung, 

pancreas, and intestinal (or 

multivisceral organs) transplants 

continue to be paid on a reasonable cost 

basis. Because these acquisition costs 

are paid separately from the prospective 

payment rate, it is necessary to subtract 

the acquisition charges from the total 

charges on each transplant bill that 

showed acquisition charges before 

computing the average cost for each 

DRG and before eliminating statistical 

outliers. 

<bullet≤ Claims with total charges or 

total length of stay less than or equal to 

zero were deleted. Claims that had an 

amount in the total charge field that 

differed by more than $10.00 from the 

sum of the routine day charges, 

intensive care charges, pharmacy 

charges, special equipment charges, 

therapy services charges, operating 

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room charges, cardiology charges, 

laboratory charges, radiology charges, 

other service charges, labor and delivery 

charges, inhalation therapy charges and 

anesthesia charges were also deleted. 

<bullet≤ At least 94 percent of the 

providers in the MedPAR file had 

charges for 10 of the 13 cost centers. 

Claims for providers that did not have 

charges greater than zero for at least 10 

of the 13 cost centers were deleted. 

<bullet≤ Statistical outliers were 

eliminated by removing all cases that 

were beyond 3.0 standard deviations 

from the mean of the log distribution of 

both the total charges per case and the 

total charges per day for each DRG. 

Once the MedPAR data were trimmed 

and the statistical outliers were 

removed, the charges for each of the 13 

cost groups for each claim were 

standardized to remove the effects of 

differences in area wage levels, indirect 

medical education and disproportionate 

share payments, and for hospitals in 

Alaska and Hawaii, the applicable costof-living adjustment. Charges were then 

summed by DRG for each of the 13 cost 

groups such that each DRG had 13 

standardized charge totals. These 

charges were then adjusted to cost by 

applying the national average CCRs 

developed from the FY 2005 cost report 

data. 

The 13 cost centers that we used in 

the relative weight calculation are 

shown in the following table. In 

addition, the table shows the lines on 

the cost report that we used to create the 

national cost center CCRs that we used 

to adjust the DRG charges to cost. For 

FY 2008, we are proposing to make 

minor revisions to the Cardiology, 

Laboratory, Radiology, and Other 

Services CCRs we are using to calculate 

the DRG relative weights, as follows: 

<bullet≤ The costs for cases involving 

Electroencephalography (EEG), cost 

report line 54, are currently in the 

Cardiology cost center group. However, 

MedPAR categorizes the claims data for 

EEG under Laboratory Charges (revenue 

codes 0740 and 0749). In order to 

maintain consistency with matching 

costs on the cost report to charges on 

MedPAR claims, we are proposing to 

move cost report line 54 for EEG out of 

the Cardiology cost center group into 

the Laboratory cost center group. 

<bullet≤ In the FY 2007 IPPS 

proposed rule, we originally included 

the costs for Radioisotopes, cost report 

line 43, in the Radiology cost center 

group. However, in response to 

comments, we moved Radioisotopes to 

the Other Services cost center group. 

After researching this issue further over 

the past year, we believe that 

Radioisotopes is a radiology-related 

service that more appropriately belongs 

in the Radiology cost center group. 

Accordingly, for FY 2008, we are 

proposing to move the cost report line 

item for line 43, Radioisotopes, out of 

the Other Services cost center group and 

into the Radiology cost center group. 

The proposed version of the 13 cost 

center groupings are in the table below: 

BILLING CODE 4120–01–P 

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BILLING CODE 4120–01–C 

We developed the national average 

CCRs as follows: 

Taking the FY 2005 cost report data, 

we removed CAHs, Indian Health 

Service hospitals, all-inclusive rate 

hospitals, and cost reports that 

represented time periods of less than 1 

year (365 days). We included hospitals 

located in Maryland as we are including 

their charges in our claims database. We 

then created CCRs for each provider for 

each cost center (see prior table for line 

items used in the calculations) and 

removed any CCRs that were greater 

than 10 or less than 0.01. We 

normalized the departmental CCRs by 

dividing the CCR for each department 

by the total CCR for the hospital for the 

purpose of trimming the data. We then 

took the logs of the normalized cost 

center CCRs and removed any cost 

center CCRs where the log of the cost 

center CCR was greater or less than the 

mean log plus/minus 3 times the 

standard deviation for the log of that 

cost center CCR. Once the cost report 

data were trimmed, we calculated a 

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the Medicare charges for each line item 

from Worksheet D, Part 4 and deriving 

the Medicare specific costs by applying 

the hospital-specific departmental CCRs 

to the Medicare-specific charges for 

each line item from Worksheet D, Part 

4. Once each hospital’s Medicarespecific costs were established, we 

summed the total Medicare-specific 

costs and divided by the sum of the total 

Medicare-specific charges to produce 

national average, charge-weighted CCRs. 

After we multiplied the total charges 

for each DRG in each of the 13 cost 

centers by the corresponding national 

average CCR, we summed the 13 ‘‘costs’’ 

across each DRG to produce a total 

standardized cost for the DRG. The 

average standardized cost for each DRG 

was then computed as the total 

standardized cost for the DRG divided 

by the transfer adjusted case count for 

the DRG. The average cost for each DRG 

was then divided by the national 

average standardized cost per case to 

determine the relative weight. 

The new cost-based weights were 

then normalized by an adjustment factor 

of 1.50988 so that the average case 

weight after recalibration was equal to 

the average case weight before 

recalibration. Since more trims were 

applied to the data under the cost-based 

weights methodology than under the 

charge-based methodology, a smaller 

universe of claims was used in the costbased methodology. In this instance, the 

different universe of claims also 

resulted in a slightly higher cost-based 

normalization factor than the 

normalization factor derived for chargebased weights. The normalization 

adjustment is intended to ensure that 

recalibration by itself neither increases 

nor decreases total payments under the 

IPPS as required by section 

1886(d)(4)(C)(iii) of the Act. 

The 13 proposed national average 

CCRs for FY 2008 are as follows: 

Group CCR 

Routine Days ...................................... 0.52 

Intensive Days .................................... 0.48 

Drugs .................................................. 0.21 

Supplies & Equipment ........................ 0.34 

Therapy Services ................................ 0.42 

Laboratory ........................................... 0.17 

Operating Room ................................. 0.30 

Cardiology ........................................... 0.19 

Radiology ............................................ 0.18 

Other Services .................................... 0.37 

Labor & Delivery ................................. 0.47 

Inhalation Therapy .............................. 0.19 

Anesthesia .......................................... 0.14 

When we recalibrated the DRG 

weights for previous years, we set a 

threshold of 10 cases as the minimum 

number of cases required to compute a 

reasonable weight. We used that same 

case threshold in recalibrating the DRG 

weights for FY 2008. Using the FY 2006 

MedPAR data set, there are 7 proposed 

MS–DRGs that contain fewer than 10 

cases. Under the proposed MS–DRGs, 

we have fewer low-volume DRGs than 

under the CMS DRGs because we no 

longer have separate DRGs for patients 

age 0 to 17 years. With the exception of 

newborns, we previously separated 

some DRGs based on whether the 

patient was age 0–17 or age 17 and 

older. Other than the age split, cases 

grouping to these DRGs are identical. 

The DRGs for patients age 0 to 17 years 

generally have very low volumes 

because children are typically ineligible 

for Medicare. In the past, we have found 

that the low volume of cases for the 

pediatric DRGs could lead to significant 

year-to-year instability in their relative 

weights. Although we have always 

encouraged non-Medicare payers to 

develop weights applicable to their own 

patient populations, we have heard 

frequent complaints from providers 

about the use of the Medicare relative 

weights in the pediatric population. We 

believe that eliminating this age split in 

the proposed MS–DRGs will provide 

more stable payment for pediatric cases 

by determining their payment using 

adult cases that are much higher in total 

volume. All of the low-volume DRGs 

listed below are for newborns. 

Newborns are unique and require 

separate DRGs that are not mirrored in 

the adult population. Therefore, it 

remains necessary to retain separate 

DRGs for newborns. In FY 2008, because 

we do not have sufficient MedPAR data 

to set accurate and stable cost weights 

for these low-volume DRGs, we are 

proposing to compute weights for the 

low-volume DRGs by adjusting their FY 

2007 weights by the percentage change 

in the average weight of the cases in 

other DRGs. The crosswalk table we are 

proposing is shown below: 

Low-volume DRG DRG title Crosswalk to DRG 

789 .......... Neonates, Died or Transferred to Another 

Acute Care Facility.

FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

790 .......... Extreme Immaturity or Respiratory Distress 

Syndrome, Neonate.

FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

791 .......... Prematurity With Major Problems ............... FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

792 .......... Prematurity Without Major Problems .......... FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

793 .......... Full-term Neonate With Major Problems .... FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

794 .......... Neonate With Other Significant Problems .. FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

795 .......... Normal Newborn ......................................... FY 2007 FR weight (adjusted by percent change in average weight of the cases in 

other DRGs). 

I. Proposed MS–LTC–DRG 

Reclassifications and Relative Weights 

for LTCHs for FY 2008 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘MS–LTC–DRGs’’ at the 

beginning of your comment.) 

1. Background 

In the June 6, 2003 LTCH PPS final 

rule (68 FR 34122), we changed the 

LTCH PPS annual payment rate update 

cycle to be effective July 1 through June 

30 instead of October 1 through 

September 30. In addition, because the 

patient classification system utilized 

under the LTCH PPS uses the same CMS 

DRGs as those currently used under the 

IPPS for acute care hospitals, in that 

same final rule, we explained that the 

annual update of the long-term care 

diagnosis-related group (LTC–DRG) 

classifications and relative weights will 

continue to remain linked to the annual 

reclassification and recalibration of the 

CMS DRGs used under the IPPS. 

Therefore, we specified that we will 

continue to update the LTC–DRG 

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classifications and relative weights to be 

effective for discharges occurring on or 

after October 1 through September 30 

each year. We further stated that we will 

publish the annual proposed and final 

update of the LTC–DRGs in same notice 

as the proposed and final update for the 

IPPS (69 FR 34125). 

In the past, the annual update to the 

IPPS CMS DRGs has been based on the 

annual revisions to the ICD–9–CM codes 

and was effective each October 1. As 

discussed in the FY 2007 IPPS final rule 

(71 FR 47971 through 47994) and in the 

Rate Year (RY) 2008 LTCH PPS 

proposed rule (72 FR 4783 through 

4789), with the implementation of 

section 503(a) of Pub. L. 108–173, there 

is the possibility that one feature of the 

GROUPER software program may be 

updated twice during a Federal fiscal 

year (October 1 and April 1) as required 

by the statute for the IPPS. Section 

503(a) of Pub. L. 108–173 amended 

section 1886(d)(5)(K) of the Act by 

adding a new clause (vii) which states 

that ‘‘the Secretary shall provide for the 

addition of new diagnosis and 

procedure codes in [sic] April 1 of each 

year, but the addition of such codes 

shall not require the Secretary to adjust 

the payment (or diagnosis-related group 

classification) * * * until the fiscal year 

that begins after such date.’’ This 

requirement improves the recognition of 

new technologies under the IPPS by 

accounting for those ICD–9–CM codes 

in the MedPAR claims data earlier than 

the agency had accounted for new 

technology in the past. In implementing 

the statutory change, the agency has 

provided that ICD–9–CM diagnosis and 

procedure codes for new medical 

technology may be created and assigned 

to existing CMS DRGs in the middle of 

the Federal fiscal year, on April 1. 

However, this policy change will not 

impact the DRG relative weights in 

effect for that year, which will continue 

to be updated only once a year (October 

1), nor will it have any impact on 

Medicare payments. The use of the ICD– 

9–CM code set is also compliant with 

the current requirements of the 

Transactions and Code Sets Standards 

regulations at 45 CFR Parts 160 and 162, 

promulgated in accordance with the 

Health Insurance Portability and 

Accountability Act of 1996 (HIPAA), 

Pub. L. 104–191. 

As noted above, the patient 

classification system used under the 

LTCH PPS (LTC–DRGs) is based on the 

patient classification system used under 

the IPPS (CMS DRGs). Therefore, the 

ICD–9–CM codes currently used under 

both the IPPS and LTCH PPS may be 

updated as often as twice a year. This 

requirement is included as part of the 

amendments to the Act relating to 

recognition of new medical technology 

under the IPPS. 

Because we do not publish a midyear 

IPPS rule, any April 1 ICD–9–CM 

coding update will not be published 

midyear. Rather, we will assign any new 

diagnosis or procedure codes to the 

same DRG in which its predecessor code 

was assigned, so that there will be no 

impact on the DRG assignments (as also 

discussed in section II.G.10. of this 

preamble). Any coding updates will be 

available through the Web sites 

provided in section II.G.10. of this 

preamble and through the Coding Clinic 

for ICD–9–CM, a product of the 

American Hospital Association. 

Publishers and software vendors 

currently obtain code changes through 

these sources in order to update their 

code books and software system. If new 

codes are implemented on April 1, 

revised code books and software 

systems, including the GROUPER 

software program, will be necessary 

because we must use current ICD–9–CM 

codes. Therefore, for purposes of the 

LTCH PPS, because each ICD–9–CM 

code must be included in the GROUPER 

algorithm to classify each case into a 

LTC–DRG, the GROUPER software 

program used under the LTCH PPS 

would need to be revised to 

accommodate any new codes. 

In implementing section 503(a) of 

Pub. L. 108–173, there will only be an 

April 1 update if new technology codes 

are requested and approved. We note 

that any new codes created for April 1 

implementation will be limited to those 

diagnosis and procedure code revisions 

primarily needed to describe new 

technologies and medical services. 

However, we reiterate that the process 

of discussing updates to the ICD–9–CM 

is an open process through the ICD–9– 

CM Coordination and Maintenance 

Committee. Requestors will be given the 

opportunity to present the merits for a 

new code and to make a clear and 

convincing case for the need to update 

ICD–9–CM codes for purposes of the 

IPPS new technology add-on payment 

process through an April 1 update (as 

also discussed in section II.G.10. of this 

preamble). 

As we discussed in the RY 2008 

LTCH PPS proposed rule (72 FR 4783 

through 4789), at the September 28, 

2006 ICD–9–CM Coordination and 

Maintenance Committee meeting, there 

were no requests for an April 1, 2007 

implementation of ICD–9–CM codes. 

Therefore, the next update to the ICD– 

9–CM coding system will not occur 

until October 1, 2007 (FY 2008). 

Because there were no coding changes 

suggested for an April 1, 2007 update, 

the ICD–9–CM coding set implemented 

on October 1, 2006, will continue 

through September 30, 2007 (FY 2008). 

The update to the ICD–9–CM coding 

system for FY 2008 is discussed above 

in section II.G.10. of this preamble. 

Accordingly, in this proposed rule, as 

discussed in greater detail below, we are 

proposing to modify and revise the 

LTC–DRG classifications and relative 

weights, to be effective October 1, 2007 

through September 30, 2008 (FY 2008). 

In addition, we will notify LTCHs of any 

revisions to the GROUPER software 

used under the IPPS and the LTCH PPS 

that may be implemented on April 1, 

2008. The proposed LTC–DRGs and 

proposed relative weights for FY 2008 

in this proposed rule are based on the 

proposed IPPS MS–DRGs (GROUPER 

Version 25.0) discussed in section II.B. 

of the preamble to this proposed rule. 

2. Proposed Changes in the LTC–DRG 

Classifications 

a. Background 

Section 123 of Pub. L. 106–113 

specifically requires that the agency 

implement a PPS for LTCHs that is a per 

discharge system with a DRG-based 

patient classification system reflecting 

the differences in patient resources and 

costs in LTCHs while maintaining 

budget neutrality. Section 307(b)(1) of 

Pub. L. 106–554 modified the 

requirements of section 123 of Pub. L. 

106–113 by specifically requiring that 

the Secretary examine ‘‘the feasibility 

and the impact of basing payment under 

such a system [the LTCH PPS] on the 

use of existing (or refined) hospital 

diagnosis-related groups (DRGs) that 

have been modified to account for 

different resource use of long-term care 

hospital patients as well as the use of 

the most recently available hospital 

discharge data.’’ 

In accordance with section 123 of 

Pub. L. 106–113 as amended by section 

307(b)(1) of Pub. L. 106–554 and §

412.515 of our existing regulations, the 

LTCH PPS uses information from LTCH 

patient records to classify patient cases 

into distinct LTC–DRGs based on 

clinical characteristics and expected 

resource needs. As described in II.D. of 

the preamble of this proposed rule, we 

are proposing to adopt MS–DRGs under 

the IPPS because we believe that 

adopting this system will result in a 

significant improvement in the DRG 

system’s recognition of severity of 

illness and resource usage. We believe 

these improvements in the DRG system 

would be equally applicable to the 

LTCH PPS. The changes we are 

currently proposing for the IPPS would 

be reflected in the FY 2008 GROUPER, 

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Version 25.0, to be effective for 

discharges occurring on or after October 

1, 2007 through September 30, 2008. 

Currently, the LTC–DRGs used as the 

patient classification component of the 

LTCH PPS correspond to the current 

CMS DRGs applicable under the IPPS 

for acute care hospitals 

Consistent with our historical practice 

of having LTC–DRGs correspond to the 

DRGs applicable under the IPPS, under 

the broad authority of section 123(a) of 

Pub. L. 106–113, as modified by section 

307(b) of Pub. L. 106–554, we are 

proposing to use MS–LTC–DRGs which 

correspond to the proposed MS–DRGs. 

In addition, as stated above, we are 

proposing to use the FY 2008 GOUPER 

Version 25.0, to be effective for 

discharges occurring on or after October 

1, 2007 through September 30, 2008. 

The proposed changes to the current 

CMS DRG classification system used 

under the IPPS for FY 2008 (GROUPER 

Version 25.0) are discussed in section 

II.D. of the preamble to this proposed 

rule. 

As noted above, the patient 

classification system used under the 

LTCH PPS (LTC–DRGs) is based on the 

patient classification system used under 

the IPPS (CMS DRGs), which 

historically has been updated annually 

as authorized by section 1886(d)(4)(C) of 

the Act and is effective for discharges 

occurring on or after October 1 through 

September 30 of each year. As such, the 

proposed updates to the CMS DRG 

classification system used under the 

IPPS for FY 2008 (GROUPER Version 

25.0), discussed in section II.D. of the 

preamble of this proposed rule, would 

be applicable to updates under the 

LTCH PPS. In conjunction with the 

proposed changes to the existing CMS 

DRGs for the IPPS by adoption of the 

proposed MS–DRGs, we are proposing 

to adopt the MS–DRGs for the LTCH 

PPS, as both sets of DRGs are based on 

the same DRG structure. However, we 

refer to the proposed DRGs under the 

LTCH PPS as MS–LTC–DRGs. This 

proposed conforming change, that is, to 

replicate the MS–LTC–DRG structure 

after the proposed MS–DRG structure is 

appropriate in order to maintain 

consistency and uniformity among a 

number of stakeholders, such as acute 

care hospitals, LTCHs, epidemiologists, 

ratesetting organizations, and payors, 

among others. 

Under the LTCH PPS, as described in 

greater detail below, we determine 

relative weights for each of the DRGs to 

account for the difference in resource 

use by patients exhibiting the case 

complexity and multiple medical 

problems characteristic of LTCH 

patients. (Unless otherwise noted in this 

proposed rule, our MS–LTC–DRG 

analysis is based on LTCH data from the 

December 2006 update of the FY 2006 

MedPAR file, which contains hospital 

bills received through December 31, 

2006, for discharges occurring in FY 

2006.) 

LTCHs do not typically treat the full 

range of diagnoses as do acute care 

hospitals. Therefore, as we discussed in 

the August 30, 2002 LTCH PPS final 

rule (67 FR 55985), which implemented 

the LTCH PPS, and the FY 2006 IPPS 

final rule (70 FR 47324), we use lowvolume quintiles in determining the 

LTC–DRG relative weights for LTC– 

DRGs with less than 25 LTCH cases 

(low-volume LTC–DRGs). Specifically, 

we group those low-volume LTC–DRGs 

into 5 quintiles based on average 

charges per discharge. (A listing of the 

composition of low-volume quintiles for 

the FY 2007 LTC–DRGs (based on FY 

2005 MedPAR data) appears in section 

II.I.2.d. of the FY 2007 IPPS final rule 

(71 FR 47975 through 47978).) We also 

adjust for cases in which the stay at the 

LTCH is less than or equal to five-sixths 

of the geometric average length of stay; 

that is, short-stay outlier cases (§

412.529), as discussed below in section 

II.I.4. of this preamble. 

b. Patient Classifications into DRGs 

Generally, under the LTCH PPS, 

Medicare payment is made at a 

predetermined specific rate for each 

discharge; that is, payment varies by the 

LTC–DRG to which a beneficiary’s stay 

is assigned. Just as cases have been 

classified into the proposed MS–DRGs 

for acute care hospitals under the IPPS 

(section II. of the preamble of this 

proposed rule), cases have been 

classified into proposed MS–LTC–DRGs 

for payment under the LTCH PPS based 

on the principal diagnosis, up to eight 

additional diagnoses, and up to six 

procedures performed during the stay, 

as well as age, sex, and discharge status 

of the patient. The diagnosis and 

procedure information is reported by 

the hospital using the ICD–9–CM codes. 

Under the proposed MS–DRGs for the 

IPPS and the proposed MS–LTC–DRGs 

for the LTCH PPS, these factors will not 

change. 

Section II.B. of the preamble of this 

proposed rule discusses the 

organization of the existing CMS DRGs, 

which we are proposing to maintain 

under the proposed MS–DRG and MS– 

LTC–DRG systems. As noted above, the 

patient classification system for the 

LTCH PPS is derived from the CMS 

DRGs and is similarly organized into 25 

major diagnostic categories (MDCs). 

Most of these MDCs are based on a 

particular organ system of the body and 

the remainder involves multiple organ 

systems (such as MDC 22, Burns). 

Accordingly, the principal diagnosis 

determines MDC assignment. Within 

most MDCs, cases are then divided into 

surgical DRGs and medical DRGs. Under 

the present CMS DRGs, some surgical 

and medical DRGs are further 

differentiated based on the presence or 

absence of CCs. The existing LTC–DRGs 

are similarly categorized. (See section 

II.B. of the preamble of this proposed 

rule for further discussion of surgical 

DRGs and medical DRGs.) 

The proposed MS–DRGs and the 

proposed MS–LTC–DRGs contain base 

DRGs that have been subdivided into 

one, two, or three severity levels. The 

most severe level has at least one code 

that is a major CC, referred to as ‘‘with 

MCC’’. The next lower severity level 

contains cases with at least one CC, 

referred to as ‘‘with CC’’. Those DRGs 

without an MCC or a CC are referred to 

as ‘‘without CC/MCC’’. When data did 

not support the creation of three 

severity levels, the base DRG was 

divided into either two levels or the 

base was not subdivided. The proposed 

two-level subdivisions consist of one of 

the following subdivisions: 

<bullet≤ With CC/MCC 

<bullet≤ Without CC/MCC 

In this type of subdivision, cases with 

at least one code that is on the CC or 

MCC list are assigned to the ‘‘with CC/ 

MCC’’ DRG. Cases without a CC or an 

MCC are assigned to the ‘‘without CC/ 

MCC’’ DRG. 

The other type of proposed two-level 

subdivision is as follows: 

<bullet≤ With MCC 

<bullet≤ Without MCC 

In this type of subdivision, cases with 

at least one code that is on the MCC list 

are assigned to the ‘‘with MCC’’ DRG. 

Cases that do not have an MCC are 

assigned to the ‘‘without MCC’’ DRG. 

This type of subdivision could include 

cases with a CC code, but no MCC. 

As under the present LTC–DRG 

system, we are proposing that the 

assignment of a case to a particular MS– 

LTC–DRG will determine the amount 

that is paid for the case. Therefore, it is 

important that the coding is accurate. 

Classifications and terminology used 

under the LTCH PPS are consistent with 

the ICD–9–CM and the Uniform 

Hospital Discharge Data Set (UHDDS), 

as recommended to the Secretary by the 

National Committee on Vital and Health 

Statistics (‘‘Uniform Hospital Discharge 

Data: Minimum Data Set, National 

Center for Health Statistics, April 

1980’’) and as revised in 1984 by the 

Health Information Policy Council 

(HIPC) of the U.S. Department of Health 

and Human Services. Again, we point 

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out that the ICD–9–CM coding 

terminology and the definitions of 

principal and other diagnoses of the 

UHDDS are consistent with the 

requirements of the Transactions and 

Code Sets Standards under HIPAA (45 

CFR Parts 160 and 162). 

The emphasis on the need for proper 

coding cannot be overstated. As under 

the present LTC–DRG system, 

inappropriate coding of cases under the 

proposed MS–LTC–DRG system could 

adversely affect the uniformity of cases 

in each proposed MS–LTC–DRG and 

produce inappropriate weighting factors 

at recalibration and result in 

inappropriate payments under the 

LTCH PPS. LTCHs are required to 

follow the same coding guidelines 

established under the IPPS, described in 

section II.G.10 of the preamble of this 

proposed rule established under the 

IPPS. It is mandatory that the coders 

continue to report the same principal 

diagnosis on all claims and include all 

diagnosis codes for conditions that 

coexist at the time of admission, for 

conditions that are subsequently 

developed, or for conditions that affect 

the treatment received. Similarly, all 

procedures performed in a LTCH, or 

paid for under arrangements by a LTCH 

(§ 412.509), during that stay are to be 

reported on each claim. Consistent with 

current practice, there will be only one 

proposed MS–LTC–DRG assigned to 

each discharge of the patient from a 

LTCH. 

Under the proposed MS–LTC–DRG 

classification system, as is required 

under existing policy, upon the 

discharge of the patient from a LTCH, 

the LTCH must assign appropriate 

diagnosis and procedure codes from the 

ICD–9–CM. Completed claim forms are 

to be submitted electronically to the 

LTCH’s fiscal intermediary (or, if 

applicable, MAC). The fiscal 

intermediary or MAC enters the clinical 

and demographic information into their 

claims processing systems and subject 

this information to a series of automated 

screening processes called the MCE. 

These screens are designed to identify 

cases that require further review before 

assignment into a LTC–DRG can be 

made. 

After screening through the MCE, 

each LTCH claim will be classified into 

the appropriate LTC–DRG by the 

Medicare LTCH GROUPER. The LTCH 

GROUPER is specialized computer 

software and is the same GROUPER 

used under the IPPS. After the LTC– 

DRG is assigned, the fiscal intermediary 

or MAC determines the prospective 

payment by using the Medicare LTCH 

PPS PRICER program, which accounts 

for LTCH hospital-specific adjustments 

and payment rates. As provided for 

under the IPPS, we provide an 

opportunity for the LTCH to review the 

LTC–DRG assignments made by the 

fiscal intermediary or MAC and to 

submit additional information, if 

necessary, within a specified timeframe 

(§ 412.513(c)). Under the proposed 

adoption of the MS–LTC–DRG, there 

would be no changes in this procedure. 

The LTCH GROUPER is used both to 

classify past cases in order to measure 

relative hospital resource consumption 

to establish the proposed MS–LTC–DRG 

weights and to classify current cases for 

purposes of determining payment. The 

records for all Medicare hospital 

inpatient discharges are maintained in 

the MedPAR file. The data in this file 

are used to evaluate possible DRG 

classification changes and to recalibrate 

the DRG weights during our annual 

update (as discussed in section II.H. of 

the preamble of this proposed rule). The 

proposed MS–LTC–DRG relative 

weights are based on data for the 

population of LTCH discharges. 

3. Development of the Proposed FY 

2008 MS–LTC–DRG Relative Weights 

a. General Overview of Development of 

the Proposed MS–LTC–DRG Relative 

Weights 

As we stated in the August 30, 2002 

LTCH PPS final rule (67 FR 55981), one 

of the primary goals for the 

implementation of the LTCH PPS is to 

pay each LTCH an appropriate amount 

for the efficient delivery of medical care 

to Medicare patients. The system must 

be able to account adequately for each 

LTCH’s case-mix in order to ensure both 

fair distribution of Medicare payments 

and access to adequate care for those 

Medicare patients whose care is more 

costly. To accomplish these goals, we 

have annually adjusted the LTCH PPS 

standard Federal prospective payment 

system rate by the applicable LTC–DRG 

relative weight in determining payment 

to LTCHs for each case. (As we have 

noted above, we are proposing to adopt 

the MS–LTC–DRGs for the LTCH PPS 

for FY 2008. However, this proposed 

change in the patient classification 

system does not affect the basic 

principles of the development of 

relative weights under a DRG-based 

prospective payment system. For 

purposes of clarity, in the general 

discussion below in which we describe 

the basic methodology of the patient 

classification system, in use since the 

start of the LTCH PPS, we use ‘‘MS– 

LTC–DRG’’ to specify the proposed DRG 

system to be used by the LTCH 

prospective payment system in FY 

2008.) 

Although the proposed adoption of 

the MS–LTC–DRGs will result in some 

modifications of existing procedures for 

assigning weights in cases of zero 

volume and/or nonmonotonicity, 

discussed in detail in the following 

sections, the basic methodology for 

developing the proposed FY 2008 MS– 

LTC–DRG relative weights in this 

proposed rule continue to be 

determined in accordance with the 

general methodology established in the 

August 30, 2002 LTCH PPS final rule 

(67 FR 55989 through 55991). 

(Therefore, as noted above, in this 

preamble, ‘‘LTC–DRGs’’ will be used in 

descriptions of the basic methodology 

established at the beginning of the 

LTCH PPS that will remain unchanged 

if we adopt the proposed MS–LTC– 

DRGs. Use of ‘‘MS–LTC–DRGs’’ will 

indicate a discussion of specifics 

aspects of our proposed adoption of the 

severity-weighted patient classification 

system for FY 2008.) 

Under the LTCH PPS, relative weights 

for each proposed MS–LTC–DRG are a 

primary element used to account for the 

variations in cost per discharge and 

resource utilization among the payment 

groups (§ 412.515). To ensure that 

Medicare patients classified to each 

proposed MS–LTC–DRG have access to 

an appropriate level of services and to 

encourage efficiency, we calculate a 

relative weight for each proposed MS– 

LTC–DRG that represents the resources 

needed by an average inpatient LTCH 

case in that proposed MS–LTC–DRG. 

For example, cases in a proposed MS– 

LTC–DRG with a relative weight of 2 

will, on average, cost twice as much to 

treat as cases in a proposed MS–LTC– 

DRG with a weight of 1. 

b. Data 

To calculate the proposed MS–LTC– 

DRG relative weights for FY 2008 in his 

proposed rule, we obtained total 

Medicare allowable charges from FY 

2006 Medicare LTCH bill data from the 

December 2006 update of the MedPAR 

file, which are the best available data at 

this time, and we used the proposed 

Version 25.0 of the CMS GROUPER 

used under the IPPS (as discussed in 

section II.B. of the preamble of this 

proposed rule) to classify cases. To 

calculate the final MS–LTC–DRG 

relative weights for FY 2008, we are 

proposing that, if more recent data are 

available (that is, data from the March 

2007 update of the MedPAR file), we 

would use those data and the finalized 

Version 25.0 of the CMS GROUPER 

used under the IPPS. 

As we discussed in the FY 2007 IPPS 

final rule (71 FR 47974), we have 

excluded the data from LTCHs that are 

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all-inclusive rate providers and LTCHs 

that are reimbursed in accordance with 

demonstration projects authorized 

under section 402(a) of Pub. L. 90–248. 

Data from demonstration projects 

authorized under section 222(a) of Pub. 

L. 92–603 are also excluded. Therefore, 

in the development of the proposed FY 

2008 MS–LTC–DRG relative weights in 

this proposed rule, we have excluded 

the data of the 19 all-inclusive rate 

providers and the 3 LTCHs that are paid 

in accordance with demonstration 

projects that had claims in the FY 2006 

MedPAR file. 

c. Hospital-Specific Relative Value 

Methodology 

By nature, LTCHs often specialize in 

certain areas, such as ventilatordependent patients and rehabilitation 

and wound care. Some case types 

(DRGs) may be treated, to a large extent, 

in hospitals that have, from a 

perspective of charges, relatively high 

(or low) charges. This nonarbitrary 

distribution of cases with relatively high 

(or low) charges in specific proposed 

MS–LTC–DRGs has the potential to 

inappropriately distort the measure of 

average charges. To account for the fact 

that cases may not be randomly 

distributed across LTCHs, we use a 

hospital-specific relative value (HSRV) 

method to calculate the proposed MS– 

LTC–DRG relative weights instead of the 

methodology used to determine the 

proposed CMS DRG relative weights 

under the IPPS described in section II.H. 

of the preamble this proposed rule. We 

believe this method will remove this 

hospital-specific source of bias in 

measuring LTCH average charges. 

Specifically, we reduce the impact of 

the variation in charges across providers 

on any particular LTC–DRG relative 

weight by converting each LTCH’s 

charge for a case to a relative value 

based on that LTCH’s average charge. 

Under the HSRV method, we 

standardize charges for each LTCH by 

converting its charges for each case to 

hospital-specific relative charge values 

and then adjusting those values for the 

LTCH’s case-mix. The adjustment for 

case-mix is needed to rescale the 

hospital-specific relative charge values 

(which, by definition, average 1.0 for 

each LTCH). The average relative weight 

for a LTCH is its case-mix, so it is 

reasonable to scale each LTCH’s average 

relative charge value by its case-mix. In 

this way, each LTCH’s relative charge 

value is adjusted by its case-mix to an 

average that reflects the complexity of 

the cases it treats relative to the 

complexity of the cases treated by all 

other LTCHs (the average case-mix of all 

LTCHs). 

In accordance with the methodology 

established under § 412.523, as 

implemented in the August 30, 2002 

LTCH PPS final rule (67 FR 55989 

through 55991), we continue to 

standardize charges for each case by 

first dividing the adjusted charge for the 

case (adjusted for short-stay outliers 

under § 412.529 as described in section 

II.I.4. (step 3) of the preamble of this 

proposed rule) by the average adjusted 

charge for all cases at the LTCH in 

which the case was treated. Short-stay 

outliers under § 412.529 are cases with 

a length of stay that is less than or equal 

to five-sixths the average length of stay 

of the proposed MS–LTC–DRG. The 

average adjusted charge reflects the 

average intensity of the health care 

services delivered by a particular LTCH 

and the average cost level of that LTCH. 

The resulting ratio is multiplied by that 

LTCH’s case-mix index to determine the 

standardized charge for the case. 

Multiplying by the LTCH’s case-mix 

index accounts for the fact that the same 

relative charges are given greater weight 

at a LTCH with higher average costs 

than they would at a LTCH with low 

average costs, which is needed to adjust 

each LTCH’s relative charge value to 

reflect its case-mix relative to the 

average case-mix for all LTCHs. Because 

we standardize charges in this manner, 

we count charges for a Medicare patient 

at a LTCH with high average charges as 

less resource intensive than they would 

be at a LTCH with low average charges. 

For example, a $10,000 charge for a case 

at a LTCH with an average adjusted 

charge of $17,500 reflects a higher level 

of relative resource use than a $10,000 

charge for a case at a LTCH with the 

same case-mix, but an average adjusted 

charge of $35,000. We believe that the 

adjusted charge of an individual case 

more accurately reflects actual resource 

use for an individual LTCH because the 

variation in charges due to systematic 

differences in the markup of charges 

among LTCHs is taken into account. 

d. Proposed Treatment of Severity 

Levels in Developing Relative Weights 

With the implementation of the LTCH 

PPS for FY 2003, we established a 

procedure to address setting relative 

weights for LTC–DRG ‘‘pairs’’ that were 

differentiated on the presence or 

absence of CCs (71 FR 47979). For FY 

2008, we are proposing to adopt a 

severity-based patient classification 

system for the LTCH PPS, the MS–LTC– 

DRGs described above, which requires 

us to adapt our existing procedures for 

dealing with setting relative weights for 

the severity levels within a specific base 

DRG. We are also proposing to modify 

our existing methodology for 

maintaining monotonicity when setting 

relative weights for the proposed MS– 

LTC–DRGs. 

As under the existing procedure, 

under the proposed MS–LTC–DRGs, for 

purposes of the annual setting of the 

relative weights, there continue to be 

three different categories of DRGs based 

on volume of cases within specific LTC– 

DRGs. DRGs with at least 25 cases are 

each assigned a relative weight; lowvolume proposed MS–LTC–DRGs (that 

is, proposed MS–LTC–DRGs that 

contain between one and 24 cases 

annually) are grouped into quintiles 

(described below) and assigned the 

weight of the quintile. Cases with novolume proposed MS–LTC–DRGs (that 

is, no cases in the databases were 

assigned to those proposed MS–LTC– 

DRGs) are crosswalked to other 

proposed MS–LTC–DRGs based on the 

clinical similarities and assigned the 

weight of the quintile that is closest to 

the relative weight of the crosswalked 

proposed MS–LTC–DRG. (We provide 

in-depth discussions of our proposals 

regarding weightsetting for low-volume 

MS–LTC–DRGs in section II.I.3.e. of the 

preamble of this proposed rule and for 

no-volume MS–LTC–DRGs, under Step 

4 in section II.I.4. of the preamble of this 

proposed rule.) 

As described above, in response to the 

need to account for severity and pay 

appropriately for cases, we have 

developed a severity-adjusted patient 

classification system which we are 

proposing for both the IPPS and the 

LTCH PPS. As described in greater 

detail above, the proposed MS–LTC– 

DRG system can accommodate three 

severity levels: MCC (most severe); 

without CC/MCC (the least severe), and 

with CC, with each level assigned an 

individual MS–LTC–DRG number. In 

cases with two subdivisions, the levels 

are either with CC/MCC and without 

CC/MCC or with MCC and without 

MCC. Two parallel numbering systems 

have been developed, based on the MS– 

DRG patient classification system 

proposed under the IPPS, to describe 

proposed MS–LTC–DRGs. That is, while 

each severity level in each DRG category 

gets a unique MS–LTC–DRG number, in 

conjunction, each of the severity levels 

in a single DRG category are also 

assigned the same ‘‘base-DRG’’ number. 

We are proposing that the term ‘‘base 

DRG’’ is actually the MS–LTC–DRG 

number of the highest severity level and 

would be used when we refer to the 

MS–LTC–DRG category that 

encompasses all the levels of severity 

for that DRG. Therefore, under the 

proposed system, multiple sclerosis and 

cerebellar ataxia with MCC is MS–LTC– 

DRG 58; multiple sclerosis and 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24759 

cerebellar ataxia with CC is MS–LTC– 

DRG 59; and multiple sclerosis and 

cerebellar ataxia without CC/MCC is 

MS–LTC–DRG 59, and the base MS– 

LTC–DRG for each is 58. 

As noted above, for FY 2008, we are 

proposing to adopt the MS–DRGs for 

use in both the LTCH PPS and the IPPS. 

While the LTCH PPS and the IPPS use 

the same patient classification system, 

the methodology that is used to set the 

DRG weights for use in each payment 

system differs because the overall 

volume of cases in the LTCH PPS is 

much less than in the IPPS. As a general 

rule, we are proposing to set the weights 

for the MS–LTC–DRGs using the 

following steps: (1) If an MS–LTC–DRG 

has at least 25 cases, it is assigned its 

own relative weight; (2) if an MS–LTC– 

DRGs has between 1 and 24 cases, it is 

assigned to a quintile to which we will 

assign a relative weight; and (3) if an 

MS–LTC–DRG has no cases, it is 

crosswalked to another DRG based upon 

clinical similarities and assigned the 

appropriate relative weight (as 

described in detail in Step 5, below). 

Theoretically, as with the existing 

LTC–DRG system, cases under the 

proposed MS–LTC–DRG system that are 

more severe require greater expenditure 

of medical care resources and will result 

in higher average charges. Therefore, in 

the three severity levels, weights should 

increase with severity, from lowest to 

highest. If the weights do not increase 

(that is, if based on the weight 

calculation, a proposed MS–LTC–DRG 

with MCC would have a lower relative 

weight than one with CC, or the DRG 

without CC/MCC would have a higher 

relative weight than either of the 

others), there is a problem with 

monotonicity. Since the start of the 

LTCH PPS for FY 2003 (67 FR 55990), 

we have adjusted the setting of the LTC– 

DRG relative weight in order to 

maintain monotonicity by grouping both 

sets of cases together and establishing a 

new relative weight that is assigned to 

both LTC–DRGs. Similarly, we are 

proposing a procedure for dealing with 

nonmonotonicity under the proposed 

MS–LTC–DRG classification system that 

we describe in detail in our explanation 

of our methodology for setting the 

proposed FY 2008 relative weights for 

the LTCH PPS, which is discussed in 

section II.F.4 of the preamble of this 

proposed rule. 

e. Low-Volume Proposed MS–LTC– 

DRGs 

In order to account for LTC–DRGs 

with low volume (that is, with fewer 

than 25 LTCH cases), under current 

policy, in accordance with the 

methodology established in the August 

30, 2002 LTCH PPS final rule (67 FR 

55984), we group those ‘‘low-volume 

LTC–DRGs’’ (that is, DRGs that 

contained between 1 and 24 cases 

annually) into one of five categories 

(quintiles) based on average charges, for 

the purposes of determining relative 

weights. For this FY 2008 IPPS 

proposed rule, we are proposing to 

continue to employ this treatment of 

low-volume proposed MS–LTC–DRGs 

with a modification to combine 

proposed MS–LTC–DRGs for the 

purpose of computing a relative weight 

in cases where necessary to maintain 

monotonicity in determining the 

proposed FY 2008 MS–LTC–DRG 

relative weights using the best available 

LTCH data. In this proposed rule, using 

LTCH cases from the December 2006 

update of the FY 2006 MedPAR file, we 

identified 307 proposed MS–LTC–DRGs 

that contained between 1 and 24 cases. 

This list of proposed MS–LTC–DRGs 

was then divided into one of the 5 lowvolume quintiles, each containing a 

minimum of 61 proposed MS–LTC– 

DRGs (307/5 = 61, with a remainder of 

2 proposed MS–LTC–DRGs). Consistent 

with our current methodology, we are 

proposing to make an assignment to a 

specific low-volume quintile by sorting 

the low-volume proposed MS–LTC– 

DRGs in ascending order by average 

charge. For this proposed rule, this 

results in a proposed assignment to a 

specific low-volume quintile of the 

sorted 307 low-volume proposed MS– 

LTC–DRGs by ascending order by 

average charge. Because the number of 

low-volume proposed MS–LTC–DRGs 

for FY 2008 is not evenly divisible by 

five, to determine the composition of 

the low-volume quintiles in accordance 

with our established methodology, the 

average charge of the low-volume 

proposed MS–LTC–DRG was used to 

determine which low-volume quintile 

received the additional proposed MS– 

LTC–DRGs. After sorting the 307 lowvolume proposed MS–LTC–DRGs in 

ascending order, we grouped the first 

fifth (1st through 61st) of low-volume 

proposed MS–LTC–DRGs (with the 

lowest average charge) into Quintile 1. 

Because the average charge of the 62nd 

proposed MS–LTC–DRG in the sorted 

list is closer to the 61st proposed MS– 

LTC–DRGs average charge (assigned to 

Quintile 1) than to the average charge of 

the 63rd proposed MS–LTC–DRG in the 

sorted list (to be assigned to Quintile 2), 

we placed the 62nd proposed MS–LTC– 

DRG into Quintile 1. This process was 

repeated through the remaining lowvolume proposed MS–LTC–DRGs so 

that 2 low-volume quintiles contain 62 

proposed MS–LTC–DRGs and 3 lowvolume quintiles contain 61 proposed 

MS–LTC–DRGs. The highest average 

charge cases were grouped into Quintile 

5. 

In order to determine the proposed 

relative weights for the proposed MS– 

LTC–DRGs with low-volume for FY 

2008, based on the methodology 

established in the August 30, 2002 

LTCH PPS final rule (67 FR 55984), we 

are proposing to use the five lowvolume quintiles described above. In 

addition, in cases where the initial 

assignment of the low-volume proposed 

MS–LTC–DRGs to quintiles results in 

nonmonotonicity within a base DRG, we 

are proposing to combine those 

proposed MS–LTC–DRGs for the 

purpose of computing a relative weight 

and set the same relative weight to each 

of the proposed MS–LTC–DRGs within 

the base DRG that required combining. 

The treatment of low-volume proposed 

MS–LTC–DRGs to preserve 

monotonicity is further discussed in 

detail in section II.I.4 (Step 6 of the 

methodology for determining the 

proposed FY 2008 MS–LTC–DRG 

relative weights). The composition of 

each of the proposed five low-volume 

quintiles shown in the chart below was 

used in determining the proposed MS– 

LTC–DRG relative weights for FY 2008. 

We would determine a proposed 

relative weight and (geometric) average 

length of stay for each of the proposed 

five low-volume quintiles using the 

methodology that we apply to the 

regular proposed MS–LTC–DRGs (25 or 

more cases), as described below in 

section II.I.4. of the preamble of this 

proposed rule. We are proposing to 

assign the same relative weight and 

average length of stay to each of the 

proposed MS–LTC–DRGs that make up 

an individual proposed low-volume 

quintile. We note that, as this system is 

dynamic, it is possible that the number 

and specific type of MS–LTC–DRGs 

with a low volume of LTCH cases will 

vary in the future. We use the best 

available claims data in the MedPAR 

file to identify low-volume MS–LTC– 

DRGs and to calculate the relative 

weights based on our methodology. 

Therefore, we are proposing that, if we 

have updated data for the final rule, we 

will use that data to determine the 

finalized FY 2008 relative weights. 

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24760 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

QUINTILE 1 

30 ................. Spinal procedures w/o CC/MCC. 

32 ................. Ventricular shunt procedures w CC. 

33 ................. Ventricular shunt procedures w/o CC/MCC. 

58 ................. Multiple sclerosis & cerebellar ataxia w MCC*. 

60 ................. Multiple sclerosis & cerebellar ataxia w/o CC/MCC*. 

66 ................. Intracranial hemorrhage or cerebral infarction w/o CC/MCC. 

67 ................. Nonspecific CVA & precerebral occlusion w/o infarct w MCC. 

68 ................. Nonspecific CVA & precerebral occlusion w/o infarct w/o MCC. 

69 ................. Transient ischemia. 

72 ................. Nonspecific cerebrovascular disorders w/o CC/MCC. 

76 ................. Viral meningitis w/o CC/MCC. 

79 ................. Hypertensive encephalopathy w/o CC/MCC. 

88 ................. Concussion w MCC***. 

133 ............... Other ear, nose, mouth & throat O.R. procedures w CC/MCC***. 

122 ............... Acute major eye infections w/o CC/MCC. 

123 ............... Neurological eye disorders. 

149 ............... Dysequilibrium. 

153 ............... Otitis media & URI w/o MCC. 

182 ............... Respiratory neoplasms w/o CC/MCC. 

183 ............... Major chest trauma w MCC. 

184 ............... Major chest trauma w CC**. 

201 ............... Pneumothorax w/o CC/MCC. 

261 ............... Cardiac pacemaker revision except device replacement w CC. 

262 ............... Cardiac pacemaker revision except device replacement w/o CC/MCC. 

313 ............... Chest pain. 

328 ............... Stomach, esophageal & duodenal proc w/o CC/MCC. 

331 ............... Major small & large bowel procedures w/o CC/MCC. 

349 ............... Anal & stomal procedures w/o CC/MCC. 

376 ............... Digestive malignancy w/o CC/MCC. 

434 ............... Cirrhosis & alcoholic hepatitis w/o CC/MCC*. 

446 ............... Disorders of the biliary tract w/o CC/MCC. 

505 ............... Foot procedures w/o CC/MCC. 

512 ............... Shoulder, elbow or forearm proc, exc major joint proc w/o CC/MCC. 

544 ............... Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC. 

547 ............... Connective tissue disorders w/o CC/MCC. 

563 ............... Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC. 

598 ............... Malignant breast disorders w CC***. 

630 ............... Other endocrine, nutrit & metab O.R. proc w/o CC/MCC. 

645 ............... Endocrine disorders w/o CC/MCC. 

661 ............... Kidney & ureter procedures for non-neoplasm w/o CC/MCC. 

688 ............... Kidney & urinary tract neoplasms w/o CC/MCC. 

696 ............... Kidney & urinary tract signs & symptoms w/o MCC. 

714 ............... Transurethral prostatectomy w/o CC/MCC. 

718 ............... Other male reproductive system O.R. proc exc malignancy w/o CC/MCC. 

724 ............... Malignancy, male reproductive system w/o CC/MCC. 

726 ............... Benign prostatic hypertrophy w/o MCC. 

756 ............... Malignancy, female reproductive system w/o CC/MCC. 

759 ............... Infections, female reproductive system w/o CC/MCC. 

761 ............... Menstrual & other female reproductive system disorders w/o CC/MCC. 

825 ............... Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC. 

836 ............... Acute leukemia w/o major O.R. procedure w/o CC/MCC. 

869 ............... Other infectious & parasitic diseases diagnoses w/o CC/MCC. 

876 ............... O.R. procedure w principal diagnoses of mental illness. 

881 ............... Depressive neuroses. 

882 ............... Neuroses except depressive. 

883 ............... Disorders of personality & impulse control. 

886 ............... Behavioral & developmental disorders. 

894 ............... Alcohol/drug abuse or dependence, left ama. 

895 ............... Alcohol/drug abuse or dependence w rehabilitation therapy. 

906 ............... Hand procedures for injuries. 

916 ............... Allergic reactions w/o MCC. 

922 ............... Other injury, poisoning & toxic effect diag w MCC. 

923 ............... Other injury, poisoning & toxic effect diag w/o MCC. 

QUINTILE 2 

75 ................. Viral meningitis w CC/MCC. 

77 ................. Hypertensive encephalopathy w MCC. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24761 

PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

78 ................. Hypertensive encephalopathy w CC**. 

83 ................. Traumatic stupor & coma, coma ≤1 hr w CC. 

84 ................. Traumatic stupor & coma, coma ≤1 hr w/o CC/MCC. 

99 ................. Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC. 

102 ............... Headaches w MCC***. 

113 ............... Orbital procedures w CC/MCC. 

121 ............... Acute major eye infections w CC/MCC. 

125 ............... Other disorders of the eye w/o MCC. 

148 ............... Ear, nose, mouth & throat malignancy w/o CC/MCC. 

152 ............... Otitis media & URI w MCC. 

156 ............... Nasal trauma & deformity w/o CC/MCC. 

157 ............... Dental & Oral Diseases w MCC***. 

158 ............... Dental & Oral Diseases w CC***. 

184 ............... Major chest trauma w CC***. 

188 ............... Pleural effusion w/o CC/MCC*. 

200 ............... Pneumothorax w CC. 

245 ............... AICD lead & generator procedures. 

282 ............... Circulatory disorders w AMI, discharged alive w/o CC/MCC. 

285 ............... Circulatory disorders w AMI, expired w/o CC/MCC*. 

304 ............... Hypertension w MCC. 

311 ............... Angina pectoris. 

336 ............... Peritoneal adhesiolysis w CC. 

382 ............... Complicated peptic ulcer w/o CC/MCC. 

384 ............... Uncomplicated peptic ulcer w/o MCC. 

390 ............... G.I. obstruction w/o CC/MCC. 

433 ............... Cirrhosis & alcoholic hepatitis w CC*. 

437 ............... Malignancy of hepatobiliary system or pancreas w/o CC/MCC. 

443 ............... Disorders of liver except malig, cirr, alc hepa w/o CC/MCC. 

499 ............... Local excision & removal int fix devices of hip & femur w/o CC/MCC. 

514 ............... Hand or wrist proc, except major thumb or joint proc w/o CC/MCC. 

534 ............... Fractures of femur w/o MCC. 

535 ............... Fractures of hip & pelvis w MCC. 

553 ............... Bone diseases & arthropathies w MCC. 

555 ............... Signs & symptoms of musculoskeletal system & conn tissue w MCC. 

556 ............... Signs & symptoms of musculoskeletal system & conn tissue w/o MCC. 

578 ............... Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC. 

598 ............... Malignant breast disorders w CC**. 

599 ............... Malignant breast disorders w/o CC/MCC**. 

600 ............... Non-malignant breast disorders w CC/MCC. 

601 ............... Non-malignant breast disorders w/o CC/MCC. 

642 ............... Inborn errors of metabolism. 

660 ............... Kidney & ureter procedures for non-neoplasm w CC. 

687 ............... Kidney & urinary tract neoplasms w CC. 

693 ............... Urinary stones w/o ESW lithotripsy w MCC. 

694 ............... Urinary stones w/o ESW lithotripsy w/o MCC**. 

723 ............... Malignancy, male reproductive system w CC. 

730 ............... Other male reproductive system diagnoses w/o CC/MCC. 

744 ............... D&C, conization, laparoscopy & tubal interruption w CC/MC 

769 ............... Postpartum & post abortion diagnoses w O.R. procedure. 

803 ............... Other O.R. proc of the blood & blood forming organs w CC. 

815 ............... Reticuloendothelial & immunity disorders w CC. 

816 ............... Reticuloendothelial & immunity disorders w/o CC/MCC**. 

842 ............... Lymphoma & non-acute leukemia w/o CC/MCC. 

848 ............... Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC. 

864 ............... Fever of unknown origin. 

897 ............... Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC. 

903 ............... Wound debridements for injuries w/o CC/MCC. 

905 ............... Skin grafts for injuries w/o CC/MCC. 

917 ............... Poisoning & toxic effects of drugs w MCC. 

918 ............... Poisoning & toxic effects of drugs w/o MCC. 

929 ............... Full thickness burn w skin graft or inhal inj w/o CC/MCC. 

956 ............... Limb reattachment, hip & femur proc for multiple significant trauma. 

964 ............... Other multiple significant trauma w CC. 

965 ............... Other multiple significant trauma w/o CC/MCC. 

977 ............... HIV w or w/o other related condition. 

QUINTILE 3 

42 ................. Periph & cranial nerve & other nerv syst proc w/o CC/MCC. 

53 ................. Spinal disorders & injuries w/o CC/MCC. 

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24762 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

78 ................. Hypertensive encephalopathy w CC***. 

102 ............... Headaches w MCC**. 

103 ............... Headaches w/o MCC. 

133 ............... Other ear, nose, mouth & throat O.R. procedures w CC/MCC**. 

134 ............... Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC**. 

157 ............... Dental & Oral Diseases w MCC**. 

158 ............... Dental & Oral Diseases w CC**. 

159 ............... Dental & Oral Diseases w/o CC/MCC**. 

238 ............... Major cardiovascular procedures w/o MCC. 

246 ............... Percutaneous cardiovascular proc w drug-eluting stent w MCC. 

250 ............... Perc cardiovasc proc w/o coronary artery stent or AMI w MCC. 

263 ............... Vein ligation & stripping. 

284 ............... Circulatory disorders w AMI, expired w CC*. 

287 ............... Circulatory disorders except AMI, w card cath w/o MCC. 

294 ............... Deep vein thrombophlebitis w CC/MCC. 

347 ............... Anal & stomal procedures w MCC. 

348 ............... Anal & stomal procedures w CC. 

352 ............... Inguinal & femoral hernia procedures w/o CC/MCC. 

354 ............... Hernia procedures except inguinal & femoral w CC. 

358 ............... Other digestive system O.R. procedures w/o CC/MCC. 

380 ............... Complicated peptic ulcer w MCC. 

381 ............... Complicated peptic ulcer w CC. 

383 ............... Uncomplicated peptic ulcer w MCC. 

387 ............... Inflammatory bowel disease w/o CC/MCC*. 

420 ............... Hepatobiliary diagnostic procedures w MCC. 

421 ............... Hepatobiliary diagnostic procedures w CC. 

424 ............... Other hepatobiliary or pancreas O.R. procedures w CC. 

425 ............... Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC. 

494 ............... Lower extrem & humer proc except hip, foot, femur w/o CC/MCC. 

502 ............... Soft tissue procedures w/o CC/MCC. 

504 ............... Foot procedures w CC. 

507 ............... Major shoulder or elbow joint procedures w CC/MCC. 

517 ............... Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC. 

533 ............... Fractures of femur w MCC. 

597 ............... Malignant breast disorders w MCC. 

599 ............... Malignant breast disorders w/o CC/MCC***. 

604 ............... Trauma to the skin, subcut tiss & breast w MCC. 

618 ............... Amputat of lower limb for endocrine, nutrit, & metabol dis w/o CC/MCC. 

619 ............... O.R. procedures for obesity w MCC. 

620 ............... O.R. procedures for obesity w CC**. 

624 ............... Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC. 

644 ............... Endocrine disorders w CC. 

657 ............... Kidney & ureter procedures for neoplasm w CC. 

662 ............... Minor bladder procedures w MCC. 

665 ............... Prostatectomy w MCC. 

667 ............... Prostatectomy w/o CC/MCC. 

694 ............... Urinary stones w/o ESW lithotripsy w/o MCC***. 

695 ............... Kidney & urinary tract signs & symptoms w MCC. 

711 ............... Testes procedures w CC/MCC***. 

722 ............... Malignancy, male reproductive system w MCC. 

746 ............... Vagina, cervix & vulva procedures w CC/MCC. 

749 ............... Other female reproductive system O.R. procedures w CC/MCC. 

755 ............... Malignancy, female reproductive system w CC. 

809 ............... Major hematol/immune diag exc sickle cell crisis & coagul w CC. 

810 ............... Major hematol/immune diag exc sickle cell crisis & coagul w/o CC/MCC. 

816 ............... Reticuloendothelial & immunity disorders w/o CC/MCC***. 

821 ............... Lymphoma & leukemia w major O.R. procedure w CC. 

826 ............... Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC. 

834 ............... Acute leukemia w/o major O.R. procedure w MCC. 

835 ............... Acute leukemia w/o major O.R. procedure w CC. 

838 ............... Chemo w acute leukemia as sdx or w high dose chemo agent w CC. 

843 ............... Other myeloprolif dis or poorly diff neopl diag w MCC***. 

844 ............... Other myeloprolif dis or poorly diff neopl diag w CC***. 

855 ............... Infectious & parasitic diseases w O.R. procedure w/o CC/MCC. 

896 ............... Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC. 

963 ............... Other multiple significant trauma w MCC. 

989 ............... Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC. 

QUINTILE 4 

28 ................. Spinal procedures w MCC. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24763 

PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

29 ................. Spinal procedures w CC. 

38 ................. Extracranial procedures w CC. 

39 ................. Extracranial procedures w/o CC/MCC. 

88 ................. Concussion w MCC**. 

89 ................. Concussion w CC. 

124 ............... Other disorders of the eye w MCC. 

168 ............... Other resp system O.R. procedures w/o CC/MCC. 

241 ............... Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC 

242 ............... Permanent cardiac pacemaker implant w MCC***. 

244 ............... Permanent cardiac pacemaker implant w/o CC/MCC. 

254 ............... Other vascular procedures w/o CC/MCC. 

257 ............... Upper limb & toe amputation for circ system disorders w/o CC/MCC*. 

286 ............... Circulatory disorders except AMI, w card cath w MCC. 

351 ............... Inguinal & femoral hernia procedures w CC. 

368 ............... Major esophageal disorders w MCC. 

369 ............... Major esophageal disorders w CC. 

370 ............... Major esophageal disorders w/o CC/MCC**. 

408 ............... Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC***. 

407 ............... Pancreas, liver & shunt procedures w/o CC/MCC. 

412 ............... Cholecystectomy w c.d.e. w CC. 

414 ............... Cholecystectomy except by laparoscope w/o c.d.e. w MCC. 

415 ............... Cholecystectomy except by laparoscope w/o c.d.e. w CC. 

418 ............... Laparoscopic cholecystectomy w/o c.d.e. w CC. 

423 ............... Other hepatobiliary or pancreas O.R. procedures w MCC. 

472 ............... Cervical spinal fusion w CC. 

476 ............... Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC*. 

478 ............... Biopsies of musculoskeletal system & connective tissue w CC. 

479 ............... Biopsies of musculoskeletal system & connective tissue w/o CC/MCC. 

482 ............... Hip & femur procedures except major joint w/o CC/MCC. 

486 ............... Knee procedures w pdx of infection w CC. 

487 ............... Knee procedures w pdx of infection w/o CC/MCC. 

490 ............... Back & neck procedures except spinal fusion w CC/MCC or disc devices. 

493 ............... Lower extrem & humer proc except hip, foot, femur w CC. 

497 ............... Local excision & removal int fix devices exc hip & femur w/o CC/MCC. 

503 ............... Foot procedures w MCC. 

511 ............... Shoulder, elbow or forearm proc, exc major joint proc w CC. 

516 ............... Other musculoskelet sys & conn tiss O.R. proc w CC. 

562 ............... Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC. 

576 ............... Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC. 

577 ............... Skin graft &/or debrid exc for skin ulcer or cellulitis w CC. 

584 ............... Breast biopsy, local excision & other breast procedures w CC/MCC. 

620 ............... O.R. procedures for obesity w CC***. 

659 ............... Kidney & ureter procedures for non-neoplasm w MCC. 

675 ............... Other kidney & urinary tract procedures w/o CC/MCC. 

709 ............... Penis procedures w CC/MCC. 

711 ............... Testes procedures w CC/MCC**. 

712 ............... Testes procedures w/o CC/MCC**. 

717 ............... Other male reproductive system O.R. proc exc malignancy w CC/MCC. 

725 ............... Benign prostatic hypertrophy w MCC. 

754 ............... Malignancy, female reproductive system w MCC. 

760 ............... Menstrual & other female reproductive system disorders w CC/MCC. 

776 ............... Postpartum & post abortion diagnoses w/o O.R. procedure. 

781 ............... Other antepartum diagnoses w medical complications. 

823 ............... Lymphoma & non-acute leukemia w other O.R. proc w MCC. 

824 ............... Lymphoma & non-acute leukemia w other O.R. proc w CC. 

843 ............... Other myeloprolif dis or poorly diff neopl diag w MCC**. 

844 ............... Other myeloprolif dis or poorly diff neopl diag w CC**. 

845 ............... Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC**. 

880 ............... Acute adjustment reaction & psychosocial dysfunction. 

909 ............... Other O.R. procedures for injuries w/o CC/MCC. 

928 ............... Full thickness burn w skin graft or inhal inj w CC/MCC. 

933 ............... Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft. 

958 ............... Other O.R. procedures for multiple significant trauma w CC. 

983 ............... Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC. 

985 ............... Prostatic O.R. procedure unrelated to principal diagnosis w CC. 

986 ............... Prostatic O.R. procedure unrelated to principal diagnosis w/o CC/MCC. 

QUINTILE 5 

12 ................. Tracheostomy for face, mouth & neck diagnoses w CC. 

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24764 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

26 ................. Craniotomy & endovascular intracranial procedures w CC. 

31 ................. Ventricular shunt procedures w MCC. 

37 ................. Extracranial procedures w MCC. 

131 ............... Cranial/facial procedures w CC/MCC. 

134 ............... Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC***. 

137 ............... Mouth procedures w CC/MCC. 

139 ............... Salivary gland procedures. 

159 ............... Dental & Oral Diseases w/o CC/MCC***. 

164 ............... Major chest procedures w CC. 

226 ............... Cardiac defibrillator implant w/o cardiac cath w MCC. 

227 ............... Cardiac defibrillator implant w/o cardiac cath w/o MCC. 

237 ............... Major cardiovascular procedures w MCC. 

242 ............... Permanent cardiac pacemaker implant w MCC**. 

243 ............... Permanent cardiac pacemaker implant w CC. 

248 ............... Percutaneous cardiovasc proc w non-drug-eluting stent w MCC. 

258 ............... Cardiac pacemaker device replacement w MCC. 

260 ............... Cardiac pacemaker revision except device replacement w MCC. 

327 ............... Stomach, esophageal & duodenal proc w CC. 

329 ............... Major small & large bowel procedures w MCC. 

330 ............... Major small & large bowel procedures w CC. 

335 ............... Peritoneal adhesiolysis w MCC. 

350 ............... Inguinal & femoral hernia procedures w MCC. 

370 ............... Major esophageal disorders w/o CC/MCC***. 

405 ............... Pancreas, liver & shunt procedures w MCC. 

406 ............... Pancreas, liver & shunt procedures w CC. 

408 ............... Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC**. 

409 ............... Biliary tract proc except only cholecyst w or w/o c.d.e. w CC. 

417 ............... Laparoscopic cholecystectomy w/o c.d.e. w MCC. 

454 ............... Combined anterior/posterior spinal fusion w CC. 

456 ............... Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w MCC. 

459 ............... Spinal fusion except cervical w MCC. 

460 ............... Spinal fusion except cervical w/o MCC. 

466 ............... Revision of hip or knee replacement w MCC. 

467 ............... Revision of hip or knee replacement w CC. 

469 ............... Major joint replacement or reattachment of lower extremity w MCC. 

470 ............... Major joint replacement or reattachment of lower extremity w/o MCC. 

471 ............... Cervical spinal fusion w MCC. 

477 ............... Biopsies of musculoskeletal system & connective tissue w MCC. 

480 ............... Hip & femur procedures except major joint w MCC. 

481 ............... Hip & femur procedures except major joint w CC. 

485 ............... Knee procedures w pdx of infection w MCC. 

488 ............... Knee procedures w/o pdx of infection w CC/MCC. 

492 ............... Lower extrem & humer proc except hip, foot, femur w MCC. 

498 ............... Local excision & removal int fix devices of hip & femur w CC/MCC. 

513 ............... Hand or wrist proc, except major thumb or joint proc w CC/MCC. 

582 ............... Mastectomy for malignancy w CC/MCC. 

664 ............... Minor bladder procedures w/o CC/MCC. 

668 ............... Transurethral procedures w MCC. 

669 ............... Transurethral procedures w CC. 

670 ............... Transurethral procedures w/o CC/MCC. 

691 ............... Urinary stones w esw lithotripsy w CC/MCC. 

712 ............... Testes procedures w/o CC/MCC***. 

713 ............... Transurethral prostatectomy w CC/MCC. 

715 ............... Other male reproductive system O.R. proc for malignancy w CC/MCC. 

802 ............... Other O.R. proc of the blood & blood forming organs w MCC. 

829 ............... Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC. 

837 ............... Chemo w acute leukemia as sdx or w high dose chemo agent w MCC. 

845 ............... Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC***. 

957 ............... Other O.R. procedures for multiple significant trauma w MCC. 

969 ............... HIV w extensive O.R. procedure w MCC. 

970 ............... HIV w extensive O.R. procedure w/o MCC. 

984 ............... Prostatic O.R. procedure unrelated to principal diagnosis w MCC 

* One of the original 307 low-volume proposed MS–LTC–DRGs initially assigned to this proposed low-volume quintile; removed from this proposed low-volume quintile in addressing nonmonotonicity (see step 6 below). 

** One of the original 307 low-volume proposed MS–LTC–DRGs initially assigned to a different proposed low-volume quintile but moved to this 

proposed low-volume quintile in addressing nonmonotonicity (see step 6 below). 

*** One of the original 307 low-volume proposed MS–LTC–DRGs initially assigned to this proposed low-volume quintile but moved to a different proposed low-volume quintile in addressing nonmonotonicity (see step 6 below). 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24765 

We note that we will continue to 

monitor the volume (that is, the number 

of LTCH cases) in these low-volume 

quintiles to ensure that our proposed 

quintile assignment results in 

appropriate payment for such cases and 

does not result in an unintended 

financial incentive for LTCHs to 

inappropriately admit these types of 

cases. 

4. Steps for Determining the Proposed 

FY 2008 MS–LTC–DRG Relative Weights 

As we noted previously, although the 

proposed adoption of the MS–LTC– 

DRGs will result in some modifications 

of existing procedures for assigning 

weights in cases of zero volume and/or 

nonmonotonicity, described in detail 

elsewhere in this section, the proposed 

FY 2008 MS–LTC–DRG relative weights 

in this proposed rule are based on the 

methodology established in the August 

30, 2002 LTCH PPS final rule (67 FR 

55989 through 55991). In summary, for 

FY 2008, LTCH cases would be grouped 

to the appropriate MS–LTC–DRG, while 

taking into account the low-volume 

proposed MS–LTC–DRGs as described 

above, before the proposed FY 2008 

MS–LTC–DRG relative weights can be 

determined. After grouping the cases to 

the appropriate proposed MS–LTC– 

DRG, we are proposing to calculate the 

proposed relative weights for FY 2008 

by first removing statistical outliers and 

cases with a length of stay of 7 days or 

less, as discussed in greater detail 

below. Next, we are proposing to adjust 

the number of cases in each proposed 

MS–LTC–DRG for the effect of shortstay outlier cases under § 412.529, as 

also discussed in greater detail below. 

The short-stay adjusted discharges and 

corresponding charges are used to 

calculate ‘‘relative adjusted weights’’ in 

each proposed MS–LTC–DRG using the 

HSRV method described above. 

Below we discuss in detail the steps 

for calculating the proposed FY 2008 

MS–LTC–DRG relative weights. We note 

that, as we stated above in section 

II.I.3.b. of the preamble of this proposed 

rule, we have excluded the data of allinclusive rate LTCHs and LTCHs that 

are paid in accordance with 

demonstration projects that had claims 

in the FY 2006 MedPAR file. 

Step 1—Remove statistical outliers. 

The first step in the calculation of the 

proposed FY 2008 MS–LTC–DRG 

relative weights is to remove statistical 

outlier cases. We define statistical 

outliers as cases that are outside of 3.0 

standard deviations from the mean of 

the log distribution of both charges per 

case and the charges per day for each 

proposed MS–LTC–DRG. These 

statistical outliers are removed prior to 

calculating the proposed relative 

weights. As noted above, we believe that 

they may represent aberrations in the 

data that distort the measure of average 

resource use. Including those LTCH 

cases in the calculation of the proposed 

relative weights could result in an 

inaccurate relative weight that does not 

truly reflect relative resource use among 

the proposed MS–LTC–DRGs. 

Step 2—Remove cases with a length 

of stay of 7 days or less. 

The proposed FY 2008 MS–LTC–DRG 

relative weights reflect the average of 

resources used on representative cases 

of a specific type. Generally, cases with 

a length of stay of 7 days or less do not 

belong in a LTCH because these stays do 

not fully receive or benefit from 

treatment that is typical in a LTCH stay, 

and full resources are often not used in 

the earlier stages of admission to a 

LTCH. As explained above, if we were 

to include stays of 7 days or less in the 

computation of the proposed FY 2008 

MS–LTC–DRG relative weights, the 

value of many relative weights would 

decrease and, therefore, payments 

would decrease to a level that may no 

longer be appropriate. We do not believe 

that it would be appropriate to 

compromise the integrity of the 

payment determination for those LTCH 

cases that actually benefit from and 

receive a full course of treatment at a 

LTCH, by including data from these 

very short-stays. Thus, as explained 

above, in determining the proposed FY 

2008 MS–LTC–DRG relative weights, we 

remove LTCH cases with a length of stay 

of 7 days or less. 

Step 3—Adjust charges for the effects 

of short-stay outliers. 

After removing cases with a length of 

stay of 7 days or less, we are left with 

cases that have a length of stay of greater 

than or equal to 8 days. The next step 

in the calculation of the proposed FY 

2008 MS–LTC–DRG relative weights is 

to adjust each LTCH’s charges per 

discharge for those remaining cases for 

the effects of short-stay outliers as 

defined in § 412.529(a). (We note that 

even if a case was removed in Step 2 

(that is, cases with a length of stay of 7 

days or less), it was paid as a short-stay 

outlier if its length of stay was less than 

or equal to five-sixths of the average 

length of stay of the MS–LTC–DRG, in 

accordance with § 412.529.) 

We make this adjustment by counting 

a short-stay outlier as a fraction of a 

discharge based on the ratio of the 

length of stay of the case to the average 

length of stay for the proposed MS– 

LTC–DRG for non-short-stay outlier 

cases. This has the effect of 

proportionately reducing the impact of 

the lower charges for the short-stay 

outlier cases in calculating the average 

charge for the proposed MS–LTC–DRG. 

This process produces the same result 

as if the actual charges per discharge of 

a short-stay outlier case were adjusted to 

what they would have been had the 

patient’s length of stay been equal to the 

average length of stay of the proposed 

MS–LTC–DRG. 

As we explained in the FY 2007 IPPS 

final (71 FR 47979), counting short-stay 

outlier cases as full discharges with no 

adjustment in determining the proposed 

MS–LTC–DRG relative weights would 

lower the proposed LTC–DRG relative 

weight for affected proposed MS–LTC– 

DRGs because the relatively lower 

charges of the short-stay outlier cases 

would bring down the average charge 

for all cases within a proposed MS– 

LTC–DRG. This would result in an 

‘‘underpayment’’ for nonshort-stay 

outlier cases and an ‘‘overpayment’’ for 

short-stay outlier cases. Therefore, we 

adjust for short-stay outlier cases under 

§ 412.529 in this manner because it 

results in more appropriate payments 

for all LTCH cases. 

Step 4—Calculate the proposed FY 

2008 MS–LTC–DRG relative weights on 

an iterative basis. 

The process of calculating the 

proposed MS–LTC–DRG relative 

weights using the HSRV methodology is 

iterative. First, for each LTCH case, we 

calculate a hospital-specific relative 

charge value by dividing the short-stay 

outlier adjusted charge per discharge 

(see step 3) of the LTCH case (after 

removing the statistical outliers (see 

step 1)) and LTCH cases with a length 

of stay of 7 days or less (see step 2) by 

the average charge per discharge for the 

LTCH in which the case occurred. The 

resulting ratio is then multiplied by the 

LTCH’s case-mix index to produce an 

adjusted hospital-specific relative 

charge value for the case. An initial 

case-mix index value of 1.0 is used for 

each LTCH. 

For each proposed DRG, the proposed 

FY 2008 MS–LTC–DRG relative weight 

is calculated by dividing the average of 

the adjusted hospital-specific relative 

charge values (from above) for the 

proposed MS–LTC–DRG by the overall 

average hospital-specific relative charge 

value across all cases for all LTCHs. 

Using these proposed recalculated MS– 

LTC–DRG relative weights, each LTCH’s 

average relative weight for all of its 

cases (case-mix) is calculated by 

dividing the sum of all the LTCH’s 

proposed MS–LTC–DRG relative 

weights by its total number of cases. The 

LTCHs’ hospital-specific relative charge 

values above are multiplied by these 

hospital-specific case-mix indexes. 

These hospital-specific case-mix 

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24766 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

adjusted relative charge values are then 

used to calculate a new set of proposed 

MS–LTC–DRG relative weights across 

all LTCHs. In this proposed rule, this 

iterative process is continued until there 

is convergence between the weights 

produced at adjacent steps, for example, 

when the maximum difference is less 

than 0.0001. 

Step 5—Determine a proposed FY 

2007 MS–LTC–DRG relative weight for 

proposed MS–LTC–DRGs with no LTCH 

cases. 

As we stated above, we determine the 

proposed relative weight for each 

proposed MS–LTC–DRG using total 

Medicare allowable charges reported in 

the December 2006 update of the FY 

2006 MedPAR file. Of the 745 proposed 

MS–LTC–DRGs for FY 2008, we 

identified 124 proposed MS–LTC–DRGs 

for which there were no LTCH cases in 

the database. That is, based on data from 

the FY 2006 MedPAR file used in this 

proposed rule, no patients who would 

have been classified to those proposed 

MS–LTC–DRGs were treated in LTCHs 

during FY 2006 and, therefore, no 

charge data were reported for those 

proposed MS–LTC–DRGs. Thus, in the 

process of determining the proposed 

MS–LTC–DRG relative weights, we are 

unable to determine weights for these 

124 proposed MS–LTC–DRGs using the 

methodology described in Steps 1 

through 4 above. However, because 

patients with a number of the diagnoses 

under these proposed MS–LTC–DRGs 

may be treated at LTCHs beginning in 

FY 2008, for this proposed rule, we are 

proposing to assign relative weights to 

each of the 124 no-volume proposed 

MS–LTC–DRGs based on clinical 

similarity and relative costliness to one 

of the remaining 621 (745-124 = 621) 

proposed MS–LTC–DRGs for which we 

are able to determine proposed relative 

weights, based on FY 2006 LTCH claims 

data. In general, we determined 

proposed relative weights for the 124 

proposed MS–LTC–DRGs with no LTCH 

cases in the FY 2006 MedPAR file used 

in this proposed rule by crosswalking 

these proposed MS–LTC–DRGs to other 

proposed MS–LTC–DRGs and then 

grouping them to the appropriate 

proposed low-volume quintile. This 

methodology is consistent with our 

methodology used in determining 

relative weights to account for the lowvolume proposed MS–LTC–DRGs 

described above. 

Our proposed methodology for 

determining the relative weights for the 

no-volume MS–LTC–DRGs is as follows: 

We crosswalk the no-volume proposed 

MS–LTC–DRG to a proposed MS–LTC– 

DRG for which there are LTCH cases in 

the FY 2006 MedPAR file and to which 

it is similar clinically and in intensity 

of use of resources as determined by 

care provided during the period of time 

surrounding surgery, surgical approach 

(if applicable), length of time of surgical 

procedure, postoperative care, and 

length of stay. If the proposed MS–LTC– 

DRG to which it is crosswalked is 

grouped to one of the proposed lowvolume quintiles, we assign the relative 

weight for the applicable low-volume 

quintile to the no volume proposed MS– 

LTC–DRG. However, if the proposed 

MS–LTC–DRG to which the no-volume 

proposed MS–LTC–DRG is crosswalked 

is not one of the proposed MS–LTC– 

DRGs in a low-volume quintile, we do 

the following: (1) compare the relative 

weight of the proposed MS–LTC–DRG 

to which the no-volume proposed MS– 

LTC–DRG is crosswalked to the relative 

weights of each of the five quintiles; (2) 

assign the no volume proposed MS– 

LTC–DRG the relative weight of the lowvolume quintile with the relative weight 

that is closest to the proposed MS–LTC– 

DRG to which the no volume proposed 

MS–LTC–DRG is crosswalked. (We note 

that in the infrequent case where 

nonmonotonicity involving a no volume 

proposed MS–LTC–DRG results, 

additional measures as described in 

Step 6 are required in order to maintain 

monotonically increasing relative 

weights.) or this proposed rule, a list of 

the no-volume proposed FY 2008 MS– 

LTC–DRGs and the proposed FY 2008 

MS–LTC–DRG to which it is 

crosswalked is shown in the chart 

below. 

NO-VOLUME PROPOSED MS–LTC–DRG CROSSWALK FOR FY 2008 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

Proposed 

crosswalked 

MS–LTC–DRG 

9 .................. Bone marrow transplant ............................................................................................................................................. 823 

20 ................ Intracranial vascular procedures w PDX hemorrhage w MCC .................................................................................. 31 

21 ................ Intracranial vascular procedures w PDX hemorrhage w CC ..................................................................................... 32 

22 ................ Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC ........................................................................ 33 

23 ................ Craniotomy w major device implant or acute complex CNS PDX w MCC ............................................................... 31 

24 ................ Craniotomy w major device implant or acute complex CNS PDX w/o MCC ............................................................ 33 

34 ................ Carotid artery stent procedure w MCC ...................................................................................................................... 37 

35 ................ Carotid artery stent procedure w CC ......................................................................................................................... 38 

36 ................ Carotid artery stent procedure w/o CC/MCC ............................................................................................................. 39 

61 ................ Acute ischemic stroke w use of thrombolytic agent w MCC ..................................................................................... 70 

62 ................ Acute ischemic stroke w use of thrombolytic agent w CC ........................................................................................ 71 

63 ................ Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC ............................................................................ 72 

115 .............. Extraocular procedures except orbit .......................................................................................................................... 125 

116 .............. Intraocular procedures w CC/MCC ............................................................................................................................ 125 

117 .............. Intraocular procedures w/o CC/MCC ......................................................................................................................... 125 

129 .............. Major head & neck procedures w CC/MCC or major device .................................................................................... 146 

130 .............. Major head & neck procedures w/o CC/MCC ........................................................................................................... 148 

135 .............. Sinus & mastoid procedures w CC/MCC .................................................................................................................. 133 

136 .............. Sinus & mastoid procedures w/o CC/MCC ............................................................................................................... 133 

150 .............. Epistaxis w MCC ........................................................................................................................................................ 152 

151 .............. Epistaxis w/o MCC ..................................................................................................................................................... 153 

215 .............. Other heart assist system implant ............................................................................................................................. 238 

216 .............. Cardiac valve & oth maj cardiothoracic proc w card cath w MCC ............................................................................ 237 

217 .............. Cardiac valve & oth maj cardiothoracic proc w card cath w CC ............................................................................... 238 

218 .............. Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC .................................................................. 250 

219 .............. Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC ......................................................................... 237 

220 .............. Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC ............................................................................ 238 

221 .............. Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC ............................................................... 250 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24767 

NO-VOLUME PROPOSED MS–LTC–DRG CROSSWALK FOR FY 2008—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

Proposed 

crosswalked 

MS–LTC–DRG 

222 .............. Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC ................................................................................ 242 

223 .............. Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC ............................................................................. 243 

224 .............. Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC ............................................................................. 242 

225 .............. Cardiac defib implant w cardiac cath w/oAMI/HF/shock w/o MCC ........................................................................... 243 

228 .............. Other cardiothoracic procedures w MCC .................................................................................................................. 252 

229 .............. Other cardiothoracic procedures w CC ..................................................................................................................... 253 

230 .............. Other cardiothoracic procedures w/o CC/MCC ......................................................................................................... 254 

231 .............. Coronary bypass w PTCA w MCC ............................................................................................................................ 237 

232 .............. Coronary bypass w PTCA w/o MCC ......................................................................................................................... 238 

233 .............. Coronary bypass w cardiac cath w MCC .................................................................................................................. 237 

234 .............. Coronary bypass w cardiac cath w/o MCC ............................................................................................................... 238 

235 .............. Coronary bypass w/o cardiac cath w MCC ............................................................................................................... 237 

236 .............. Coronary bypass w/o cardiac cath w/o MCC ............................................................................................................ 238 

296 .............. Cardiac arrest, unexplained w MCC .......................................................................................................................... 283 

297 .............. Cardiac arrest, unexplained w CC ............................................................................................................................. 284 

298 .............. Cardiac arrest, unexplained w/o CC/MCC ................................................................................................................. 285 

332 .............. Rectal resection w MCC ............................................................................................................................................ 356 

333 .............. Rectal resection w CC ............................................................................................................................................... 357 

334 .............. Rectal resection w/o CC/MCC ................................................................................................................................... 358 

338 .............. Appendectomy w complicated principal diag w MCC ............................................................................................... 371 

339 .............. Appendectomy w complicated principal diag w CC .................................................................................................. 372 

340 .............. Appendectomy w complicated principal diag w/o CC/MCC ...................................................................................... 373 

341 .............. Appendectomy w/o complicated principal diag w MCC ............................................................................................ 371 

342 .............. Appendectomy w/o complicated principal diag w CC ............................................................................................... 372 

343 .............. Appendectomy w/o complicated principal diag w/o CC/MCC ................................................................................... 373 

344 .............. Minor small & large bowel procedures w MCC ......................................................................................................... 371 

345 .............. Minor small & large bowel procedures w CC ............................................................................................................ 372 

346 .............. Minor small & large bowel procedures w/o CC/MCC ................................................................................................ 373 

457 .............. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w CC .............................................................................. 456 

461 .............. Bilateral or multiple major joint procs of lower extremity w MCC ............................................................................. 480 

462 .............. Bilateral or multiple major joint procs of lower extremity w/o MCC .......................................................................... 482 

483 .............. Major joint & limb reattachment proc of upper extremity w CC/MCC ....................................................................... 480 

484 .............. Major joint & limb reattachment proc of upper extremity w/o CC/MCC .................................................................... 482 

506 .............. Major thumb or joint procedures ................................................................................................................................ 514 

509 .............. Arthroscopy ................................................................................................................................................................ 505 

537 .............. Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC ............................................................................ 505 

538 .............. Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC ......................................................................... 505 

614 .............. Adrenal & pituitary procedures w CC/MCC ............................................................................................................... 629 

615 .............. Adrenal & pituitary procedures w/o CC/MCC ............................................................................................................ 630 

625 .............. Thyroid, parathyroid & thyroglossal procedures w MCC ........................................................................................... 628 

626 .............. Thyroid, parathyroid & thyroglossal procedures w CC .............................................................................................. 629 

627 .............. Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC .................................................................................. 630 

653 .............. Major bladder procedures w MCC ............................................................................................................................. 659 

654 .............. Major bladder procedures w CC ................................................................................................................................ 660 

655 .............. Major bladder procedures w/o CC/MCC .................................................................................................................... 661 

666 .............. Prostatectomy w CC .................................................................................................................................................. 665 

671 .............. Urethral procedures w CC/MCC ................................................................................................................................ 687 

672 .............. Urethral procedures w/o CC/MCC ............................................................................................................................. 688 

697 .............. Urethral stricture ........................................................................................................................................................ 688 

707 .............. Major male pelvic procedures w CC/MCC ................................................................................................................ 660 

708 .............. Major male pelvic procedures w/o CC/MCC ............................................................................................................. 661 

734 .............. Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC ....................................................................... 717 

735 .............. Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC .................................................................... 718 

736 .............. Uterine & adnexa proc for ovarian or adnexal malignancy w MCC .......................................................................... 754 

737 .............. Uterine & adnexa proc for ovarian or adnexal malignancy w CC ............................................................................. 755 

738 .............. Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC ................................................................. 756 

739 .............. Uterine,adnexa proc for non-ovarian/adnexal malig w MCC ..................................................................................... 754 

740 .............. Uterine,adnexa proc for non-ovarian/adnexal malig w CC ........................................................................................ 755 

741 .............. Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC ........................................................................... 756 

742 .............. Uterine & adnexa proc for non-malignancy w CC/MCC ............................................................................................ 755 

743 .............. Uterine & adnexa proc for non-malignancy w/o CC/MCC ......................................................................................... 756 

748 .............. Female reproductive system reconstructive procedures ........................................................................................... 749 

765 .............. Cesarean section w CC/MCC .................................................................................................................................... 744 

766 .............. Cesarean section w/o CC/MCC ................................................................................................................................. 769 

767 .............. Vaginal delivery w sterilization &/or D&C .................................................................................................................. 769 

768 .............. Vaginal delivery w O.R. proc except steril &/or D&C ................................................................................................ 769 

770 .............. Abortion w D&C, aspiration curettage or hysterotomy .............................................................................................. 769 

774 .............. Vaginal delivery w complicating diagnoses ............................................................................................................... 769 

775 .............. Vaginal delivery w/o complicating diagnoses ............................................................................................................ 769 

777 .............. Ectopic pregnancy ..................................................................................................................................................... 769 

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24768 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

NO-VOLUME PROPOSED MS–LTC–DRG CROSSWALK FOR FY 2008—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description 

Proposed 

crosswalked 

MS–LTC–DRG 

778 .............. Threatened abortion ................................................................................................................................................... 759 

779 .............. Abortion w/o D&C ...................................................................................................................................................... 759 

780 .............. False labor ................................................................................................................................................................. 759 

782 .............. Other antepartum diagnoses w/o medical complications .......................................................................................... 759 

789 .............. Neonates, died or transferred to another acute care facility ..................................................................................... 761 

790 .............. Extreme immaturity or respiratory distress syndrome, neonate ................................................................................ 761 

791 .............. Prematurity w major problems ................................................................................................................................... 760 

792 .............. Prematurity w/o major problems ................................................................................................................................ 761 

793 .............. Full term neonate w major problems ......................................................................................................................... 760 

794 .............. Neonate w other significant problems ....................................................................................................................... 760 

795 .............. Normal newborn ......................................................................................................................................................... 761 

799 .............. Splenectomy w MCC ................................................................................................................................................. 423 

800 .............. Splenectomy w CC .................................................................................................................................................... 424 

801 .............. Splenectomy w/o CC/MCC ........................................................................................................................................ 425 

827 .............. Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC .................................................................................. 823 

887 .............. Other mental disorder diagnoses .............................................................................................................................. 881 

927 .............. Extensive burns or full thickness burns w MV 96+ hrs w skin graft ......................................................................... 933 

955 .............. Craniotomy for multiple significant trauma ................................................................................................................ 26 

To illustrate this methodology for 

determining the proposed relative 

weights for the 124 proposed MS–LTC– 

DRGs with no LTCH cases, we are 

providing the following example, which 

refers to the no volume proposed MS– 

LTC–DRGs crosswalk information for 

FY 2008 provided in the chart above. 

Example 1: 

There were no cases in the FY 2006 

MedPAR file used for this proposed rule 

for proposed MS–LTC–DRG 22 

(Intracranial vascular procedures w PDX 

hemorrhage w/o CC/MCC). We 

determined that proposed MS–LTC– 

DRG 33 (Ventricular shunt procedures 

w/o CC/MCC), which is assigned to lowvolume Quintile 1 for the purpose of 

determining the proposed FY 2008 

relative weights, is similar clinically 

and based on resource use to proposed 

MS–LTC–DRG 22. Therefore, we are 

proposing to assign the same relative 

weight of proposed MS–LTC–DRG 33 of 

0.48011 (Quintile 1) for FY 2008 (Table 

11 in the Addendum to this proposed 

rule) to proposed MS–LTC–DRG 22. 

Furthermore, for FY 2008 we are 

proposing to establish proposed MS– 

LTC–DRG relative weights of 0.0000 for 

the following transplant proposed MS– 

LTC–DRGs: Heart transplant or implant 

of heart assist system w MCC (proposed 

LTC–DRG 1); Heart transplant or 

implant of heart assist system w/o MCC 

(proposed LTC–DRG 2); Liver transplant 

w MCC or intestinal transplant 

(proposed LTC–DRG 5); Liver transplant 

w/o MCC (proposed LTC–DRG 6); Lung 

transplant (proposed LTC–DRG 7); 

Simultaneous pancreas/kidney 

transplant (proposed LTC–DRG 8); and 

Pancreas transplant (proposed LTC– 

DRG 10). This is because Medicare will 

only cover these procedures if they are 

performed at a hospital that has been 

certified for the specific procedures by 

Medicare and presently no LTCH has 

been so certified. Based on our research, 

we found that most LTCHs only perform 

minor surgeries, such as minor small 

and large bowel procedures, to the 

extent any surgeries are performed at 

all. Given the extensive criteria that 

must be met to become certified as a 

transplant center for Medicare, we 

believe it is unlikely that any LTCHs 

will become certified as a transplant 

center. In fact, in the nearly 20 years 

since the implementation of the IPPS, 

there has never been a LTCH that even 

expressed an interest in becoming a 

transplant center. 

If in the future a LTCH applies for 

certification as a Medicare-approved 

transplant center, we believe that the 

application and approval procedure 

would allow sufficient time for us to 

determine appropriate weights for the 

proposed MS–LTC–DRGs affected. At 

the present time, we would only include 

these seven proposed transplant MS– 

LTC–DRGs in the GROUPER program 

for administrative purposes only. 

Because we use the same GROUPER 

program for LTCHs as is used under the 

IPPS, removing these proposed MS– 

LTC–DRGs would be administratively 

burdensome. 

Again, we note that, as this system is 

dynamic, it is entirely possible that the 

number of proposed MS–LTC–DRGs 

with no volume of LTCH cases based on 

the system will vary in the future. We 

used the most recent available claims 

data in the MedPAR file to identify no 

volume proposed MS–LTC–DRGs and to 

determine the proposed relative weights 

in this proposed rule. 

Table 11 in the Addendum to this 

proposed rule lists the proposed MS– 

LTC–DRGs and their respective 

proposed relative weights, geometric 

mean length of stay, and five-sixths of 

the geometric mean length of stay (to 

assist in the determination of short-stay 

outlier payments under § 412.529) for 

FY 2008. 

Step 6—Adjust the proposed FY 2008 

MS–LTC–DRG relative weights to 

account for nonmonotonically 

increasing relative weights. 

As explained in section II.B. of this 

preamble, the IPPS proposed FY 2008 

MS–DRGs, on which the proposed FY 

2008 MS–LTC–DRGs are based, provide 

a significant improvement in the DRG 

system’s recognition of severity of 

illness and resource usage. The 

proposed MS-DRGs contain base DRGs 

that have been subdivided into one, 

two, or three severity levels. Where 

there are three severity levels, the most 

severe level has at least one code that is 

referred to as an MCC. The next lower 

severity level contains cases with at 

least one code that is a CC. Those cases 

without a MCC or a CC are referred to 

as without CC/MCC. When data did not 

support the creation of three severity 

levels, the base was divided into either 

two levels or the base was not 

subdivided. The two-level subdivisions 

could consist of the CC/MCC and the 

without CC/MCC. Alternatively, the 

other type of two level subdivision 

could consist of the MCC and without 

MCC. In base DRGs with two levels, 

cases classified into a ‘‘without CC/ 

MCC’’ proposed MS–LTC–DRG are 

expected to have lower resource use 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24769 

(and lower costs) than the ‘‘with CC/ 

MM’’ and ‘‘with MCC.’’ 

That is, theoretically, cases that are 

more severe typically require greater 

expenditure of medical care resources 

and will result in higher average 

charges. Therefore, in the three severity 

levels, relative weights should increase 

by severity, from lowest to highest. If 

the weights do not increase (that is, if 

within a base MS–LTC–DRG, a 

proposed MS–LTC–DRG with MCC has 

a lower relative weight than one with 

CC, or the proposed MS–LTC–DRG 

without CC/MCC has a higher relative 

weight than either of the others, they are 

nonmonotonic. We continue to believe 

that utilizing nonmonotonic relative 

weights to adjust Medicare payments 

would result in inappropriate payments. 

Consequently, we are proposing that, in 

general, we would combine proposed 

MS–LTC–DRG severity levels within a 

proposed base MS–LTC–DRG for the 

purpose of computing a relative weight 

when necessary to ensure that 

monotonicity is maintained. 

Specifically, under each of the example 

scenarios provided below, we would 

combine severity levels within a 

proposed base MS–LTC–DRG as 

follows: 

The first example of 

nonmonotonically increasing relative 

weights for MS–LTC–DRG pertains to 

base DRGs with a three-level split and 

each of the three levels has 25 or more 

LTCH cases and, therefore, did not fall 

into one of the proposed five lowvolume quintiles. If nonmonotonicity is 

detected in the relative weights of 

proposed MS–LTC–DRGs in adjacent 

severity levels (for example, the relative 

weight of the ‘‘with MCC’’ (the highest 

severity level) is less than the ‘‘with CC’’ 

(the middle level), or the ‘‘with CC’’ is 

less than the ‘‘without CC/MCC’’), we 

are proposing to combine the adjacent 

proposed MS–LTC–DRGs and determine 

one relative weight based on the caseweighted average of the combined LTCH 

cases of the nonmonotonic proposed 

MS–LTC–DRG. The case-weighted 

average charge is determined by 

dividing the total charges for all LTCH 

cases in both severity levels by the total 

number of LTCH cases for the combined 

proposed MS–LTC–DRGs. We are 

proposing to apply this relative weight 

to both affected levels of the proposed 

base MS–LTC–DRG. If nonmonotonicity 

remains an issue because the above 

process results in a relative weight that 

is still nonmonotonic to the remaining 

proposed MS–LTC–DRG, we are 

proposing to combine all three of the 

severity levels to determine one relative 

weight which is assigned to each of the 

proposed MS–LTC–DRG in that 

proposed base MS–LTC–DRG. 

A second scenario of 

nonmonotonically increasing relative 

weights for an MS–LTC–DRG pertains to 

the situation where one or more of the 

severity levels within a base DRG has 

less than 25 LTCH cases (that is, low 

volume). If nonmonotonicity occurs in 

the case where either the highest or 

lowest severity level (with MCC’’ or 

‘‘without CC/MCC’’) has 25 LTCH cases 

or more and the other two severity 

levels are low volume (and therefore the 

other two severity levels would 

otherwise be assigned to quintiles), we 

are proposing to combine the data for 

the cases in the two adjacent lowvolume proposed MS–LTC–DRGs for 

the purpose of determining a relative 

weight. If the combination results in at 

least 25 cases, we are proposing to 

calculate one relative weight and assign 

it to both of the proposed severity 

levels. If the combination results in less 

than 25 cases, based on the caseweighted average charge of the 

combined low-volume MS–LTC–DRGs, 

both MS–LTC–DRGs, are assigned the 

relative weight of the quintile that has 

the closest relative weight to the case 

weighted average change of the 

combined low volume case. If 

nonmonotonicity persists, we are 

proposing to combine all three severity 

levels and one relative weight would be 

assigned to all three levels based on the 

case weighted average of the combined 

severity level. Similarly, in 

nonmonotonic cases where the middle 

level has 25 cases or more but either or 

both the lowest or highest severity level 

has less than 25 cases (that is, low 

volume), we are proposing to combine 

the nonmonotonic low-volume 

proposed MS–LTC–DRG with the 

middle level proposed MS–LTC–DRG of 

the base DRG. We are proposing to 

calculate one relative weight and apply 

it to both of the affected proposed MS– 

LTC–DRGs. If the nonmonotonicity 

persists, we are proposing to combine 

all three levels for the purpose of 

determining a relative weight, and apply 

that relative weight to all three levels. 

A third scenario addresses 

nonmonotonicity in a base DRG where 

at least one of the severity levels has no 

cases. As discussed in greater detail in 

Step 5, based on clinical similarity, we 

would cross-walk the proposed MS– 

LTC–DRG to a proposed MS–LTC–DRG 

to which it is similar clinically and in 

intensity of resource use and then assign 

it to a quintile with the relative weight 

closest to that of the MS–LTC–DRG to 

which the no-volume MS–LTC–DRG 

had been cross-walked. If this results in 

nonmonotonicity, in the case where the 

no-volume proposed MS–LTC–DRG is 

either the lowest or highest severity 

level, we are proposing to assign to the 

no-volume proposed MS–LTC–DRG the 

same relative weight that is assigned to 

the middle level of the MS–LTC–DRG in 

that base DRG. If nonmonotonicity 

persists, we are proposing that all three 

severity levels be combined for the 

purpose of calculating one relative 

weight which is applied to each of the 

three levels. We note that this is a 

departure from our current treatment of 

no-volume LTC–DRGs which results in 

an ultimate assignment to a quintile. 

However, we propose that in the 

infrequent case where nonmonotonicity 

involves a no-volume proposed MS– 

LTC–DRG, we believe it is appropriate 

to resolve the nonmonotonicity by 

assigning the no-volume proposed MS– 

LTC–DRG the relative weight of the 

proposed MS–LTC–DRG(s) in the base 

DRG, regardless of whether the other 

proposed MS–LTC–DRG(s) is low 

volume (therefore assigned a relative 

weight of a quintile) or high volume 

(assigned its own relative weight). We 

believe this treatment achieves 

monotonically increasing relative 

weights while providing appropriate 

payment for the no-volume proposed 

MS–LTC–DRG because the relative 

weight assigned to the no-volume 

proposed MS–LTC–DRG is based on the 

average charges of services rendered 

within the same proposed base MS– 

LTC–DRG, rather than a quintile which 

contains proposed MS–LTC–DRGs from 

different proposed base MS–LTC–DRGs. 

We are proposing to apply the same 

process where the proposed base MS– 

LTC–DRG contains a two-level split. For 

example, if nonmonotonicity occurs in 

a proposed base MS–LTC–DRG with 

two severity levels (that is, the higher 

severity level relative weight is less than 

the lower severity level), where both of 

the MS–LTC–DRGs have at least 25 

cases or where one or both of the 

proposed MS–LTC–DRGs is low 

volume, we are proposing to combine 

the two proposed MS–LTC–DRGs of that 

proposed base MS–LTC–DRG for the 

purpose of determining a case-weighted 

relative weight. If the combination still 

results in at least 25 cases, we are 

proposing to calculate one relative 

weight and assign it to both of the 

proposed MS–LTC–DRGs. If the 

combination results in less than 25 

cases, we determine the quintile 

assignment for both MS–LTC–DRGs 

based on the case-weighted average 

charge and assign both MS–LTC–DRGs 

the same relative weight of the 

appropriate quintile. 

Step 7—Calculate the proposed FY 

2008 budget neutrality factor. 

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24770 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

As we stated in the FY 2008 LTCH 

PPS proposed rule (72 FR 4784 through 

4786), under the broad authority 

conferred upon the Secretary under 

section 123 of Pub. L. 106–113 as 

amended by section 307(b) of Pub. L. 

106–554 to develop the LTCH PPS, we 

proposed that, beginning with the MS– 

LTC–DRG update for FY 2008, the 

annual update to the proposed MS– 

LTC–DRG classifications and relative 

weights would be done in a budget 

neutral manner such that estimated 

aggregate LTCH PPS payments would be 

unaffected, that is, would be neither 

greater than nor less than the estimated 

aggregate LTCH PPS payments that 

would have been made without the 

proposed MS–LTC–DRG classification 

and relative weight changes. Currently 

under § 412.517, the LTC–DRG 

classifications and relative weights are 

adjusted annually to reflect changes in 

factors affecting the relative use of 

LTCH resources, such as treatment 

patterns, technology and number of 

discharges. In addition, there are 

currently no statutory or regulatory 

requirements that the annual update to 

the LTC–DRG classifications and 

relative weights be done in a budget 

neutral manner. Since the initial 

implementation of the LTCH PPS in FY 

2003, we have updated the LTC–DRG 

relative weights each year without a 

budget neutrality adjustment based on 

the most recent available LTCH claims 

data, which reflect current LTCH patient 

mix and coding practices, and 

appropriately reflected more or less 

resource use than the previous year’s 

LTC–DRG relative weights (71 FR 

47991). Historically, we have not 

updated the LTC–DRGs in a budget 

neutral manner because we believed 

that past fluctuations in the LTC–DRG 

relative weights were primarily due to 

changes in LTCH coding practices. We 

believe that changes in the LTCH PPS 

payment rates, including the LTC–DRG 

relative weights, should accurately 

reflect changes in LTCHs’ true cost of 

treating patients (real CMI increase), and 

should not be influenced by changes in 

coding practices (apparent CMI 

increase). Because LTCH 2006 claims 

data does not appear to significantly 

reflect changes in LTCH coding 

practices in response to the 

implementation of the LTCH PPS, we 

believe that it may be appropriate to 

update the LTC–DRGs so that estimated 

aggregate LTCH PPS payments would 

neither increase nor decrease. Thus, in 

the FY 2008 LTCH PPS proposed rule 

(72 FR 4784), we proposed that the 

annual update to the LTC–DRG 

classifications and relative weights be 

done in a budget neutral manner. (For 

a detailed discussion on updating the 

LTC–DRG classifications and relative 

weights in a budget neutral manner, 

refer to the FY 2008 LTCH PPS 

proposed rule (72 FR 4784 through 

4786). Updating the LTC–DRGs in a 

budget neutral manner would result in 

an annual update to the individual 

LTC–DRG classifications and relative 

weights based on the most recent 

available data to reflect changes in 

relative LTCH resource use, and the 

LTC–DRG relative weights would be 

uniformly adjusted to ensure that 

estimated aggregate payments under the 

LTCH PPS would not be affected (that 

is, decreased or increased). Consistent 

with that proposal, we are proposing to 

update the proposed MS–LTC–DRG 

classifications and relative weights for 

FY 2008 based on the most recent 

available data and include a budget 

neutrality adjustment. To ensure budget neutrality in 

updating the MS–LTC–DRG 

classifications and relative weights 

under the proposed change to §

412.517, we are proposing to use a 

method that is similar to the 

methodology used under the IPPS. (A 

discussion of the IPPS DRG budget 

neutrality adjustment can be found in 

the FY 2007 IPPS final rule (71 FR 

47970).) Specifically, we are proposing 

that, after recalibrating the proposed 

MS–LTC–DRG relative weights, as we 

do under the methodology as described 

in detail in Steps 1 through 6 above, we 

would calculate and apply a 

normalization factor to the proposed 

MS–LTC–DRG relative weights to 

ensure that estimated payments are not 

influenced by changes in the 

composition of case types or changes 

made to the classification system. That 

is, the normalization adjustment is 

intended to ensure that the recalibration 

of the proposed MS–LTC–DRG relative 

weights (that is, the process itself) 

neither increases nor decreases total 

estimated payments. To calculate the 

normalization factor, we are proposing 

to use the most recent available claims 

data (FY 2006) and apply the proposed 

GROUPER (Version 25.0) to calculate 

the proposed relative weights. 

Furthermore, we are proposing to use 

the most recent available claims data in 

the analysis for the final rule. These 

weights are determined such that the 

average CMI value is 1.0. Then, we are 

proposing to group the same claims data 

(FY 2006) using the current GROUPER 

(Version 24.0) and current relative 

weights. The average CMI is calculated 

for the claims data using the current 

GROUPER and relative weights. Finally, 

the ratio of the average CMI of the 

claims data set under the current 

GROUPER and the proposed GROUPER 

is calculated as the proposed 

normalization factor. For FY 2008, 

based on the latest available data, the 

proposed normalization factor is 

estimated as 1.020302, which is applied 

to each proposed MS–LTC–DRG relative 

weight. (However, if more current data 

become available prior to publication of 

the final rule, we will use those data to 

determine the normalization factor.) 

That is, each proposed MS–LTC–DRG 

relative weight is multiplied by 

1.020302 in the first step of the budget 

neutrality process. We are also 

proposing to ensure that estimated 

aggregate LTCH PPS payments (based 

on the most recent available LTCH 

claims data) after recalibration (the 

proposed relative weights) would be 

equal to estimated aggregate LTCH PPS 

payments (for the same most recent 

available LTCH claims data) before 

recalibration (the existing relative 

weights). Therefore, we are proposing to 

calculate the budget neutrality 

adjustment factor by simulating 

estimated payments under both sets of 

GROUPERs and relative weights. We are 

proposing to simulate total estimated 

payments under the current payment 

policies (RY 2007) using the most recent 

available claims data (FY 2006) and 

using the proposed GROUPER (Version 

25.0), and normalized relative weights. 

Then, we are proposing to simulate 

estimated payments using the most 

recent available claims data (FY 2006) 

and apply the proposed GROUPER 

(Version 25.0). We next calculate 

payments using the same claims data 

(FY 2006) with the current GROUPER 

(Version 24.0). The ratio of the 

estimated average payment under the 

current GROUPER and the proposed 

GROUPER is calculated as the proposed 

budget neutrality factor. Then each of 

the proposed normalized relative 

weights is multiplied by the budget 

neutrality factor to determine the 

proposed budget neutral relative weight 

for each proposed MS–LTC–DRG. 

Accordingly, based on the most recent 

available data, we are proposing a 

budget neutrality factor of 1.003924 that 

is applied to the relative weights after 

normalizing. If more current data 

become available prior to publication of 

the final rule, we will use those data to 

determine the budget neutrality factor. 

The relative weights in Table 11 in the 

Addendum of this proposed rule reflect 

those budget neutral weights. If, as a 

result of comments, we decide not to 

finalize the proposed budget neutrality 

policy, the proposed weights in Table 

11 of the Addendum to this proposed 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24771 

rule change by the two factors discussed 

herein. 

Step 8—Apply the proposed case-mix 

budget neutrality factor to the proposed 

MS–LTC–DRG relative weight. 

As discussed under section II.D.6. of 

the preamble of this proposed rule, we 

are proposing a budget neutral 

adjustment for FY 2008 and FY 2009 to 

eliminate the effect of changes in coding 

or classification of discharges that do 

not reflect real change in case-mix 

because we believe that adoption of the 

proposed MS–LTC–DRGs would create 

a risk of increased aggregate levels of 

payment as a result of increased 

documentation and coding. The 

additional step 8 would be necessary for 

FY 2008 and FY 2009 to ensure that 

estimated aggregate LTCH PPS 

payments would be neither greater than 

nor less than the estimated aggregate 

LTCH PPS payments that would have 

been made without the adoption of the 

proposed MS–LTC–DRG patient 

classification system. Accordingly, each 

of the relative weights in Table 11 of the 

Addendum to this proposed rule reflects 

this proposed adjustment. That is, each 

proposed MS–LTC–DRG relative weight 

is multiplied by a factor of 0.976 to 

account for changes in coding or 

classification of discharges resulting 

from the adoption of the new patient 

classification system. 

J. Proposed Add-On Payments for New 

Services and Technologies 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘New Technology’’ at the 

beginning of your comment.) 

1. Background 

Sections 1886(d)(5)(K) and (L) of the 

Act establish a process of identifying 

and ensuring adequate payment for new 

medical services and technologies 

(sometimes collectively referred to in 

this section as ‘‘new technologies’’) 

under the IPPS. Section 

1886(d)(5)(K)(vi) of the Act specifies 

that a medical service or technology will 

be considered new if it meets criteria 

established by the Secretary after notice 

and opportunity for public comment. 

Section 1886(d)(5)(K)(ii)(I) of the Act 

specifies that the process must apply to 

a new medical service or technology if, 

‘‘based on the estimated costs incurred 

with respect to discharges involving 

such service or technology, the DRG 

prospective payment rate otherwise 

applicable to such discharges under this 

subsection is inadequate.’’ 

The regulations implementing this 

provision establish three criteria for new 

medical services and technologies to 

receive an additional payment. First, §

412.87(b)(2) defines when a specific 

medical service or technology will be 

considered new for purposes of new 

medical service or technology add-on 

payments. The statutory provision 

contemplated the special payment 

treatment for new medical services or 

technologies until such time as data are 

available to reflect the cost of the 

technology in the DRG weights through 

recalibration. There is a lag of 2 to 3 

years from the point a new medical 

service or technology is first introduced 

on the market and when data reflecting 

the use of the medical service or 

technology are used to calculate the 

DRG weights. For example, data from 

discharges occurring during FY 2006 are 

used to calculate the proposed FY 2008 

DRG weights in this proposed rule. 

Section 412.87(b)(2) provides that, ‘‘a 

medical service or technology may be 

considered new within 2 or 3 years after 

the point at which data begin to become 

available reflecting the ICD–9-CM code 

assigned to the new medical service or 

technology (depending on when a new 

code is assigned and data on the new 

medical service or technology become 

available for DRG recalibration). After 

CMS has recalibrated the DRGs based on 

available data to reflect the costs of an 

otherwise new medical service or 

technology, the medical service or 

technology will no longer be considered 

‘new’ under the criterion for this 

section.’’ 

The 2-year to 3-year period during 

which a medical service or technology 

can be considered new would ordinarily 

begin with FDA approval, unless there 

was some documented delay in bringing 

the product onto the market after that 

approval (for instance, component 

production or drug production has been 

postponed until FDA approval due to 

shelf life concerns or manufacturing 

issues). After the DRGs have been 

recalibrated to reflect the costs of an 

otherwise new medical service or 

technology, the special add-on payment 

for new medical services or technologies 

ceases (§ 412.87(b)(2)). For example, an 

approved new technology that received 

FDA approval in October 2006 and 

entered the market at that time may be 

eligible to receive add-on payments as a 

new technology until FY 2010 

(discharges occurring before October 1, 

2009), when data reflecting the costs of 

the technology could be used to 

recalibrate the DRG weights. Because 

the FY 2009 DRG weights would be 

calculated using FY 2007 MedPAR data, 

the costs of such a new technology 

would be reflected in the FY 2009 DRG 

weights. 

Section 412.87(b)(3) further provides 

that new medical services or 

technologies must be inadequately paid 

otherwise under the DRG system to 

receive the add-on payment. To assess 

whether technologies would be 

inadequately paid under the DRGs, we 

establish thresholds to evaluate 

applicants for new technology add-on 

payments. In the FY 2004 IPPS final 

rule (68 FR 45385), we established the 

threshold at the geometric mean 

standardized charge for all cases in the 

DRG plus 75 percent of 1 standard 

deviation above the geometric mean 

standardized charge (based on the 

logarithmic values of the charges and 

transformed back to charges) for all 

cases in the DRG to which the new 

medical service or technology is 

assigned (or the case-weighted average 

of all relevant DRGs, if the new medical 

service or technology occurs in many 

different DRGs). 

However, section 503(b)(1) of Pub. L. 

108–173 amended section 

1886(d)(5)(K)(ii)(I) of the Act to provide 

for ‘‘applying a threshold * * * that is 

the lesser of 75 percent of the 

standardized amount (increased to 

reflect the difference between cost and 

charges), or 75 percent of 1 standard 

deviation for the diagnosis-related group 

involved.’’ The provisions of section 

503(b)(1) apply to classification for 

fiscal years beginning with FY 2005. 

(Refer to section IV.D. of the preamble 

to the FY 2005 IPPS final rule (69 FR 

49084) for a discussion of the revision 

of the regulations to incorporate the 

change made by section 503(b)(1) of 

Pub. L. 108–173.) Table 10 of the 

Addendum to the FY 2007 IPPS final 

rule (71 FR 48319) contained the final 

thresholds that are being used to 

evaluate applications for new 

technology add-on payments for FY 

2008. An applicant must demonstrate 

that the cost threshold is met using 

information from inpatient hospital 

claims. 

We were recently asked to revisit the 

issue of whether the HIPAA Privacy 

Rule at 45 CFR Parts 160 and 164 

applies to claims information that 

providers submit with applications for 

new technology add-on payments. We 

previously addressed this issue in the 

September 7, 2001 final rule (66 FR 

46917) that established the new 

technology add-on payment regulations. 

In the preamble to that final rule, we 

explained that health plans, including 

Medicare, and providers that conduct 

certain transactions electronically, 

including the hospitals that would be 

receiving payment under the FY 2001 

IPPS final rule, are required to comply 

with the HIPAA Privacy Rule. We 

further explained how such entities 

could meet the applicable HIPAA 

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requirements by discussing how the 

HIPAA Privacy Rule permitted 

providers to share with health plans 

information needed to ensure correct 

payment, if they have obtained consent 

from the patient to use that patient’s 

data for treatment, payment, or health 

care operations. We also explained that 

because the information to be provided 

within applications for new technology 

add-on payment would be needed to 

ensure correct payment, no additional 

consent would be required. The HHS 

Office of Civil Rights has since amended 

the HIPAA Privacy Rule, but the results 

remain. The HIPAA Privacy Rule no 

longer requires covered entities to 

obtain consent from patients to use or 

disclose individually identifiable health 

information for treatment, payment, or 

health care operations, and expressly 

permits such entities to use or to 

disclose individually identifiable health 

information to covered entities for any 

of these purposes (45 CFR § §

164.502(a)(1)(ii), and 506(c)(1) and 

(c)(3); and the Standards for Privacy of 

Individually Identifiable Health 

Information published in the Federal 

Register on August 14, 2002 for a full 

discussion of changes in consent 

requirements). 

Section 412.87(b)(1) of our existing 

regulations provides that a new 

technology is an appropriate candidate 

for an additional payment when it 

represents ‘‘an advance that 

substantially improves, relative to 

technologies previously available, the 

diagnosis or treatment of Medicare 

beneficiaries.’’ For example, a new 

technology represents a substantial 

clinical improvement when it reduces 

mortality, decreases the number of 

hospitalizations or physician visits, or 

reduces recovery time compared to the 

technologies previously available. (Refer 

to the September 7, 2001 final rule (66 

FR 46902) for a complete discussion of 

this criterion.) 

The new medical service or 

technology add-on payment policy 

provides additional payments for cases 

with high costs involving eligible new 

medical services or technologies while 

preserving some of the incentives under 

the average-based payment system. The 

payment mechanism is based on the 

cost to hospitals for the new medical 

service or technology. Under § 412.88, 

Medicare pays a marginal cost factor of 

50 percent for the costs of a new 

medical service or technology in excess 

of the full DRG payment. If the actual 

costs of a new medical service or 

technology case exceed the DRG 

payment by more than the 50-percent 

marginal cost factor of the new medical 

service or technology, Medicare 

payment is limited to the DRG payment 

plus 50 percent of the estimated costs of 

the new technology. The Congressional report language 

accompanying section 533 of Pub. L. 

106–554 indicated Congress’ intent to 

require the Secretary to implement the 

new mechanism on a budget neutral 

basis (H.R. Conf. Rep. No. 106–1033, 

106th Cong., 2nd Sess. at 897 (2000)). 

Section 1886(d)(4)(C)(iii) of the Act 

requires that the adjustments to annual 

DRG classifications and relative weights 

must be made in a manner that ensures 

that aggregate payments to hospitals are 

not affected. Therefore, in the past, we 

accounted for projected payments under 

the new medical service and technology 

provision during the upcoming fiscal 

year at the same time we estimated the 

payment effect of changes to the DRG 

classifications and recalibration. The 

impact of additional payments under 

this provision was then included in the 

budget neutrality factor, which was 

applied to the standardized amounts 

and the hospital-specific amounts. Section 1886(d)(5)(K)(ii)(III) of the 

Act, as amended by section 503(d)(2) of 

Pub. L. 108–173, provides that there 

shall be no reduction or adjustment in 

aggregate payments under the IPPS due 

to add-on payments for new medical 

services and technologies. Therefore, 

add-on payments for new medical 

services or technologies for FY 2005 and 

later years have not been budget neutral. Applicants for add-on payments for 

new medical services or technologies for 

FY 2009 must submit a formal request, 

including a full description of the 

clinical applications of the medical 

service or technology and the results of 

any clinical evaluations demonstrating 

that the new medical service or 

technology represents a substantial 

clinical improvement, along with a 

significant sample of data to 

demonstrate the medical service or 

technology meets the high-cost 

threshold. Complete application 

information, along with final deadlines 

for submitting a full application, will be 

available on our web site after 

publication of the IPPS FY 2008 final 

rule at: http://www.cms.hhs.gov/ 

AcuteInpatientPPS/08—newtech.asp. 

To allow interested parties to identify 

the new medical services or 

technologies under review before the 

publication of the proposed rule for FY 

2009, the web site will also list the 

tracking forms completed by each 

applicant. 

2. Public Input Before Publication of a 

Notice of Proposed Rulemaking on AddOn Payments 

Section 1886(d)(5)(K)(viii) of the Act, 

as amended by section 503(b)(2) of Pub. 

L. 108–173, provides for a mechanism 

for public input before publication of a 

notice of proposed rulemaking regarding 

whether a medical service or technology 

represents a substantial clinical 

improvement or advancement. The 

process for evaluating new medical 

service and technology applications 

requires the Secretary to— <bullet≤ Provide, before publication 

of a proposed rule, for public input 

regarding whether a new service or 

technology represents an advance in 

medical technology that substantially 

improves the diagnosis or treatment of 

Medicare beneficiaries. 

<bullet≤ Make public and periodically 

update a list of the services and 

technologies for which applications for 

add-on payments are pending. <bullet≤ Accept comments, 

recommendations, and data from the 

public regarding whether a service or 

technology represents a substantial 

clinical improvement. <bullet≤ Provide, before publication 

of a proposed rule, for a meeting at 

which organizations representing 

hospitals, physicians, manufacturers, 

and any other interested party may 

present comments, recommendations, 

and data regarding whether a new 

medical service or technology 

represents a substantial clinical 

improvement to the clinical staff of 

CMS. 

In order to provide an opportunity for 

public input regarding add-on payments 

for new medical services and 

technologies for FY 2008 before 

publication of the FY 2008 IPPS 

proposed rule, we published a notice in 

the Federal Register on December 22, 

2006 (71 FR 77031), and held a town 

hall meeting at the CMS Headquarters 

Office in Baltimore, MD, on February 

22, 2007. In the announcement notice 

for the meeting, we stated that the 

opinions and alternatives provided 

during the meeting would assist us in 

our evaluations of applications by 

allowing public discussion of the 

substantial clinical improvement 

criterion for each of the FY 2008 new 

medical service and technology add-on 

payment applications before the 

publication of the FY 2008 IPPS 

proposed rule. Approximately 70 individuals 

attended the town hall meeting in 

person, while additional participants 

listened over an open telephone line. 

Boston Scientific presented data on how 

its product (Wingspan[reg] Stent System 

with GatewayTM PTA Balloon Catheter) 

meets the substantial clinical 

improvement criterion, as well as the 

need for additional payments to ensure 

its access to Medicare beneficiaries. No 

other attendees at the town hall meeting 

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made a presentation with regard to the 

Wingspan[reg] new technology add-on 

payment application. We considered Boston Scientific’s 

presentation made at the town hall 

meeting, as well as written comments 

submitted with their application, in our 

evaluation of the Wingspan[reg] new 

technology application for FY 2008 in 

this proposed rule. We have 

summarized these comments under 

section I.4. of this preamble. We did not receive any other 

comments regarding substantial clinical 

improvement of Wingspan[reg]. 

However, there were a number of public 

comments made at the town hall 

meeting suggesting that CMS provide 

more specific detail about how it would 

apply the substantial clinical 

improvement criterion. For example, the 

public commenters at the town hall 

meeting suggested that CMS provide 

clear guidance with respect to the type 

of data that applicants should submit to 

support an application for add-on 

payments for new medical services and 

technologies. We were asked to work 

with stakeholders, including 

researchers, clinicians, representatives 

of patients, and manufacturers, to 

develop specific criteria and data 

quality standards that would make 

determinations of ‘‘substantial clinical 

improvement’’ more predictable and 

transparent. We welcome public comment on this 

issue. In particular, we are interested in 

any ‘‘specific criteria or data quality 

standards’’ that the commenters believe 

we should adopt to improve the new 

technology add-on application process, 

or any concerns or challenges that 

commenters believe we may encounter 

in undertaking this effort. Again, as we 

stated at the new technology town hall 

meeting, we are always interested in 

working with our stakeholders to 

improve the inpatient new technology 

add-on payment process. We are 

interested in ensuring that the latest 

medical technology that improves care 

for the Medicare patient population 

continues to be available to our 

beneficiaries. 

3. FY 2008 Status of Technologies 

Approved for FY 2007 Add-On 

Payments 

a. Endovascular Graft Repair of the 

Thoracic Aorta 

W. L. Gore & Associates, Inc. 

submitted an application for 

consideration of its Endovascular Graft 

Repair of the Thoracic Aorta (GORE 

TAG) for new technology add-on 

payments for FY 2006. The 

manufacturer argued that endovascular 

stent-grafting of the descending thoracic 

aorta provides a less invasive alternative 

to the traditional open surgical 

approach required for the management 

of descending thoracic aortic 

aneurysms. The GORE TAG device is a 

tubular stent-graft mounted on a 

catheter-based delivery system, and it 

replaces the synthetic graft normally 

sutured in place during open surgery. 

The device was initially identified using 

ICD–9–CM procedure code 39.79 (Other 

endovascular repair (of aneurysm) of 

other vessels). The applicant also 

requested a unique ICD–9–CM 

procedure code. As noted in Table 6B of 

the FY 2006 IPPS final rule (70 FR 

47637), new procedure code 39.73 

(Endovascular implantation of graft in 

thoracic aorta) was assigned to this 

technology. In the FY 2006 IPPS final rule (70 FR 

47356), we approved the GORE TAG 

device for new technology add-on 

payment for FY 2006. FDA approved 

GORE TAG on March 23, 2005. Because 

the technology remained within the 2- 

to 3-year period during which it could 

be considered new for FY 2007, we 

continued add-on payments for the 

endovascular graft repair of the thoracic 

aorta in the FY 2007 IPPS final rule (71 

FR 47999). GORE TAG will have been 

on the market for more than 3 years as 

of March 23, 2008, or less than 6 months 

of FY 2008. Our practice has been to 

begin and end new technology add-on 

payments on the basis of a fiscal year. 

In general, we extend add-on payments 

for an additional year only if the 3-year 

anniversary date of the product’s entry 

on the market occurs in the latter half 

of the fiscal year (70 FR 47362). Because 

the 3-year anniversary date of GORE 

TAG’s entry onto the market was in the 

first half of the fiscal year, we are 

proposing to discontinue its new 

technology add-on payment for FY 

2008. 

b. Restore[supreg] Rechargeable 

Implantable Neurostimulator 

Medtronic Neurological submitted an 

application for new technology add-on 

payments for its Restore[supreg] 

Rechargeable Implantable 

Neurostimulator for FY 2006. The 

Restore[supreg] Rechargeable 

Implantable Neurostimulator is 

designed to deliver electrical 

stimulation to the spinal cord to block 

the sensation of pain. The technology 

standard for neurostimulators uses 

internal sealed batteries as the power 

source to generate the electrical current. 

These internal batteries have finite lives, 

and require replacement when their 

power has been completely discharged. 

According to the manufacturer, the 

Restore[supreg] Rechargeable 

Implantable Neurostimulator 

‘‘represents the next generation of 

neurostimulator technology, allowing 

the physician to set the voltage 

parameters in such a way that fully 

meets the patient’s requirements to 

achieve adequate pain relief without 

fear of premature depletion of the 

battery.’’ The applicant stated that the 

expected life of the Restore[supreg] 

rechargeable battery is 9 years, 

compared to an average life of 3 years 

for conventional neurostimulator 

batteries. We approved new technology 

add-on payments for all rechargeable, 

implantable neurostimulators for FY 

2006 and FY 2007. Cases involving 

these devices, made by any 

manufacturer, are identified by the 

presence of newly created ICD–9–CM 

code 86.98 (Insertion or replacement of 

dual array rechargeable neurostimulator 

pulse generator). 

The FDA approved the 

Restore[supreg] Rechargeable 

Implantable Neurostimulator in 2005. 

However, as noted in the FY 2006 IPPS 

final rule (70 FR 47358), at least one 

similar product was approved by the 

FDA as early as April 2004. Because the 

Restore’’ Rechargeable Implantable 

Neurostimulator will be beyond the 2- 

to 3-year period during which it can be 

considered new for FY 2008, we are 

proposing to discontinue add-on 

payments for the technology in FY 2008. 

c. X STOP Interspinous Process 

Decompression System 

St. Francis Medical Technologies 

submitted an application for new 

technology add-on payments for the X 

STOP Interspinous Process 

Decompression System (X STOP) for FY 

2007. Lumbar spinal stenosis describes 

a condition that occurs when the spaces 

between bones in the spine become 

narrowed due to arthritis and other agerelated conditions. This narrowing, or 

stenosis, causes nerves coming from the 

spinal cord to be compressed, thereby 

causing symptoms including pain, 

numbness, and weakness. It particularly 

causes symptoms when the spine is in 

extension, when a patient stands fully 

upright or leans back. The X STOP 

device is inserted between the spinous 

processes of adjacent vertebrae in order 

to provide a minimally invasive 

alternative to conservative treatment 

(exercise and physical therapy) and 

invasive surgery (spinal fusion). It 

works by limiting the spine’s extension 

that compresses the nerve’s roots while 

still preserving as much motion as 

possible. The device is inserted in a 

relatively simple, primarily outpatient 

procedure using local anesthesia. 

However, in some circumstances, the 

physician may prefer to admit the 

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patient for an inpatient stay. The 

manufacturer described the device as 

providing ‘‘a new minimally invasive, 

stand-alone alternative treatment for 

lumbar spinal stenosis.’’ 

The X STOP Interspinous Process 

Decompression system received premarket approval from the FDA on 

November 21, 2005. The device is 

currently described by ICD–9–CM code 

84.58 (Implantation of Interspinous 

process decompression device) 

(excluding: Fusion of spine (codes 81.00 

through 81.08, and 81.30 through 

81.39)). This ICD–9–CM code went into 

effect on October 1, 2005. 

In the FY 2007 final rule, with respect 

to substantial clinical improvement, we 

noted our concern that, during the FDA 

approval process, the Center for Devices 

and Radiological Health Advisory Panel 

voted against pre-market approval of X 

STOP because of concerns about proper 

patient selection, as well as the lack of 

objective endpoints. The applicant 

addressed our concerns by 

demonstrating that the mechanism of 

effect on the spine in cadavers with in 

vivo clinical radiographic data. That is, 

the applicant was able to show that the 

X STOP device limits spine extension 

that compresses the nerve. Thus, we 

indicated that we believed the 

technology has promise for providing a 

less invasive alternative to procedures 

such as laminectomy or fusion for 

patients that have failed conservative 

treatment (exercise, physical therapy 

and medication). The X STOP system 

represents a new level of treatment on 

the continuum of care for patients with 

lumbar spinal stenosis that previously 

did not exist. 

Accordingly, after consideration of 

the comments received, we approved 

the X STOP Interspinous Process 

Decompression System for new 

technology add-on payment for FY 

2007. Cases involving X STOP are 

identified by ICD–9–CM code 84.58 

(Implantation of interspinous process 

decompression device). These cases are 

generally included in CMS–DRG 499 

(Back and Neck Procedures Except 

Spinal Fusion with CC) and CMS–DRG 

500 (Back and Neck Procedures Except 

Spinal Fusion without CC) for FY 2007. 

The X STOP Interspinous Process 

Decompression System is still within 

the 2- to 3-year period during which it 

can be considered new for FY 2008. 

However, we are concerned that it may 

no longer meet the cost-threshold 

criterion. In section II.D. of the preamble 

of this proposed rule, we are proposing 

to adopt MS–DRGs for FY 2008 and 

assign cases with procedure codes 84.58 

into proposed MS–DRG 490 (Back and 

Neck Procedures Except Spinal Fusion 

with CC or MCC or Disc Devices). 

Proposed MS–DRG 490 includes back 

and neck procedures except spinal 

fusion with a CC or MCC. As indicated 

earlier, we did a comprehensive review 

of the spinal fusion and nonspinal 

fusion DRGs. Based on this review, we 

are proposing to further modify MS– 

DRG 490 to also include the higher cost 

of cases where the patient receives a 

spinal disc device such as an artificial 

spinal disc prosthesis, or an 

interspinous process decompression 

system. Our earlier analysis of the 

spinal and nonspinal fusion DRGs 

showed that the average charge per case 

for cases involving X STOP is $29,162. 

The average charge per case for MS– 

DRG 490 is $29,656. Therefore, cases 

that use X STOP have a lower average 

charge per case than all cases in MS– 

DRG 490. The data show that the 

technology is not inadequately paid 

under the revised MS–DRGs, and it no 

longer meets the cost threshold for new 

technology add-on payment. For this 

reason, we are proposing to discontinue 

new technology add-on payments for X 

STOP in FY 2008 and correlate the 

payments under MS–DRG 490. The high 

costs for cases using X STOP that 

necessitated an add-on payment under 

the CMS DRGs will no longer be 

necessary because of the higher 

payment that would be made under the 

proposed MS–DRG 490. 

4. FY 2008 Application for New 

Technology Add-On Payments 

Boston Scientific submitted an 

application for the Wingspan[reg] Stent 

System with Gateway PTA Balloon 

Catheter (Wingspan[reg]) for new 

technology add-on payments for FY 

2008. The device is designed for the 

treatment of patients with significant 

intracranial arterial stenosis who are 

refractory to medical management. The 

device consists of the following: a selfexpanding nitinol stent; a multilumen 

over wire delivery catheter; and a 

GatewayTM PTA Balloon Catheter. The 

device is used to treat stenoses that 

occur in the intracranial vessels. Prior to 

stent placement, the GatewayTM PTA 

Balloon is inflated to dilate the target 

lesion, and then the stent is deployed 

across the lesion to restore and maintain 

luminal patency. Effective October 1, 

2004, two new ICD–9–CM procedure 

codes were created to code intracranial 

angioplasty and intracranial stenting 

procedures: procedure codes 00.62 

(Percutaneous angioplasty or 

atherectomy of intracranial vessels) and 

00.65 (Percutaneous insertion of 

intracranial vascular stents). 

On August 3, 2005, the Wingspan[reg] 

was approved by the FDA as a 

Humanitarian Device Exemption (HDE). 

We note that the applicant submitted an 

application for new technology add-on 

payments in FY 2006 but was not 

approved for add-on payments because 

it had not yet received FDA approval. In 

November 2006, we issued a national 

coverage determination (NCD) on 

intracranial stents. The NCD stated that 

the treatment of cerebral artery stenosis 

in patients with intracranial 

atherosclerotic disease with intracranial 

percutaneous transluminal angioplasty 

(PTA) and stenting is reasonable and 

necessary when furnished in accordance 

with the FDA-approved protocols 

governing Category B Investigational 

Device Exemption (IDE) clinical trials. 

Currently, there are no clinical trials in 

place for the Wingspan[reg]. However, 

because the technology is covered by 

Medicare, if it is used in the setting of 

a clinical trial, we will evaluate whether 

the Wingspan[reg] meets the criteria for 

an inpatient new technology add-on 

payment. The Wingspan[reg] has been 

available on the market since August 3, 

2005. Therefore, we believe that the 

technology meets the newness criterion. 

The applicant noted in its application 

that cases of intracranial angioplasty 

and stenting cases are currently grouped 

to CMS DRGs 533 (Extracranial 

Procedure with CC) and 534 

(Extracranial Procedure Without CC). 

However, the applicant believes these 

cases should be assigned to CMS DRGs 

1 (Craniotomy Age ≤ 17 With CC), 2 

(Craniotomy Age ≤ 17 Without CC), and 

543 (Craniotomy With Major Device 

Implant or Acute Complex Central 

Nervous System Principal Diagnosis) 

based on resource use and for clinical 

consistency with other endovascular 

intracranial procedures assigned to 

these DRGs. As discussed in section 

II.D. of the preamble of this proposed 

rule, we are proposing to move 

procedure code 00.62 to proposed MS– 

DRGs 25, 26, and 27 (Craniotomy & 

Endovascular Intracranial Procedures 

With MCC, With CC, and Without CC/ 

MCC, respectively) and proposed MS– 

DRGs 23 and 24 (Craniotomy With 

Major Device Implant or Acute Complex 

Central Nervous System Principal 

Diagnosis With MCC or Without MCC, 

respectively) under the proposed MS– 

DRG system, which are comparable to 

DRGs 1, 2, and 543 under the current 

CMS–DRG system. 

To demonstrate that the 

Wingspan[reg] meets the cost threshold, 

the manufacturer submitted data from 

MedPAR and non-MedPAR databases. 

Using the FY 2005 MedPAR data, the 

applicant identified cases of intracranial 

angioplasty that had a procedure code of 

39.50 (Angioplasty or atherectomy of 

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other noncoronary vessels) in 

combination with one of the following 

principal diagnosis codes: Any 

principal diagnosis code that begins 

with the prefix of 433 (Occlusion and 

stenosis of precerebral arteries), 

excluding 433.10 (Cartoid artery 

without mention of cerebral infarction) 

and 433.11 (Cartoid artery with cerebral 

infarction); any principal diagnosis code 

that begins with the prefix of 434 

(Occlusion of cerebral arteries), 437.0 

(Cerebral atherosclerosis), 437.1 (Other 

generalized ischemic cerebrovascular 

disease), or 437.9 (Unspecified). The 

applicant noted that procedure code 

39.50 is the predecessor code for 

identifying cases of intracranial 

angioplasty. The applicant explained 

that, given the newness of procedure 

codes 00.62 and 00.65 that were 

implemented beginning October 1, 

2005, it believes there are still cases 

being coded with the predecessor 

procedure codes. Using this 

methodology, the applicant found 577 

cases in DRG 533 and 179 cases in DRG 

534. The applicant noted that charges in 

the MedPAR file do not include the total 

costs of devices, drugs, and medical 

supplies associated with the 

Wingspan[reg], so the applicant 

conducted an estimate of the charges 

associated with the Wingspan[reg]. The 

applicant determined that costs 

associated with the Wingspan[reg] are 

approximately $10,073. Because we use 

charges to determine if a technology 

meets the threshold, it is necessary to 

inflate the costs to charges. Using the 

national average CCR of 0.47, the 

applicant inflated the costs associated 

with the Wingspan[reg] to $21,432 in 

charges. After adding the charges 

associated with the Wingspan[reg], the 

average standardized charge per case 

was $76,416 and $51,277 for DRGs 533 

and 534, respectively. We are concerned regarding whether 

the cases identified by the applicant are 

a useful proxy to identify cases of 

intracranial angioplasty. Procedure code 

39.50 describes cases of angioplasty in 

any artery of the body except the heart. 

Intracranial angioplasty with stenting 

was not covered by Medicare in any 

circumstance prior to October 2006. 

Therefore, the Medicare cases submitted 

by the applicant under procedure code 

39.50 should not involve intracranial 

angioplasty because they are neither 

described by the code nor covered by 

Medicare. Furthermore, procedure code 

00.62 is assigned to the Non-Covered 

Procedure edit of the MCE. The 

applicant supplied Medicare data from 

FY 2005 for claims coded with 

procedure code 00.62. It is unclear to us 

how these claims were processed 

despite the Non-Covered Procedure edit. 

Because these data appear to be based 

on claims that may not have been coded 

or processed correctly, we question the 

reliability and validity of these data. We 

are concerned that it may not be 

appropriate to rely on these data for 

purposes of determining whether the 

technology meets the cost threshold. As stated above, the applicant also 

submitted non-Medicare data. The 

applicant used the 2005 patient 

discharge data from California’s Office 

of Statewide Health Planning and 

Development database for hospitals in 

California and the 2005 patient data 

from Florida’s Agency for Health Care 

Administration for hospitals in Florida. 

Similar to the analysis above, the 

applicant identified cases of intracranial 

angioplasty using procedure code 39.50 

in combination with the diagnosis codes 

listed above. The applicant identified 43 

cases in DRG 533, and 21 cases in DRG 

534. Because these cases already 

include charges associated with 

Wingspan[supreg], it was not necessary 

to include the $21,432 in charges 

associated with Wingspan[supreg]. The 

average standardized charge per case 

was $89,697 and $40,475 for DRGs 533 

and 534, respectively. As discussed 

above, we are concerned about whether 

these cases actually represent cases of 

intracranial angioplasty. We also note 

that we are unable to validate these data 

because they are non-Medicare data. In 

addition, similar to the analysis 

described above, the applicant also 

identified cases of intracranial 

angioplasty using procedure code 00.62. 

The applicant found 30 cases in DRG 

533, and 23 cases in DRG 534. The 

average standardized charge per case 

was $93,215 and $31,479 for DRGs 533 

and 534, respectively. Based on these 

data, the applicant maintains that the 

technology meets the cost threshold. As noted above, the applicant has 

requested that cases of the 

Wingspan[supreg] be reassigned to CMS 

DRGs 1, 2 and 543. In section II.G.2. of 

the preamble of this proposed rule, we 

are proposing to assign procedure code 

00.62 to proposed MS-DRGs 23, 24, 25, 

26 and 27, which replace DRGs 1, 2, and 

543 of the current CMS DRGs. The 

thresholds in Table 10 of the Addendum 

of the FY 2007 IPPS final rule (as 

corrected at 71 FR 60040) for DRGs 1, 

2 and 543 are $53,969, $37,116 and 

$64,397, respectively. Analyzing the 

same Medicare and non-Medicare data 

that the applicant used to demonstrate 

that the Wingspan[supreg] exceeds the 

cost threshold for DRGs 533 and 534, 

the applicant compared the average 

standardized charge per case to the 

thresholds for DRGs 1, 2, and 543. The 

applicant maintains that the 

Wingspan[supreg] would still exceed 

the cost threshold even if it were 

reassigned to DRGs 1, 2, and 543. 

However, for the reasons described 

above, it is not clear whether 

Wingspan[supreg] meets the cost 

threshold for new technology add-on 

payment. We welcome public comments 

on this issue. 

The applicant also maintains that the 

technology meets the substantial 

clinical improvement criterion. In the 

past there has been no surgical or 

medical treatment available for 

recurrent strokes that occur despite 

optimal medical management. The 

applicant asserts that the 

Wingspan[supreg] provides a new 

treatment option for these patients. The 

applicant submitted three studies to 

support this position. 

First, the applicant cites data derived 

from a series of cases of 45 patients who 

received the Wingspan[supreg] that 

demonstrate 4.4 percent composite 

ipsilateral stroke or death at 30 days, 7.0 

percent composite ipsilateral stroke or 

death at 6 months, and 9.3 percent 

ipsilateral stroke or death at 13 months. 

The applicant then used patients in the 

well known Warfarin-Aspirin 

Symptomatic Intracranial Disease 

(WASID) trial as a historical control 

against which to compare patients who 

received Wingspan[supreg]. The WASID 

trial compared the warfarin vs. aspirin 

therapy in treating symptomatic 

intracranial arterial stenosis, and it 

demonstrated a 23 percent stroke/death 

rate at one year in patients with severe 

(70 percent or greater) stenosis, and a 21 

percent stroke/death rate at 2 years in 

patients with 50 percent or greater 

stenosis. The applicant also submitted 

data from an ongoing Wingspan[supreg] 

registry of patients that demonstrate a 

4.8 percent stroke/death rate at 30 days, 

and a 9.7 percent stroke/death rate at 3 

to 6 month follow up in 72 patients. In 

addition, the applicant submitted data 

from a multicenter NIH registry of 131 

patients with 70 percent or greater 

stenosis that demonstrate an 8.4 percent 

rate of stroke, intracerebral hemorrhage 

or death at 30 days and a 9.9 percent 

rate of stroke and death at the mean 3.2 

months followup. 

While we recognize that 

Wingspan[supreg] may represent a 

promising technology in patients with 

significant intracranial arterial stenosis 

who are refractory to medical 

management, we are concerned that, to 

date, there has been no controlled, 

randomized trial to demonstrate its 

clinical efficacy. We are also concerned 

that the Wingspan[supreg] data did not 

compare patients over the same 

followup periods as WASID. In 

addition, we are concerned over the use 

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of WASID patients as a control group 

against which to compare 

Wingspan[supreg] patients. The current 

FDA Humanitarian Device Exemption, 

in combination with the current CMS 

NCD, while providing access to this 

technology for very ill patients with 

generally poor prognoses who have few 

other options, also effectively designates 

the technology as investigational, and in 

need of further studies to prove its 

effectiveness. We would prefer that the 

product’s effectiveness be demonstrated 

before we judge whether the product 

represents a substantial clinical 

improvement. For these reasons, we are 

concerned that there may not be 

sufficient evidence that 

Wingspan[supreg] represents an 

advance that substantially improves the 

diagnosis or treatment of Medicare 

beneficiaries. However, we welcome 

public comments that may pertain to 

this matter. 

5. Technical Correction 

Section 1886(d)(5)(K)(i) of the Act 

requires that the Secretary establish a 

mechanism to recognize the costs of 

new medical services and technologies 

under subsection (d) of section 1886 of 

the Act. As made clear under section 

1886(d)(1)(A) of the Act, subsection (d) 

provides the methodology for payment 

with respect to the operating costs of 

inpatient hospital services. Section 

1886(g) of the Act provides for payment 

of capital costs of inpatient hospital 

services. Although it has always been 

our policy that new technology add-on 

payment is available only with respect 

to operating costs, § 412.88(a)(2) of our 

regulations does not specifically refer to 

operating costs or the operating CCR. 

Therefore, we are proposing to revise §

412.88(a)(2) to clarify that the new 

technology add-on payment is available 

only for operating costs, and that we 

estimate the costs of a case by applying 

the hospital’s operating CCR to the 

billed charges. This proposed correction 

would not have an impact on new 

technology add-on payments because, to 

the best of our knowledge, MACs 

already correctly apply only the 

operating CCR to calculate new 

technology add-on payments. 

III. Proposed Changes to the Hospital 

Wage Index 

A. Background 

Section 1886(d)(3)(E) of the Act 

requires that, as part of the methodology 

for determining prospective payments to 

hospitals, the Secretary must adjust the 

standardized amounts ‘‘for area 

differences in hospital wage levels by a 

factor (established by the Secretary) 

reflecting the relative hospital wage 

level in the geographic area of the 

hospital compared to the national 

average hospital wage level.’’ In 

accordance with the broad discretion 

conferred under the Act, we currently 

define hospital labor market areas based 

on the definitions of statistical areas 

established by the Office of Management 

and Budget (OMB). A discussion of the 

proposed FY 2008 hospital wage index 

based on the statistical areas, including 

OMB’s revised definitions of 

Metropolitan Areas, appears under 

section III.B. of this preamble. 

Beginning October 1, 1993, section 

1886(d)(3)(E) of the Act requires that we 

update the wage index annually. 

Furthermore, this section provides that 

the Secretary base the update on a 

survey of wages and wage-related costs 

of short-term, acute care hospitals. The 

survey must exclude the wages and 

wage-related costs incurred in 

furnishing skilled nursing services. This 

provision also requires us to make any 

updates or adjustments to the wage 

index in a manner that ensures that 

aggregate payments to hospitals are not 

affected by the change in the wage 

index. The proposed adjustment for FY 

2008 is discussed in section II.B. of the 

Addendum to this proposed rule. 

As discussed below in section III.I. of 

this preamble, we also take into account 

the geographic reclassification of 

hospitals in accordance with sections 

1886(d)(8)(B) and 1886(d)(10) of the Act 

when calculating IPPS payment 

amounts. Under section 1886(d)(8)(D) of 

the Act, the Secretary is required to 

adjust the standardized amounts so as to 

ensure that aggregate payments under 

the IPPS after implementation of the 

provisions of sections 1886(d)(8)(B) and 

(C) and 1886(d)(10) of the Act are equal 

to the aggregate prospective payments 

that would have been made absent these 

provisions. The proposed budget 

neutrality adjustment for FY 2008 is 

discussed in section II.A.4.b. of the 

Addendum to this proposed rule. 

Section 1886(d)(3)(E) of the Act also 

provides for the collection of data every 

3 years on the occupational mix of 

employees for short-term, acute care 

hospitals participating in the Medicare 

program, in order to construct an 

occupational mix adjustment to the 

wage index. A discussion of the 

occupational mix adjustment that we 

are proposing to apply beginning 

October 1, 2007 (the FY 2008 wage 

index) appears under section III.C. of 

this preamble. 

B. Core-Based Statistical Areas for the 

Hospital Wage Index 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘CBSAs’’ at the beginning of 

your comments.) 

The wage index is calculated and 

assigned to hospitals on the basis of the 

labor market area in which the hospital 

is located. In accordance with the broad 

discretion under section 1886(d)(3)(E) of 

the Act, beginning with FY 2005, we 

define hospital labor market areas based 

on the Core-Based Statistical Areas 

(CBSAs) established by OMB and 

announced in December 2003 (69 FR 

49027). For a discussion of OMB’s 

revised definitions of CBSAs and our 

implementation of the CBSA 

definitions, we refer readers to the 

preamble of the FY 2005 IPPS final rule 

(69 FR 49026 through 49032). The 

revised area designations established by 

OMB resulted in a higher wage index for 

some areas and a lower wage index for 

others. Further, some hospitals that 

were previously classified as urban 

became classified as rural. Given the 

significant payment impacts upon some 

hospitals because of these changes, we 

provided a transition period to the new 

labor market areas in the FY 2005 IPPS 

final rule. As part of that transition, we 

allowed urban hospitals that became 

rural under the new definitions to 

maintain their assignment to the MSA 

where they were previously located for 

the 3-year period of FY 2005, FY 2006, 

and FY 2007. For a discussion of the 

transition, we refer readers to the FY 

2005 IPPS final rule (69 FR 49032 

through 49034). 

FY 2007 was the last year of the 

transition period for urban hospitals 

that became classified as rural. 

Therefore, for discharges on or after 

October 1, 2007 (FY 2008), these 

hospitals will receive their statewide 

rural wage index or their FY 2008 

MGCRB reclassified age index. (These 

hospitals were and are eligible to apply 

for reclassification by the MGCRB both 

during the transition period and in 

subsequent years. These hospitals are 

considered rural for reclassification 

purposes.) 

Consistent with the FY 2005, FY 

2006, and FY 2007 IPPS final rules, for 

FY 2008 we are proposing to provide 

that hospitals receive 100 percent of 

their wage index based upon the CBSA 

configurations. Specifically, for each 

hospital, we will determine a wage 

index for FY 2008 employing wage 

index data from FY 2004 hospital cost 

reports and using the CBSA labor 

market definitions. We consider CBSAs 

that are MSAs to be urban, and CBSAs 

that are Micropolitan Statistical Areas as 

well as areas outside of CBSAs to be 

rural. In addition, where an MSA has 

been divided into Metropolitan 

Divisions, we consider the Metropolitan 

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Division to comprise the labor market 

areas for purposes of calculating the 

wage index (69 FR 49029). 

On December 18, 2006, OMB 

announced the inclusion of two new 

CBSAs and the revision of designations 

for six areas (OMB Bulletin No. 07–01). 

The new CBSAs are as follows: 

<bullet≤ Lake Havasu-Kingman, 

Arizona (CBSA 29420). This CBSA 

comes from Mohave County, Arizona; 

<bullet≤ Palm Coast, Florida (CBSA 

37380). This CBSA comes from Flager 

County, Florida; 

The revised CBSA designations are as 

follows: 

<bullet≤ Mauldin, South Carolina and 

Easley, South Carolina qualify as new 

principal cities of the GreenvilleMauldin-Easley, South Carolina CBSA; 

<bullet≤ Conway, Arkansas qualifies 

as a new principal city of the Little 

Rock-North Little Rock-Conway, 

Arkansas CBSA; 

<bullet≤ Goleta, California qualifies as 

a new principal city of the Santa 

Barbara-Santa Maria-Goleta, California 

CBSA; 

<bullet≤ Franklin, Tennessee qualifies 

as a new principal city of the NashvilleDavidson-Murfreesboro-Franklin, 

Tennessee CBSA; 

<bullet≤ Fort Pierce, Florida no longer 

qualifies as a principal city of the Port 

St. Lucie-Fort Pierce, Florida CBSA; the 

new designation is Port St. Lucie, 

Florida CBSA. 

(We note also that OMB renamed the 

Essex County, Massachusetts 

Metropolitan Division as the Peabody, 

Massachusetts Metropolitan Division. 

OMB also changed the CBSA code from 

21604 to 37764.) 

The OMB bulletin is available on the 

OMB Web site at http:// 

www.whitehouse.gov/OMB—go to 

‘‘Bulletins’’ or ‘‘Statistical Programs and 

Standards.’’ CMS will apply these 

changes to the IPPS beginning October 

1, 2007. 

C. Proposed Occupational Mix 

Adjustment to the Proposed FY 2008 

Wage Index 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Occupational Mix 

Adjustment’’ at the beginning of your 

comment.) 

As stated earlier, section 1886(d)(3)(E) 

of the Act provides for the collection of 

data every 3 years on the occupational 

mix of employees for each short-term, 

acute care hospital participating in the 

Medicare program, in order to construct 

an occupational mix adjustment to the 

wage index, for application beginning 

October 1, 2004 (the FY 2005 wage 

index). The purpose of the occupational 

mix adjustment is to control for the 

effect of hospitals’ employment choices 

on the wage index. For example, 

hospitals may choose to employ 

different combinations of registered 

nurses, licensed practical nurses, 

nursing aides, and medical assistants for 

the purpose of providing nursing care to 

their patients. The varying labor costs 

associated with these choices reflect 

hospital management decisions rather 

than geographic differences in the costs 

of labor. 

1. Development of Data for the 

Proposed FY 2008 Occupational Mix 

Adjustment 

On October 14, 2005, we published a 

notice in the Federal Register (70 FR 

60092) proposing to use a new survey, 

the 2006 Medicare Wage Index 

Occupational Mix Survey (the 2006 

survey) to apply an occupational mix 

adjustment to the FY 2008 wage index. 

In the proposed 2006 survey, we 

included several modifications based on 

the comments and recommendations we 

received on the 2003 survey, including 

(1) allowing hospitals to report their 

own average hourly wage rather than 

using BLS data; (2) extending the 

prospective survey period; and (3) 

reducing the number of occupational 

categories but refining the subcategories 

for registered nurses. 

We made the changes to the 

occupational categories in response to 

MedPAC comments to the FY 2005 IPPS 

final rule (69 FR 49036). Specifically, 

MedPAC recommended that CMS assess 

whether including subcategories of 

registered nurses would result in a more 

accurate occupational mix adjustment. 

MedPAC believed that including all 

registered nurses in a single category 

may obscure significant wage 

differences among the subcategories of 

registered nurses, for example, the 

wages of surgical registered nurses and 

floor registered nurses may differ. Also, 

to offset additional reporting burden for 

hospitals, MedPAC recommended that 

CMS should combine the general 

service categories that account for only 

a small percentage of a hospital’s total 

hours with the ‘‘all other occupations’’ 

category because most of the 

occupational mix adjustment is 

correlated with the nursing general 

service category. 

In addition, in response to the public 

comments on the October 14, 2005 

notice, we modified the 2006 survey. On 

February 10, 2006, we published a 

Federal Register notice (71 FR 7047) 

that solicited comments and announced 

our intent to seek OMB approval on the 

revised occupational mix survey (Form 

CMS–10079 (2006)). OMB approved the 

survey on April 25, 2006. 

The 2006 survey provides for the 

collection of hospital-specific wages and 

hours data, a 6-month prospective 

reporting period (that is, January 1, 

2006, through June 30, 2006), the 

transfer of each general service category 

that comprised less than 4 percent of 

total hospital employees in the 2003 

survey to the ‘‘all other occupations’’ 

category (the revised survey focuses 

only on the mix of nursing occupations), 

additional clarification of the 

definitions for the occupational 

categories, an expansion of the 

registered nurse category to include 

functional subcategories, and the 

exclusion of average hourly rate data 

associated with advance practice nurses. 

The 2006 survey included only two 

general occupational categories: nursing 

and ‘‘all other occupations.’’ The 

nursing category has four subcategories: 

registered nurses, licensed practical 

nurses, aides, orderlies, attendants, and 

medical assistants. The registered nurse 

subcategory includes two functional 

subcategories: Management personnel 

and staff nurses or clinicians. As 

indicated above, the 2006 survey 

provided for a 6-month data collection 

period, from January 1, 2006 through 

June 30, 2006. However, we allowed 

flexibility for the reporting period begin 

and end dates to accommodate some 

hospitals’ bi-weekly payroll and 

reporting systems. That is, the 6-month 

reporting period had to begin on or after 

December 25, 2005, and end before July 

9, 2006. 

We are proposing to use the 6-month 

2006 survey data to calculate the 

occupational mix adjustment for the FY 

2008 wage index. We used the 1st 

quarter of 2006 survey data in the FY 

2007 wage index to comply with a court 

decision in Bellevue Hosp. Center v. 

Leavitt, 443 F.3d 163 (2nd Cir. 2006). 

For a discussion of our use of the 2006 

survey data in the FY 2007 wage index, 

in compliance with the Bellevue 

decision, we refer readers to the FY 

2007 IPPS final rule (71 FR 48007) as 

well as the FY 2007 IPPS final notice 

(71 FR 90886). However, as stated 

above, we are proposing to use the 

entire 6-month 2006 survey data (that is, 

from the period January 1, 2006 through 

June 30, 2006) to calculate the 

occupational mix adjustment for the FY 

2008 wage index. 

2. Timeline for the Collection, Review, 

and Correction of the Occupational Mix 

Data 

In a Joint-Signature Memorandum 

that we issued on April 21, 2006 (JSM– 

06412), and in the FY 2007 IPPS final 

rule (71 FR 48008), we discussed the 

schedule for the 1st quarter 2006 

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occupational mix survey data that 

would be used in the FY 2007 wage 

index. The schedule included deadlines 

for— 

<bullet≤ Hospitals to submit 1st 

quarter occupational mix data. The 

deadline was June 1, 2006. 

<bullet≤ MAC review of the submitted 

1st quarter data. The deadline was June 

22, 2006. 

<bullet≤ Availability of the submitted 

first quarter data on the CMS Web site. 

The deadline was June 29, 2006. 

<bullet≤ Hospitals to submit requests 

to their MACs for corrections to their 1st 

quarter occupational mix data. The 

deadline was July 13, 2006. 

<bullet≤ MACs to submit corrected 

1st quarter occupational mix survey 

data to CMS. The deadline was July 27, 

2006. 

In the Joint-Signature Memorandum, 

we also indicated that hospitals were to 

submit their 2nd quarter 2006 

occupational mix survey data to their 

intermediaries (MACs) by August 31, 

2006. On October 6, we published on 

our web site both the audited 1st quarter 

and unaudited 2nd quarter 2006 

occupational survey data and Worksheet 

S–3 wage data to be used in calculating 

the FY 2008 wage index. In addition, we 

sent a letter to hospitals through their 

MACs (dated October 6, 2006) that 

discussed the timeframe for reviewing 

and correcting Worksheet S–3 wage data 

and the 2nd quarter 2006 survey data, 

and an opportunity for hospitals to 

request additional adjustments to their 

1st quarter 2006 survey data for the FY 

2008 wage index. The revision and 

correction process for all of the data to 

be used for computing the FY 2008 

wage index is discussed in detail in 

section III.K. of this preamble. 

3. Calculation of the Proposed 

Occupational Mix Adjustment for FY 

2008 

For FY 2008 (as we did for FY 2007), 

we are proposing to calculate the 

occupational mix adjustment factor 

using the following steps: 

Step 1—For each hospital, determine 

the percentage of the total nursing 

category attributable to a nursing 

subcategory by dividing the nursing 

subcategory hours by the total nursing 

category’s hours (registered nurse 

management personnel and registered 

nurse staff nurses or clinicians are 

treated as separate nursing 

subcategories). Repeat this computation 

for each of the five nursing 

subcategories: registered nurse 

management personnel, registered nurse 

staff nurses or clinicians, licensed 

practical nurses; nursing aides, 

orderlies, and attendants; and medical 

assistants. 

Step 2—Determine a national average 

hourly rate for each nursing subcategory 

by dividing a subcategory’s total salaries 

for all hospitals in the occupational mix 

survey database by the subcategory’s 

total hours for all hospitals in the 

occupational mix survey database. 

Step 3—For each hospital, determine 

an adjusted average hourly rate for each 

nursing subcategory by multiplying the 

percentage of the total nursing category 

(from Step 1) by the national average 

hourly rate for that nursing subcategory 

(from Step 2). Repeat this calculation for 

each of the five nursing subcategories. 

Step 4—For each hospital, determine 

the adjusted average hourly rate for the 

total nursing category by summing the 

adjusted average hourly rate (from Step 

3) for each of the nursing subcategories. 

Step 5—Determine the national 

average hourly rate for the total nursing 

category by dividing total nursing 

category salaries for all hospitals in the 

occupational mix survey database by 

total nursing category hours for all 

hospitals in the occupational mix 

survey database. 

Step 6—For each hospital, compute 

the occupational mix adjustment factor 

for the total nursing category by 

dividing the national average hourly 

rate for the total nursing category (from 

Step 5) by the hospital’s adjusted 

average hourly rate for the total nursing 

category (from Step 4). 

If the hospital’s adjusted average 

hourly rate is less than the national 

average hourly rate (indicating the 

hospital employs a less costly mix of 

nursing employees), the occupational 

mix adjustment factor would be greater 

than 1.0000. If the hospital’s adjusted 

average hourly rate is greater than the 

national average hourly rate, the 

occupational mix adjustment factor 

would be less than 1.0000. 

Step 7—For each hospital, calculate 

the occupational mix adjusted salaries 

and wage-related costs for the total 

nursing category by multiplying the 

hospital’s total salaries and wage-related 

costs (from Step 5 of the unadjusted 

wage index calculation in section III.F. 

of this preamble) by the percentage of 

the hospital’s total workers attributable 

to the total nursing category (using the 

occupational mix survey data, this 

percentage is determined by dividing 

the hospital’s total nursing category 

salaries by the hospital’s total salaries 

for ‘‘nursing and all other’’) and by the 

total nursing category’s occupational 

mix adjustment factor (from Step 6 

above). 

The remaining portion of the 

hospital’s total salaries and wage-related 

costs that is attributable to all other 

employees of the hospital is not 

adjusted by the occupational mix. A 

hospital’s all other portion is 

determined by subtracting the hospital’s 

nursing category percentage from 100 

percent. 

Step 8—For each hospital, calculate 

the total occupational mix adjusted 

salaries and wage-related costs for a 

hospital by summing the occupational 

mix adjusted salaries and wage-related 

costs for the total nursing category (from 

Step 7) and the portion of the hospital’s 

salaries and wage-related costs for all 

other employees (from Step 7). 

To compute a hospital’s occupational 

mix adjusted average hourly wage, 

divide the hospital’s total occupational 

mix adjusted salaries and wage-related 

costs by the hospital’s total hours (from 

Step 4 of the unadjusted wage index 

calculation in section III.F. of this 

preamble). 

Step 9—To compute the occupational 

mix adjusted average hourly wage for an 

urban or rural area, sum the total 

occupational mix adjusted salaries and 

wage-related costs for all hospitals in 

the area, then sum the total hours for all 

hospitals in the area. Next, divide the 

area’s occupational mix adjusted 

salaries and wage-related costs by the 

area’s hours. 

Step 10—To compute the national 

occupational mix adjusted average 

hourly wage, sum the total occupational 

mix adjusted salaries and wage-related 

costs for all hospitals in the Nation, then 

sum the total hours for all hospitals in 

the Nation. Next, divide the national 

occupational mix adjusted salaries and 

wage-related costs by the national 

hours. 

Step 11—To compute the 

occupational mix adjusted wage index, 

divide each area’s occupational mix 

adjusted average hourly wage (Step 9) 

by the national occupational mix 

adjusted average hourly wage (Step 10). 

Step 12—To compute the Puerto Rico 

specific occupational mix adjusted wage 

index, follow Steps 1 through 11 above. 

The table below is an illustrative 

example of the proposed occupational 

mix adjustment. 

BILLING CODE 4120–01–P 

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BILLING CODE 4120–01–C Because the occupational mix 

adjustment is required by statute, all 

hospitals that are subject to payments 

under the IPPS, or any hospital that 


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would be subject to the IPPS if not 

granted a waiver, must complete the 

occupational mix survey, unless the 

hospital has no associated cost report 

wage data that are included in the 

proposed FY 2008 wage index. 

For the FY 2007 wage index, if a 

hospital did not respond to the 

occupational mix survey, or if we 

determined that a hospital’s submitted 

data were too erroneous to include in 

the wage index, we assigned the 

hospital the average occupational mix 

adjustment for the labor market area (71 

FR 48013). We believed this method had 

the least impact on the wage index for 

other hospitals in the area. For areas 

where no hospital submitted data for 

purposes of calculating the occupational 

mix adjustment, we applied the national 

occupational mix factor of 1.0000 in 

calculating the area’s FY 2007 

occupational mix adjusted wage index. 

We indicated in the FY 2007 IPPS final 

rule that we reserve the right to apply 

a different approach in future years, 

including potentially penalizing 

nonresponsive hospitals. 

For the FY 2008 wage index, we are 

proposing to handle the data for 

hospitals that did not respond to the 

occupational mix survey (neither the 1st 

quarter nor 2nd quarter data) in the 

same manner as discussed above for the 

FY 2007 wage index. In addition, if a 

hospital submitted survey data for either 

the 1st quarter or 2nd quarter, but not 

for both quarters, we are proposing to 

use the data the hospital submitted for 

one quarter to calculate the hospital’s 

FY 2008 occupational mix adjustment 

factor. Lastly, if a hospital submitted a 

survey(s), but that survey data could not 

be used because we determined it to be 

aberrant, we also assigned the hospital 

the average occupational mix 

adjustment for its labor market area. For 

example, if a hospital’s individual nurse 

category average hourly wages were out 

of range (that is, unusually high or low), 

and the hospital did not provide 

sufficient documentation to explain the 

aberrancy, or the hospital did not 

submit any registered nurse staff salaries 

or hours data, we assigned the hospital 

the average occupational mix 

adjustment for the labor market area in 

which it is located. 

In calculating the average 

occupational mix adjustment factor for 

a labor market area, we replicated Steps 

1 through 6 of the calculation for the 

occupational mix adjustment. However, 

instead of performing these steps at the 

hospital level, we aggregated the data at 

the labor market area level. In following 

these steps, for example, for CBSAs that 

contain providers that did not submit 

occupational mix survey data, the 

occupational mix adjustment factor 

ranged from a low of 0.8972 (CBSA 

39820, Redding, CA), to a high of 1.0728 

(CBSA 19, Rural Louisiana). Also, in 

computing a hospital’s occupational 

mix adjusted salaries and wage-related 

costs for nursing employees (Step 7 of 

the calculation), in the absence of 

occupational mix survey data, we 

multiplied the hospital’s total salaries 

and wage-related costs by the 

percentage of the area’s total workers 

attributable to the area’s total nursing 

category. For FY 2008, there is one 

CBSA in which none of the providers 

submitted the occupational mix survey 

(CBSA 49740, Yuma, AZ). In the 

absence of any data in this labor market 

area, we applied an occupational mix 

adjustment factor of 1.0 to all 

provider(s). 

In the FY 2007 IPPS final rule, we 

also indicated that we would give 

serious consideration to applying a 

hospital-specific penalty if a hospital 

does not comply with regulations 

requiring submission of occupational 

mix survey data in future years. We 

stated that we believe that section 

1886(d)(5)(I)(i) of the Act provides us 

with the authority to penalize hospitals 

that do not submit occupational mix 

survey data. That section authorizes us 

to provide for exceptions and 

adjustments to the payment amounts 

under IPPS as the Secretary deems 

appropriate. We also indicated that we 

would address this issue in the FY 2008 

IPPS proposed rule. 

We are soliciting comments and 

suggestions for a hospital-specific 

penalty for hospitals that do not submit 

occupational mix survey. In response to 

the FY 2007 IPPS proposed rule, some 

commenters suggested a 1-percent to 2- 

percent reduction in the hospital’s wage 

index value or a set percentage of the 

standardized amount. Any penalty that 

we would determine for nonresponsive 

hospitals would apply to a future wage 

index, not the FY 2008 wage index. 

4. Proposed 2007–2008 Occupational 

Mix Survey for the FY 2010 Wage Index 

As stated earlier, section 304(c) of 

Pub. L. 106–554 amended section 

1886(d)(3)(E) of the Act to require CMS 

to collect data every 3 years on the 

occupational mix of employees for each 

short-term, acute care hospital 

participating in the Medicare program. 

We are currently using occupational 

mix survey data collected in 2006 in the 

FY 2007 IPPS. Since we implemented 

the 2006 survey, we received several 

public comments suggesting further 

improvements to the occupational mix 

survey instructions and definitions. 

Specifically, some commenters 

recommended that we include certain 

employees, such as surgical technicians 

and paramedics in the occupational mix 

adjustment. The commenters indicated 

that these occupations perform similar 

functions, and in some cases, are used 

as substitutes for nursing staff. 

Therefore, they recommended that CMS 

include these occupations with the 

nursing categories on the survey. (On 

the 2003 and 2006 surveys, these 

categories were included in the ‘‘All 

Other Occupations’’ category.) The 

commenters also recommended that 

CMS expand the list of cost centers for 

the survey to include additional cost 

centers that contain a significant 

number of nursing personnel. 

Some commenters suggested that 

CMS not collect occupational mix data 

for the ‘‘Registered Nurse’’ subcategories 

(that is, Management Personnel and 

Staff Nurse/Clinician). The commenters 

expressed concern that requiring the 

subcategories led to errors and 

inconsistencies in reporting, and added 

to the hospitals’ collection burden. The 

commenters did not believe that this 

level of specificity significantly affects 

the adjustment. Therefore they 

recommended that CMS eliminate the 

RN subcategories. 

In addition, commenters 

recommended that CMS provide for a 1- 

year data collection period rather than 

a 6-month data collection period for the 

next survey collection. The commenters 

suggested that a 1-year data collection 

period would provide a better 

representation of a hospital’s 

employment mix, which can vary 

during different times of the year. The 

commenters also indicated that a 1-year 

data collection period would allow 

hospitals to verify their wages and hours 

to year-end payroll reports and 

contractor invoices. 

In response to these suggestions we 

have modified the occupational mix 

survey. The revised 2007–2008 

occupational mix survey will provide 

for the collection of hospital-specific 

wages and hours data for a 1-year 

prospective reporting period from July 

1, 2007, through June 30, 2008, 

additional clarifications to the survey 

instructions, the elimination of the 

registered nurse subcategories, some 

refinements to the definitions of the 

occupational categories, and the 

inclusion of additional cost centers that 

typically provide nursing services. The 

revised 2007–2008 Medicare 

occupational mix survey will be applied 

beginning with the FY 2010 wage index. 

On February 2, 2007, we published a 

notice soliciting comments on the 

proposed revisions to the occupational 

mix survey (Form CMS–10079 (2006)) 

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(72 FR 5055). The comment period for 

the proposed survey ended on April 3, 

2007. A final notice is expected to be 

published in the Federal Register by 

July 1, 2007. 

D. Worksheet S–3 Wage Data for the 

Proposed FY 2008 Wage Index 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Wage Data’’ at the beginning of 

your comment.) The proposed FY 2008 wage index 

values (to be effective for hospital 

discharges occurring on or after October 

1, 2007, and before October 1, 2008) in 

section II.B. of the Addendum to this 

proposed rule are based on the data 

collected from the Medicare cost reports 

submitted by hospitals for cost reporting 

periods beginning in FY 2004 (the FY 

2007 wage index was based on FY 2003 

wage data). 

1. Included Categories of Costs 

The proposed FY 2008 wage index 

includes the following categories of data 

associated with costs paid under the 

IPPS (as well as outpatient costs): <bullet≤ Salaries and hours from 

short-term, acute care hospitals 

(including paid lunch hours and hours 

associated with military leave and jury 

duty). <bullet≤ Home office costs and hours. 

<bullet≤ Certain contract labor costs 

and hours (which includes direct 

patient care, certain top management, 

pharmacy, laboratory, and nonteaching 

physician Part A services). <bullet≤ Wage-related costs, including 

pensions and other deferred 

compensation costs. 

2. Contract Labor for Indirect Patient 

Care Services 

In the FY 2003 IPPS final rule (67 FR 

50022), we discussed the inclusion of 

contract labor cost in calculating the 

wage index. Our policy has evolved 

over the years with the increasing role 

of contract labor in meeting special 

personnel needs of hospitals. In 

response to suggestions that we further 

expand our definition of contract labor 

for the wage index, we indicated our 

intent to begin collecting data in future 

Medicare cost reports on the following 

overhead services: administrative and 

general (A&G); housekeeping; and 

dietary. We selected these three 

overhead services for consideration 

because they are provided at all 

hospitals, either directly or through 

contracts, and together they comprise 

about 60 percent of a hospital’s 

overhead hours. Consistent with our 

consideration of contract A&G services, 

we also stated that we would begin 

collecting costs and hours data 

associated with other contract 

management services that would not be 

included on the cost report as overhead 

A&G and are not top management 

contracts (that is, the chief executive 

officer, chief financial officer, chief 

operating officer, and nurse 

administrator) that are included on Line 

9 of Worksheet S–3, Part II. 

We revised the cost report, beginning 

October 1, 2003 (the FY 2004 cost 

report), to provide for the collection of 

cost and hours data for the four 

identified contract indirect patient care 

services. We added four new line items 

to Worksheet S–3, Part II: Line 9.03 

(Contract management and 

administrative services); Line 22.01 

(Contract A & G services); Line 26.01 

(Contract housekeeping services); and 

Line 27.01 (Contract dietary services). 

We stated in the FY 2003 final rule that 

our decision on whether to include 

these costs in calculating the wage 

index would depend on our analyses of 

the data and public comments. The FY 

2008 wage index, which is based on FY 

2004 cost report data, is the first year 

that we can assess the impact of 

including these costs in the wage index. As part of the FY 2008 wage index 

desk review program, we required the 

fiscal intermediaries (or, if applicable, 

the MAC) to verify the accuracy of the 

data reported on the new Lines 9.03, 

22.01, 26.01, and 27.01. After the 

completion of these reviews, some 

hospitals continued to fail our edits for 

reasonableness: 12 hospitals (0.3 

percent) failed edits for Line 9.03; 130 

hospitals (3.6 percent) failed edits for 

Line 22.01; 56 hospitals (1.6 percent) 

failed edits for Line 26.01; and 99 

hospitals (2.8 percent) failed edits for 

Line 27.01. Many of these edit failures 

are for wage data that are not to be 

included in the wage index and will be 

excluded through the wage index 

calculation. That is, as specified in the 

cost reporting instructions in the 

Provider Reimbursement Manual, Part 

II, section 3605.2, if a hospital’s ratio of 

excluded area hours (Lines 8 and 8.0) on 

Worksheet S–3, Part II to total adjusted 

hours is less than 15 percent, Lines 21 

through 35 of Part II should not be 

completed by hospitals. In addition, 

some of the aberrant data will be 

resolved by the final rule through the 

correction process described in section 

III.K. of the preamble of this proposed 

rule. Nevertheless, we believe that the 

amount of aberrant data on these new 

line items is minimal and will have 

little impact on area wage index values. In addition, we have simulated the 

effect of including these wage data for 

contract indirect patient care services on 

the wage index. Under this simulation, 

we found that the resulting average 

hourly wage would not affect 3,231 

hospitals (90.2 percent), would decrease 

for 121 hospitals (3.4 percent), and 

would increase for 229 hospitals (6.4 

percent). Only one hospital would 

experience a decrease of greater than 1 

percent (3 percent), and 19 hospitals 

would experience an increase of greater 

than 1 percent (the largest being 7.8 

percent). At the labor market area level, 

we found that the resulting average 

hourly wage would not affect 316 areas 

(72.6 percent), would decrease for 28 

areas (6.4 percent), and would increase 

for 91 areas (20.9 percent). No area, 

rural or urban, would experience an 

increase or decrease of greater than 0.6 

percent in its wage index. We believe 

that the combined effect of including 

these costs in the wage index is 

negligible because the higher labor costs 

associated with contract management 

and A&G services are offset by the lower 

labor costs associated with contract 

housekeeping and dietary services. 

Public commenters have expressed 

interest in including in the wage index 

the costs and hours for contract 

management, A&G, housekeeping, and 

dietary services. We also believe that 

including a more comprehensive 

measure of area differences in the cost 

of labor will improve the accuracy of the 

wage index. For these reasons, we are 

proposing to include these contract 

services in the wage index, beginning 

with FY 2008. Although we invite 

public comment on whether we should 

revise a future cost report to collect 

contract labor data for the remaining 

indirect patient care cost centers on 

Worksheet S–3, Part II for possible 

inclusion in the wage index, we will 

consider these comments in the context 

of potential reforms of the IPPS wage 

index for FY 2009 and subsequent years. 

As indicated in section III.M. of the 

preamble of this proposed rule, section 

106(b) of the MIEA-TRHCA (Pub. L. 

109–432) requires the Secretary to 

consider a MedPAC study and nine 

specific aspects of the wage index in 

making one or more proposals for 

revisions in FY 2009. 

3. Excluded Categories of Costs 

Consistent with the wage index 

methodology for FY 2007, the proposed 

wage index for FY 2008 also excludes 

the direct and overhead salaries and 

hours for services not subject to IPPS 

payment, such as SNF services, home 

health services, costs related to GME 

(teaching physicians and residents) and 

certified registered nurse anesthetists 

(CRNAs), and other subprovider 

components that are not paid under the 

IPPS. The proposed FY 2008 wage index 

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also excludes the salaries, hours, and 

wage-related costs of hospital-based 

rural health clinics (RHCs), and 

Federally qualified health centers 

(FQHCs) because Medicare pays for 

these costs outside of the IPPS (68 FR 

45395). In addition, salaries, hours, and 

wage-related costs of CAHs are excluded 

from the wage index, for the reasons 

explained in the FY 2004 IPPS final rule 

(68 FR 45397). 

4. Use of Wage Index Data by Providers 

Other Than Acute Care Hospitals under 

the IPPS 

Data collected for the IPPS wage 

index are also currently used to 

calculate wage indices applicable to 

other providers, such as SNFs, home 

health agencies, and hospices. In 

addition, they are used for prospective 

payments to IRFs, IPFs, and LTCHs, and 

for hospital outpatient services. We note 

that, in the IPPS rules, we do not 

address comments pertaining to the 

wage indices for non-IPPS providers. 

Such comments should be made in 

response to separate proposed rules for 

those providers. 

E. Verification of Worksheet S–3 Wage 

Data 

(If you choose to comment on this 

section, please include the caption 

‘‘Wage Data’’ at the beginning of your 

comment.) 

The wage data for the proposed FY 

2008 wage index were obtained from 

Worksheet S–3, Parts II and III of the FY 

2004 Medicare cost reports. Instructions 

for completing the Worksheet S–3, Parts 

II and III are in the Provider 

Reimbursement Manual, Part I, sections 

3605.2 and 3605.3. The data file used to 

construct the proposed wage index 

includes FY 2004 data submitted to us 

as of February 26, 2007 As in past years, 

we will perform an intensive review of 

the wage data, mostly through the use 

of edits designed to identify aberrant 

data. 

We asked our fiscal intermediaries/ 

MACs to revise or verify data elements 

that resulted in specific edit failures. We 

identified and excluded 23 hospitals 

with data that was too aberrant to 

include in the proposed wage index, 

although if these data elements are 

corrected, we may include some of these 

providers in the FY 2008 final wage 

index. However, some unresolved data 

elements are included in the calculation 

of the proposed FY 2008 wage index. 

We instructed fiscal intermediaries/ 

MACs to complete their data 

verification of questionable data 

elements and to transmit any changes to 

the wage data no later than April 13, 

2007. We believe all unresolved data 

elements will be resolved by the date 

the final rule is issued. The revised data 

will be reflected in the final rule. 

In constructing the proposed FY 2008 

wage index, we include the wage data 

for facilities that were IPPS hospitals in 

FY 2004, even for those facilities that 

have since terminated their 

participation in the program as 

hospitals, as long as those data do not 

fail any of our edits for reasonableness. 

We believe that including the wage data 

for these hospitals is, in general, 

appropriate to reflect the economic 

conditions in the various labor market 

areas during the relevant past period. 

However, we exclude the wage data for 

CAHs as discussed in 68 FR 45397. For 

this proposed rule, we removed 18 

hospitals that converted to CAH status 

between February 17, 2006, the cut-off 

date for CAH exclusion from the FY 

2007 wage index, and February 16, 

2007, the cut-off date for CAH exclusion 

from the FY 2008 wage index. After 

removing hospitals with aberrant data 

and hospitals that converted to CAH 

status, the proposed FY 2008 wage 

index is calculated based on 3,581 

hospitals. 

F. Wage Index for Multicampus 

Hospitals 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Multicampus Hospitals’’ at the 

beginning of your comment.) 

As discussed earlier under section 

III.B. of this preamble, effective October 

1, 2004, for the IPPS, CMS implemented 

new labor market areas based on the 

CBSA definitions of MSAs. As a result 

of the new labor market areas, there are 

multicampus hospitals previously 

located in a single MSA that are now 

located in more than one CBSA. A 

multicampus hospital is a single 

integrated institution. For this reason, 

the multicampus hospital has one 

provider number and submits a single 

cost report that combines the total 

wages and hours of each of its 

campuses. When campuses of a 

multicampus hospital are located in the 

same CBSA, the wages and hours for the 

entire institution are included in the 

calculation of the wage index for that 

labor market area and there is no need 

to separate the data by campus. 

However, when a multicampus hospital 

has campuses located in different labor 

market areas, wages and hours are 

reported in a single CBSA even though 

the hospital’s staff is working at 

campuses in more than one labor market 

area. The wage data are reported in the 

labor market area of the hospital campus 

associated with the provider number. 

Wages and hours are not reported 

separately for each campus and no data 

from the multicampus hospital are used 

in determining the wage index for the 

labor market area(s) where the other 

campus(es) are located. Under §

412.64(b)(5) of our regulations, the 

wage-adjusted standardized amount is 

based on geographic location of the 

hospital facility at which the discharge 

occurred. Therefore, the wage index for 

each hospital campus used to make the 

IPPS payment is based on its geographic 

location, while the wage data from all of 

the campuses, including those that may 

be located in a different geographic area, 

are applied to one area only. We have 

received inquiries from several hospitals 

suggesting that we should adopt a 

policy that results in an allocation of a 

multicampus hospital’s wages and 

hours across the different labor market 

areas where its campuses are located. 

The wage index was developed to 

adjust the IPPS standardized amount to 

reflect area differences in hospital wage 

levels in the hospital’s geographic area 

compared to the national hospital wage 

level as required under section 

1886(d)(3)(E) of the Act. Although we 

acknowledge that reporting the wage 

data into a single labor market area 

when individual campuses of a 

multicampus hospital are located in 

different labor market areas may not 

allocate wage data with exact precision, 

the Medicare cost report, in its current 

form, does not enable a multicampus 

hospital to separately report its costs by 

location. The fact that a multicampus 

hospital submits a single cost report 

reflects that it is an integrated 

institution with one accounting 

structure. Nevertheless, we agree with 

the comments brought to our attention 

that we should consider a policy that 

allocates a multicampus hospital’s 

wages and hours among the different 

labor market areas where it is located. 

That is, rather than giving 100 percent 

of the hospital’s wage data to the labor 

market area associated with its provider 

number, we believe that an allocation of 

its wage data should be made to each 

campus. 

We considered three alternative 

methods of apportionment: beds, 

discharges, or FTE staff. A hospital’s 

number of discharges can fluctuate from 

year to year and may be an unstable data 

source to use in allocating a hospital’s 

wages and hours among the different 

campuses. Alternatively, while a 

hospital’s number of beds is a more 

static number, it likely does not 

correlate well with how a hospital 

incurs its wage costs. Furthermore, 

neither of these numbers is available on 

a campus-specific basis in Medicare’s 

data systems. (While an individual 

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campus of a multicampus hospital 

located in a different labor market area 

than the remainder of the institution is 

required to indicate a suffix on its 

provider number when submitting a 

claim in order to receive payment using 

the wage index for its geographic 

location, the suffix is only used by the 

fiscal intermediary (or, if applicable, the 

MAC) and is not retained in Medicare’s 

historical data files that we use to 

determine IPPS rates). 

Given the unavailability of beds and 

discharges and their respective 

drawbacks for allocating wages and 

hours across multiple campuses, we are 

proposing to apportion wages and hours 

for each campus of a multicampus 

hospital based on FTE staff. For 

example, a multicampus hospital may 

have three campuses located in two 

different labor market areas. Campuses 

A and B are located in labor market area 

1 and have 50 and 25 FTEs, 

respectively. Campus C is located in 

labor market area 2 and has an 

additional 25 FTEs. Therefore, 75 

percent of the hospital’s FTEs work in 

labor market 1 and 25 percent in labor 

market area 2. Under the proposed 

policy, we would apportion 75 percent 

of the hospital’s occupational mix 

adjusted total salaries, wage-related 

costs and hours to labor market 1 and 

25 percent to labor market 2. We believe 

that the number of FTEs will provide 

the best method of apportioning wages 

and hours among the different 

campuses, thereby allowing the 

apportioned wage data to be included in 

each geographic area where the hospital 

has employees working. 

This proposed policy requires the 

identification of all multicampus 

hospitals located in more than one 

CBSA, the county, State, and zip code 

of each campus, and the campusspecific number of FTEs. Based on our 

comprehensive interactions with our 

fiscal intermediaries since adopting the 

revised labor market areas beginning in 

FY 2005, we are only aware of three 

multicampus hospitals that are located 

in more than one labor market area. We 

are beginning the process to make 

updates and refinements to the cost 

report for the future. We are currently 

planning to add additional lines to 

Worksheet S–2 of the cost report that 

will allow a multicampus hospital to 

report the locations of its different 

campuses (county, State, and zip code) 

and number of FTE staff by location so 

this information would become part of 

the cost report submission process. The 

effective date of the revised cost report 

is not expected until FY 2009. 

Therefore, we would not have data from 

multicampus hospitals under our 

normal wage data collection process to 

be able to allocate wages to each labor 

market area by FTEs until at least the FY 

2013 wage index. In the interim, we will 

collect this information from 

multicampus hospitals on a small 

survey form through our fiscal 

intermediaries/MACs as part of the 

wage index desk review process 

beginning with the FY 2009 wage index. 

We will not be able to apply this policy 

to the FY 2008 wage index unless we 

have this information from multicampus 

hospitals prior to the close of the 

comment period on this proposed rule. 

Therefore, for the FY 2008 wage index, 

multicampus hospitals with campuses 

located in more than one geographic 

area should submit the information 

during the comment period on this 

proposed rule for the county, State, and 

zip code of its campuses, and the FTE 

number, including contract labor, per 

campus along with supporting 

documentation to: Centers for Medicare 

& Medicaid Services, Wage Index Team, 

C4–08–06, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Attn: Kathy 

Ellingson. 

The hospitals should submit data 

from their FY 2004 cost reporting period 

to match the same data that will be used 

for the FY 2008 wage index. However, 

if unavailable, the hospital may submit 

the data for a subsequent cost reporting 

period that is closest to the FY 2004 

reporting period that provides the 

information in order to apportion the 

hospital’s wage data among its 

campuses. These data will enable CMS 

to apportion the wages and hours of the 

multicampus hospital among its 

different campuses for use in the FY 

2008 wage index calculations should 

this proposal become final. As stated 

earlier, we are only aware of three 

hospitals that would be affected by this 

proposed information collection 

request. As stipulated under 5 CFR 

1320.3(c)(4), the proposed information 

collection request is exempt from the 

Paperwork Reduction Act (PRA) as it 

does not affect 10 or more persons 

within a 12-month period. However, if 

during the IPPS rule comment period, 

we determine the number of affected 

persons surpasses the threshold of 10 as 

specified in 5 CFR 1320.3(c)(4), we will 

not adopt the policy until FY 2009 in 

order for us to seek the requisite 

approval from OMB under the PRA. 

G. Computation of the Proposed FY 

2008 Unadjusted Wage Index 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Wage Index’’ at the beginning 

of your comment.) 

1. Method for Computing the Proposed 

FY 2008 Unadjusted Wage Index 

The method used to compute the 

proposed FY 2008 wage index without 

an occupational mix adjustment 

follows: 

Step 1—As noted above, we based the 

proposed FY 2008 wage index on wage 

data reported on the FY 2004 Medicare 

cost reports. We gathered data from each 

of the non-Federal, short-term, acute 

care hospitals for which data were 

reported on the Worksheet S–3, Parts II 

and III of the Medicare cost report for 

the hospital’s cost reporting period 

beginning on or after October 1, 2003, 

and before October 1, 2004. In addition, 

we include data from some hospitals 

that had cost reporting periods 

beginning before October 2003 and 

reported a cost reporting period 

covering all of FY 2004. These data are 

included because no other data from 

these hospitals would be available for 

the cost reporting period described 

above, and because particular labor 

market areas might be affected due to 

the omission of these hospitals. 

However, we generally describe these 

wage data as FY 2004 data. We note 

that, if a hospital had more than one 

cost reporting period beginning during 

FY 2004 (for example, a hospital had 

two short cost reporting periods 

beginning on or after October 1, 2003, 

and before October 1, 2004), we include 

wage data from only one of the cost 

reporting periods, the longer, in the 

wage index calculation. If there was 

more than one cost reporting period and 

the periods were equal in length, we 

include the wage data from the later 

period in the wage index calculation. 

Step 2—Salaries—The method used to 

compute a hospital’s average hourly 

wage excludes certain costs that are not 

paid under the IPPS. In calculating a 

hospital’s average salaries plus wagerelated costs, we subtract from Line 1 

(total salaries) the GME and CRNA costs 

reported on Lines 2, 4.01, 6, and 6.01, 

the Part B salaries reported on Lines 3, 

5 and 5.01, home office salaries reported 

on Line 7, and exclude salaries reported 

on Lines 8 and 8.01 (that is, direct 

salaries attributable to SNF services, 

home health services, and other 

subprovider components not subject to 

the IPPS). We also subtract from Line 1 

the salaries for which no hours were 

reported. To determine total salaries 

plus wage-related costs, we add to the 

net hospital salaries the costs of contract 

labor for direct patient care, certain top 

management, pharmacy, laboratory, and 

nonteaching physician Part A services 

(Lines 9 and 10), home office salaries 

and wage-related costs reported by the 

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hospital on Lines 11 and 12, and 

nonexcluded area wage-related costs 

(Lines 13, 14, and 18). 

We note that contract labor and home 

office salaries for which no 

corresponding hours are reported are 

not included. In addition, wage-related 

costs for nonteaching physician Part A 

employees (Line 18) are excluded if no 

corresponding salaries are reported for 

those employees on Line 4. 

Step 3—Hours—With the exception of 

wage-related costs, for which there are 

no associated hours, we compute total 

hours using the same methods as 

described for salaries in Step 2. 

Step 4—For each hospital reporting 

both total overhead salaries and total 

overhead hours greater than zero, we 

then allocate overhead costs to areas of 

the hospital excluded from the wage 

index calculation. First, we determine 

the ratio of excluded area hours (sum of 

Lines 8 and 8.01 of Worksheet S–3, Part 

II) to revised total hours (Line 1 minus 

the sum of Part II, Lines 2, 3, 4.01, 5, 

5.01, 6, 6.01, 7, and Part III, Line 13 of 

Worksheet S–3). We then compute the 

amounts of overhead salaries and hours 

to be allocated to excluded areas by 

multiplying the above ratio by the total 

overhead salaries and hours reported on 

Line 13 of Worksheet S–3, Part III. Next, 

we compute the amounts of overhead 

wage-related costs to be allocated to 

excluded areas using three steps: (1) we 

determine the ratio of overhead hours 

(Part III, Line 13) to revised hours (Line 

1 minus the sum of Lines 2, 3, 4.01, 5, 

5.01, 6, 6.01, 7, 8, and 8.01); (2) we 

compute overhead wage-related costs by 

multiplying the overhead hours ratio by 

wage-related costs reported on Part II, 

Lines 13, 14, and 18; and (3) we 

multiply the computed overhead wagerelated costs by the above excluded area 

hours ratio. Finally, we subtract the 

computed overhead salaries, wagerelated costs, and hours associated with 

excluded areas from the total salaries 

(plus wage-related costs) and hours 

derived in Steps 2 and 3. 

Step 5—For each hospital, we adjust 

the total salaries plus wage-related costs 

to a common period to determine total 

adjusted salaries plus wage-related 

costs. To make the wage adjustment, we 

estimate the percentage change in the 

employment cost index (ECI) for 

compensation for each 30-day 

increment from October 14, 2003, 

through April 15, 2005, for private 

industry hospital workers from the BLS’ 

Compensation and Working Conditions. 

We use the ECI because it reflects the 

price increase associated with total 

compensation (salaries plus fringes) 

rather than just the increase in salaries. 

In addition, the ECI includes managers 

as well as other hospital workers. This 

methodology to compute the monthly 

update factors uses actual quarterly ECI 

data and assures that the update factors 

match the actual quarterly and annual 

percent changes. We also note that, 

since April 2006 with the publication of 

March 2006 data, the BLS’ ECI uses a 

different classification system, the North 

American Industrial Classification 

System (NAICS), instead of the Standard 

Industrial Codes (SICs), which no longer 

exist. We have consistently used the ECI 

as the data source for our wages and 

salaries and other price proxies in the 

IPPS market basket and are not 

proposing to make any changes to the 

usage at this time. However, we are 

soliciting comments on our continued 

use of the BLS ECI data in light of the 

BLS change in system usage to the 

NAICS-based ECI. The factors used to 

adjust the hospital’s data were based on 

the midpoint of the cost reporting 

period, as indicated below. 

MIDPOINT OF COST REPORTING PERIOD

After Before Adjustment Factor 

10/14/2003 11/15/2003 1.05743 

11/14/2003 12/15/2003 1.05355 

12/14/2003 01/15/2004 1.04964 

01/14/2004 02/15/2004 1.04578 

02/14/2004 03/15/2004 1.04198 

03/14/2004 04/15/2004 1.03830 

04/14/2004 05/15/2004 1.03482 

05/14/2004 06/15/2004 1.03153 

06/14/2004 07/15/2004 1.02821 

07/14/2004 08/15/2004 1.02466 

08/14/2004 09/15/2004 1.02086 

09/14/2004 10/15/2004 1.01705 

10/14/2004 11/15/2004 1.01344 

11/14/2004 12/15/2004 1.01003 

12/14/2004 01/15/2005 1.00671 

01/14/2005 02/15/2005 1.00336 

02/14/2005 03/15/2005 1.00000 

03/14/2005 04/15/2005 0.99663 

For example, the midpoint of a cost 

reporting period beginning January 1, 

2004, and ending December 31, 2004, is 

June 30, 2004. An adjustment factor of 

1.02821 would be applied to the wages 

of a hospital with such a cost reporting 

period. In addition, for the data for any 

cost reporting period that began in FY 

2004 and covered a period of less than 

360 days or more than 370 days, we 

annualize the data to reflect a 1-year 

cost report. Dividing the data by the 

number of days in the cost report and 

then multiplying the results by 365 

accomplishes annualization. 

Step 6—Each hospital is assigned to 

its appropriate urban or rural labor 

market area before any reclassifications 

under section 1886(d)(8)(B), section 

1886(d)(8)(E), or section 1886(d)(10) of 

the Act. Within each urban or rural 

labor market area, we add the total 

adjusted salaries plus wage-related costs 

obtained in Step 5 for all hospitals in 

that area to determine the total adjusted 

salaries plus wage-related costs for the 

labor market area. 

Step 7—We divide the total adjusted 

salaries plus wage-related costs obtained 

under both methods in Step 6 by the 

sum of the corresponding total hours 

(from Step 4) for all hospitals in each 

labor market area to determine an 

average hourly wage for the area. 

Step 8—We add the total adjusted 

salaries plus wage-related costs obtained 

in Step 5 for all hospitals in the Nation 

and then divide the sum by the national 

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sum of total hours from Step 4 to arrive 

at a national average hourly wage. Using 

the data as described above, the 

proposed national average hourly wage 

is $30.9298. 

Step 9—For each urban or rural labor 

market area, we calculate the hospital 

wage index value, unadjusted for 

occupational mix, by dividing the area 

average hourly wage obtained in Step 7 

by the national average hourly wage 

computed in Step 8. 

Step 10—Following the process set 

forth above, we develop a separate 

Puerto Rico-specific wage index for 

purposes of adjusting the Puerto Rico 

standardized amounts. (The national 

Puerto Rico standardized amount is 

adjusted by a wage index calculated for 

all Puerto Rico labor market areas based 

on the national average hourly wage as 

described above.) We add the total 

adjusted salaries plus wage-related costs 

(as calculated in Step 5) for all hospitals 

in Puerto Rico and divide the sum by 

the total hours for Puerto Rico (as 

calculated in Step 4) to arrive at an 

overall proposed average hourly wage of 

$13.4729 for Puerto Rico. For each labor 

market area in Puerto Rico, we calculate 

the Puerto Rico-specific wage index 

value by dividing the area average 

hourly wage (as calculated in Step 7) by 

the overall Puerto Rico average hourly 

wage. 

Step 11—Section 4410 of Pub. L. 105– 

33 provides that, for discharges on or 

after October 1, 1997, the area wage 

index applicable to any hospital that is 

located in an urban area of a State may 

not be less than the area wage index 

applicable to hospitals located in rural 

areas in that State. For FY 2008, this 

change affects 239 hospitals in 65 urban 

areas. The areas affected by this 

provision are identified by a footnote in 

Table 4A in the Addendum of this 

proposed rule. 

2. Expiration of the Imputed Floor 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Imputed Floor’’ at the 

beginning of your comment.) 

Section 4410 of Pub. L. 105–33 

provides that the area wage index 

applicable to any hospital that is located 

in an urban area of a State may not be 

less than the area wage index applicable 

to hospitals located in rural areas of that 

State (‘‘the rural floor’’). There are two 

States that have no rural areas (New 

Jersey and Rhode Island) and one State 

that has rural areas but no IPPS 

hospitals located in the rural areas of 

the State (Massachusetts). In the FY 

2005 IPPS final rule (69 FR 49109), we 

adopted an ‘‘imputed’’ floor measure to 

address the concern that hospitals in allurban States were disadvantaged by the 

absence of rural areas, because there is 

no floor within the State. We limited 

application of the policy to FYs 2005, 

2006, and 2007 and indicated our intent 

to make additional changes to the policy 

or eliminate it for fiscal years after FY 

2007. 

In FY 2008, the rural floor will apply 

to 239 hospitals in 25 States. If the 

imputed rural floor were to continue 

into FY 2008, it would apply to an 

additional 28 hospitals in New Jersey. In 

FY 2007, 40 hospitals in 10 urban areas 

received higher wage indices due to the 

imputed floor policy: Massachusetts (10 

hospitals in 2 areas); New Jersey (30 

hospitals in 8 areas); Rhode Island (no 

areas and no hospitals). In 

Massachusetts, the imputed rural floor 

will no longer apply even if it were to 

continue because one hospital acquired 

rural status under § 412.103. We note 

that if a State has a hospital reclassified 

as rural under § 412.103, the State will 

be considered to have IPPS hospitals 

located in rural areas because, in this 

case, the reclassified hospital is treated 

as being located in a rural area in 

accordance with section 1886(d)(8)(E) of 

the Act. This policy also accords with 

how we defined an ‘‘all-urban State’’ 

under § 412.64(h)(5) of the regulations, 

which specifies that ‘‘A State with rural 

areas and with hospitals reclassified as 

rural under § 412.103 is not an allurban State.’’ Therefore, in the case 

where a State has no hospitals that are 

geographically located in its rural areas, 

and one or more hospitals in the State 

are reclassified as rural under §

412.103, the data for the reclassified 

rural hospitals will be used to set the 

rural floor for the State until a new 

geographically located rural hospital 

opens and data are available from that 

hospital (as noted above, 4 years later) 

to compute the rural floor. 

We are proposing to discontinue the 

imputed floor policy after the FY 2007 

wage index. After further considering 

the issue, we do not believe that it is 

necessary to have an ‘‘imputed’’ rural 

floor in States that have no rural areas 

or no rural hospitals. As discussed 

above, the imputed floor would not 

apply to two of the three States: it is not 

necessary for Rhode Island and is no 

longer necessary for Massachusetts. In 

addition, the imputed rural floor 

methodology creates a disadvantage in 

the application of the wage index to 

hospitals in States with rural hospitals 

but no urban hospitals receiving the 

rural floor. Because the application of a 

rural floor requires a transfer of 

payments from hospitals in States with 

rural hospitals but where the rural floor 

is not applied to hospitals in States 

where either a rural or imputed floor is 

applied, we believe the policy should 

apply only when required by statute. 

Thus, only States with both rural areas 

and hospitals located in such areas 

(including any hospital reclassified 

under § 412.103) would benefit from 

the rural floor, as required by Congress. 

For all of the reasons stated above, we 

are not proposing to continue the 

imputed rural floor. Nevertheless, we 

recognize that we would still need a 

policy for determining the rural wage 

index when a new IPPS hospital opens 

in a State that has rural areas, but no 

IPPS hospitals. There is a lag between 

the time a hospital opens or becomes an 

IPPS provider and when the hospital’s 

cost report wage data are available to 

include in calculating the area wage 

index. For example, if a hospital files its 

first Medicare cost report as an IPPS 

provider with a beginning date of 

January 1, 2007, and an ending date of 

December 31, 2007, the hospital’s FY 

2007 wage data would not be included 

in the wage index until the FY 2011 

IPPS update. Therefore, when a rural 

IPPS hospital opens in a State that has 

rural areas, but no wage data are 

available to calculate a rural wage 

index, we are proposing to apply a wage 

index to that hospital using the same 

methodology that we currently use for 

home health and other post-acute care 

providers in rural Massachusetts (71 FR 

65906). That is, we would use the 

unweighted average of the wage indices 

from all CBSAs that are contiguous to 

the rural counties of the State. (We 

define contiguous as sharing a border.) 

We would apply the wage index 

calculated above until the new IPPS 

hospital files a cost report for the base 

year that is used in calculating the wage 

index. (In the above example, the rural 

hospital’s wage index would be 

calculated for FYs 2008, 2009, and 2010 

using urban area data.) Further, under 

section 4410 of Pub. L. 105–33, the wage 

index for this rural hospital would 

become the State’s rural floor. As stated 

above, however, if a State has rural 

areas, and a hospital is reclassified as 

rural under § 412.103, then there would 

be no need to apply the above policy. 

The reclassified hospital would set the 

rural floor, and the wage data of the 

newly opened rural hospitals would be 

included in the calculation of the wage 

index of the rural area only once their 

wage data correlated with the survey 

year used to establish the wage index (4 

years after wage data are reported). 

3. CAHs Reverting Back to IPPS 

Hospitals and Raising the Rural Floor 

(If you choose to comment on issues 

in this section, please include the 

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16 The BBA was enacted on August 5, 1997, and 

required application of the rural floor beginning 

with the FY 1998 IPPS. See the following for a 

description and calculation of the IPPS 

standardized amounts since that time: 62 FR 

46038–46043, August 29, 1997; 63 FR 41006–41010, 

July 31, 1998; 64 FR 41544–41549, July 30, 1999; 

65 FR 47111–47116, August 1, 2000; 66 FR 39939– 

39946, August 1, 2001; 67 FR 50120–50126, August 

1, 2002; 68 FR 45474–45480, August 1, 2003; 69 FR 

49273–49282, August 11, 2004; 70 FR 47491–47498, 

August 12, 2005; 71 FR 59889–58980, October 11, 

2006. 

caption ‘‘Rural Floor’’ at the beginning 

of your comment.) 

Medicare payments to CAHs are based 

on 101 percent of reasonable costs and 

are generally greater than the payments 

Medicare would make if the same 

hospitals were paid under the IPPS, 

which pays hospitals a fixed rate per 

discharge. Also, as a CAH, a hospital is 

guaranteed to recover is costs, while 

under the IPPS, it is not. We are aware 

of a situation where two rural hospitals 

in a State are considering converting 

from CAH status back to IPPS even 

though they continue to be CAH 

eligible. The CAHs would convert back 

to IPPS even though it would not 

directly benefit them. As IPPS 

providers, the hospitals’ wage data 

would eventually set the rural floor for 

the State (that is, in 4 years when the 

hospitals’ first IPPS cost reports would 

be included in a base year used in 

calculating the State’s rural wage index). 

In this case, we are concerned that these 

hospitals are converting solely in order 

to take advantage of the rural floor 

provisions for the other hospitals in the 

State, but not for any reasons that are 

intrinsic to the two specific hospitals. 

Because the hospitals’ wage levels are 

higher than most, if not all, of the urban 

IPPS hospitals in the State, including 

one hospital in the State that acquired 

rural status under § 412.103, the wage 

indices for most, if not all, of the State’s 

urban hospitals would increase as a 

result of the rural floor provision if the 

CAHs convert to IPPS status. Such an 

arrangement would increase payments 

to the hospitals in the State at the 

expense of every other IPPS hospital in 

the nation. The two rural hospitals that 

are currently CAHs were last paid under 

the IPPS in FY 2003. We simulated the 

effect of allowing these two hospitals to 

set the State’s rural floor with the same 

data used to calculate the FY 2003 wage 

index as would occur in FY 2011 if 

these hospitals were to convert to IPPS 

status in FY 2007 and no other hospitals 

were to open in the rural area of the 

State. Based on this simulation, all 

hospitals except two would be paid 

using the rural floor, increasing 

payments in excess of $220 million for 

a single year. If the average hourly wage 

for these two hospitals increased faster 

than the national average, the increase 

in payments would be even higher. It 

seems likely that over 5 years, Medicare 

payments to hospitals in this State 

would increase by more than $1 billion. 

Again, these increased payments would 

be budget neutralized at the expense of 

all other IPPS hospitals nationwide. 

Given that the hospitals continue to be 

eligible for the higher paying CAH 

status, we are concerned that hospitals 

are converting to IPPS status solely in 

order to raise the State’s rural floor. We 

are concerned about the propriety of 

such an arrangement if the intent is to 

manipulate the State’s area wage index 

values to receive higher Medicare 

reimbursement. 

Section 1886(d)(5)(I)(i) of the Act 

allows the Secretary the authority to 

‘‘provide by regulation for such other 

exceptions and adjustments * * * as the 

Secretary deems appropriate.’’ We are 

soliciting comments regarding whether 

it would be appropriate for CMS to 

establish a policy under this authority to 

preclude the arrangement described 

above and, if so, how such a policy 

would be applied. We believe that any 

policy should only apply to a CAH that 

continues to meet the CAH certification 

requirements and should not apply if a 

CAH no longer met those requirements 

and converted to an IPPS provider. 

4. Application of Rural Floor Budget 

Neutrality 

Section 4410 of the Balanced Budget 

Act of 1997 (BBA) established the rural 

floor by requiring that the wage index 

for a hospital in any urban area cannot 

be less than the area wage index 

determined for the State’s rural area. 

Since FY 1998, we have implemented 

the budget neutrality requirement of this 

provision by adjusting the standardized 

amounts. A discussion and illustration 

of the calculation of the standardized 

amounts is shown in the Addendum of 

every year’s IPPS rule.16

In this proposed rule, we are 

proposing a prospective change to how 

budget neutrality is applied to 

implement the rural floor for FY 2008 

and subsequent years. Section 4410(a) of 

the BBA indicates that ‘‘the area wage 

index applicable * * * to any hospital 

which is not located in a rural area’may 

not be less than the area wage index 

applicable * * * to hospitals located in 

rural areas in the State in which the 

hospital is located.’’ Section 4410(b) of 

the BBA imposes the budget neutrality 

requirement and states that the 

Secretary shall ‘‘adjust the area wage 

index referred to in subsection (a) for 

hospitals not described in such 

subsection.’’ 

One possible interpretation of section 

4410(b) of the BBA is that the budget 

neutrality adjustment would be applied 

only to those hospitals that do not 

receive the rural floor. In other words, 

the wage index of an urban hospital 

subject to the rural floor would be 

increased to the level of the rural wage 

index in the same State, but would not 

be adjusted for budget neutrality. Thus, 

urban hospitals receiving the rural floor 

would receive a higher wage index than 

the rural hospitals within the same State 

(because rural floor hospitals would not 

be subject to budget neutrality, whereas 

rural hospitals would be). We believe 

such a reading would not be in 

accordance with Congressional intent, 

which was to set a floor for urban 

hospitals, not to pay urban hospitals a 

wage index higher than the wage index 

applicable to rural hospitals. 

In order to avoid the apparent 

contradiction between raising an urban 

hospital’s wage index to the rural floor 

and not applying budget neutrality to its 

wage index, we also believe the statute 

could be read to allow an iterative 

calculation of budget neutrality and 

wage indices. Under such iterative 

calculations (consistent with section 

4410(a) of the BBA), we would raise the 

wage index for urban hospitals to the 

level of the pre-budget neutrality rural 

wage index. Consistent with section 

4410(b) of the BBA, we would adjust the 

wage index for all nonrural floor 

hospitals to achieve budget neutrality. 

However, such an adjustment would 

result in an urban hospital that would 

receive the rural floor having a higher 

wage index than a rural hospital in the 

same State. Therefore, we would then 

decrease wage indices for the rural floor 

hospitals so they are equal to the 

adjusted rural wage index in the same 

State. At this point, payments would be 

less in the aggregate than they were 

prior to applying the rural floor. 

Accordingly, a new budget neutrality 

adjustment would have to be calculated 

to raise the wage indices and total 

payments for rural hospitals and 

nonrural floor urban hospitals. The rural 

wage index would now be higher than 

the wage index for the rural floor 

hospitals in the same State. Therefore, 

the wage index for rural floor hospitals 

would then be increased again to the 

level of the State’s rural wage index, 

leading to budget neutrality being 

recalculated again, the wage index 

reduced for rural floor hospitals, and so 

forth until the wage index and the 

budget neutrality adjustment stabilize. 

We have determined that the iterative 

method is substantively equivalent to 

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24788 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

simply adjusting all area wage indices 

by a uniform percentage. We have 

performed the iterative calculation 

using provider-level data based on FY 

2007 MedPAR data and the first half of 

FY 2007 wage index data. Using such 

data, we determined that the iterative 

method results in the same final wage 

indices through four decimal places that 

would result if a uniform budget 

neutrality factor were applied to all 

hospitals’ wage indices. Furthermore, an 

iterative method, which requires 

adjusting only the wage index values of 

nonrural floor providers, reassigning the 

lowered rural floor value to rural floor 

providers, and reiterating the budget 

neutrality factor applied to the nonrural 

floor providers would require an 

excessive number of iterations and 

computer processing, which is not 

necessary if we simply apply a uniform 

budget neutrality adjustment to all wage 

index values. The latter method is 

accomplished more quickly, is less 

complex, and arrives at the same final 

wage index values. Because the IPPS 

schedule is relatively condensed, with a 

proposed rule issued in April, a 60-day 

comment period until June, and then 

only 2 months to analyze comments, 

respond to them, determine final 

policies and calculate final rates prior to 

the August 1 publication, we believe it 

would not be practical to require such 

multiple layers of calculations, when a 

uniform adjustment would produce 

substantively identical results. 

Therefore, we are proposing to 

implement the rural floor budget 

neutrality requirement by applying a 

uniform budget neutrality adjustment to 

all hospital wage indices rather than the 

more complicated iterative process 

illustrated below. 

The following hypothetical example, 

which includes a series of nine 

iterations, illustrates how the iterative 

process works. The example assumes 

three IPPS hospitals in one State. 

Hospital A is rural and Hospitals B and 

C are urban. 

PRE-FLOOR WAGE INDEX

Hospital A Hospital B Hospital C Total 

Wage Index ............................ 0.9500 .................................... 1.1700 .................................... 0.8600 .................................... ........................

Relative Weights .................... 100 ......................................... 200 ......................................... 150 ......................................... ........................

Location .................................. Rural ...................................... Urban ..................................... Urban ..................................... ........................

Standardized Amounts ........... $1,000 .................................... $1,000 .................................... $1,000 .................................... ........................

Payments ............................... $95,000 .................................. $234,000 ................................ $129,000 ................................ $458,000 

Note: Hospital C is urban and has a lower wage index than Hospital A which is rural. 

Post-Floor Wage Index; Pre-Budget 

Neutrality 

I Hospital A Hospital B Hospital C Total 

Wage Index ............................ 0.9500 .................................... 1.1700 .................................... 0.9500 .................................... ........................

Relative Weights .................... 100 ......................................... 200 ......................................... 150 ......................................... ........................

Location .................................. Rural ...................................... Urban ..................................... Urban ..................................... ........................

Standardized Amounts ........... $1,000 .................................... $1,000 .................................... $1,000 .................................... ........................

Payments ............................... $95,000 .................................. $234,000 ................................ $142,500 ................................ $471,500 

Note: Hospital C’s wage index is raised to the same level as Hospital A. 

Post Floor—Budget Neutrality Process 

Iteration 1: 

Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9110 ............................... 1.1220 ............................... 0.9500 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.95897. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $91,102 ............................. $224,398 ........................... $142,500 ........................... $458,000. 

Step 2: Reduce Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9110 ............................... 1.1220 ............................... 0.9110 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.95897. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $91,102 ............................. $224,398 ........................... $136,653 ........................... $452,153. 

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Iteration 2: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9279 ............................... 1.1428 ............................... 0.9110 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.01853. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,790 ............................. $228,557 ........................... $136,653 ........................... $458,000. 

Step 2: Increase Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9279 ............................... 1.1428 ............................... 0.9279 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.01854. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,790 ............................. $228,557 ........................... $139,185 ........................... $460,532. 

Iteration 3: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9206 ............................... 1.1338 ............................... 0.9279 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99212. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,059 ............................. $226,756 ........................... $139,185 ........................... $458,000. 

Step 2: Reduce Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9206 ............................... 1.1338 ............................... 0.9206 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99212. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,059 ............................. $226,756 ........................... $138,088 ........................... $456,903. 

Iteration 4: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9238 ............................... 1.1377 ............................... 0.9206 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.00344. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,376 ............................. $227,536 ........................... $138,088 ........................... $458,000. 

Step 2: Increase Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9238 ............................... 1.1377 ............................... 0.9238 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.00344. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,376 ............................. $227,536 ........................... $138,563 ........................... $458,475. 

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Iteration 5: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9224 ............................... 1.1360 ............................... 0.9238 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99852. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,238 ............................. $227,198 ........................... $138,563 ........................... $458,000. 

Step 2: Reduce Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9224 ............................... 1.1360 ............................... 0.9224 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99852. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,238 ............................. $227,198 ........................... $138,358 ........................... $457,794. 

Iteration 6: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9230 ............................... 1.1367 ............................... 0.9224 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.00064. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,298 ............................. $227,344 ........................... $138,358 ........................... $458,000. 

Step 2: Increase Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9230 ............................... 1.1367 ............................... 0.9230 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.00064. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,298 ............................. $227,344 ........................... $138,447 ........................... $458,089. 

Iteration 7: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9227 ............................... 1.1364 ............................... 0.9230 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99972. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,272 ............................. $227,281 ........................... $138,447 ........................... $458,000. 

Step 2: Reduce Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9227 ............................... 1.1364 ............................... 0.9227 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99972. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,272 ............................. $227,281 ........................... $138,408 ........................... $457,961. 

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Iteration 8: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9228 ............................... 1.1365 ............................... 0.9227 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.00012. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,283 ............................. $227,308 ........................... $138,408 ........................... $458,000. 

Step 2: Increase Hospital C’s wage 

index to Hospital A’s level. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9228 ............................... 1.1365 ............................... 0.9228 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 1.00012. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,283 ............................. $227,308 ........................... $138,425 ........................... $458,016. 

Iteration 9: Step 1: Apply budget neutrality to 

Hospital A and Hospital B. 

I Hospital A Hospital B Hospital C Total 

Wage Index ....................... 0.9228 ............................... 1.1365 ............................... 0.9228 ............................... BN Factor. 

Relative Weights ............... 100 .................................... 200 .................................... 150 .................................... 0.99995. 

Location ............................. Rural .................................. Urban ................................ Urban ................................ Target. 

Standardized Amounts ...... $1,000 ............................... $1,000 ............................... $1,000 ............................... $458,000. 

Payments ........................... $92,279 ............................. $227,297 ........................... $138,425 ........................... $458,000. 

In the example above, the wage 

indices are shown only to the 4th 

decimal place even though they are not 

rounded. However, the actual wage 

indices that we calculate for the IPPS 

are rounded to 4 decimal places. In the 

9th and final iteration of the budget 

neutrality adjustment shown above, 

there was no change to the wage indices 

through the 4th decimal place relative to 

the 8th iteration. Therefore, because the 

wage indices stopped changing, we 

could not obtain further precision in the 

budget neutrality and wage index 

calculations in the example shown 

above with further iterations. We note 

that the example above produces the 

same result as simply applying a 

uniform adjustment to hospital wage 

indices. Using the same data as the 

above hypothetical example, we show 

this result below: 

PRE-FLOOR WAGE INDEX

Hospital A Hospital B Hospital C Total 

Wage Index ............................ 0.9500 .................................... 1.1700 .................................... 0.8600 .................................... ........................

Relative Weights .................... 100 ......................................... 200 ......................................... 150 ......................................... ........................

Location .................................. Rural ...................................... Urban ..................................... Urban ..................................... ........................

Standardized Amounts ........... $1,000 .................................... $1,000 .................................... $1,000 .................................... ........................

Payments ............................... $95,000 .................................. $234,000 ................................ $129,000 ................................ $458,000 

Note: Hospital C is urban and has a lower wage index than Hospital A which is rural. 

Post-Floor Wage Index; Pre-Budget 

Neutrality 

I Hospital A Hospital B Hospital C Total 

Wage Index ............................ 0.9500 .................................... 1.1700 .................................... 0.9500 .................................... ........................

Relative Weights .................... 100 ......................................... 200 ......................................... 150 ......................................... ........................

Location .................................. Rural ...................................... Urban ..................................... Urban ..................................... ........................

Standardized Amounts ........... $1,000 .................................... $1,000 .................................... $1,000 .................................... ........................

Payments ............................... $95,000 .................................. $234,000 ................................ $142,500 ................................ $471,500 

Note: Hospital C’s wage index is raised to the same level as Hospital A. 

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Post Floor—Budget Neutrality 

I Hospital A Hospital B Hospital C Total 

Wage Index ............................ 0.9228 .................................... 1.1365 .................................... 0.9228 .................................... BN Factor 

Relative Weights .................... 100 ......................................... 200 ......................................... 150 ......................................... 0.971368 

Location .................................. Rural ...................................... Urban ..................................... Urban ..................................... Target 

Standardized Amounts ........... $1,000 .................................... $1,000 .................................... $1,000 .................................... $458,000 

Payments ............................... $92,280 .................................. $227,300 ................................ $138,420 ................................ $458,000 

We note that our proposed change 

would apply the budget neutrality 

adjustment to the wage index, and not 

to the standardized amount. In previous 

years, we applied a budget neutrality 

adjustment to the standardized amount 

to ensure that payments remained 

constant to payments that would have 

occurred in the absence of the rural 

floor requirement in section 4410 of the 

BBA. We believe such an adjustment is 

in keeping with the statute, which 

requires that the rural floor will not 

result in aggregate payments that are 

greater or less than those that would 

have been made in the absence of a rural 

floor. We believe that an adjustment to 

the wage index would result in a 

substantially similar payment as an 

adjustment to the standardized amount, 

as both involve multipliers to the 

standardized amount, and both would 

be based upon the same modeling 

parameters. We do note that because 

hospitals have different labor-related 

shares (62 percent for hospitals with 

wage indices less than or equal to 1; 

69.7 percent for hospitals with wage 

indices greater than 1), an adjustment to 

the wage index would have slightly 

different effects from an adjustment to 

the standardized amount, as each wage 

index would be adjusted by a uniform 

percentage. For FY 2008, we are proposing to use 

FY 2006 discharge data and FY 2008 

wage indices to simulate IPPS payments 

without the rural floor. We would 

compare these simulated payments to 

simulated payments using the same data 

with a rural floor. 

We believe that the statute supports 

either an adjustment to the standardized 

amount or the wage indices because 

under either methodology, the rural 

floor would not result in aggregate 

payments that were greater or less than 

those that would have been made in the 

absence of a rural floor. 

H. Analysis and Implementation of the 

Proposed Occupational Mix Adjustment 

and the Proposed FY 2008 Occupational 

Mix Adjusted Wage Index 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Occupational Mix Adjusted 

Wage Index’’ at the beginning of your 

comment.) 

As discussed in section III.C. of this 

preamble, for FY 2008, we are proposing 

to apply the occupational mix 

adjustment to 100 percent of the FY 

2008 wage index. We calculated the 

occupational mix adjustment using data 

from the 2006 occupational mix survey 

data, using the methodology described 

in section III.C.3. of this preamble. Using the first and second quarter 

occupational mix survey data and 

applying the occupational mix 

adjustment to 100 percent of the FY 

2008 wage index results in a proposed 

national average hourly wage of 

$30.9074 and a proposed Puerto Ricospecific average hourly wage of 

$13.4678. After excluding data of 

hospitals that either submitted aberrant 

data that failed critical edits, or that do 

not have FY 2004 Worksheet S–3 cost 

report data for use in calculating the 

proposed FY 2008 wage index, we 

calculated the proposed FY 2008 wage 

index using the occupational mix 

survey data from 3,368 hospitals. Using 

the Worksheet S–3 cost report data of 

3,581 hospitals and occupational mix 

first and/or second quarter survey data 

from 3,368 hospitals represents a 94.1 

percent survey response rate. The 

proposed FY 2008 national average 

hourly wages for each occupational mix 

nursing subcategory as calculated in 

Step 2 of the occupational mix 

calculation are as follows: 

Occupational mix nursing 

subcategory 

Average hourly wage 

National RN Management .... $38.6214 

National RN Staff .................. 33.4800 

National LPN ........................ 19.2485 

National Nurse Aides, Orderlies, and Attendants .......... 13.7267 

National Medical Assistants 15.7936 

National Nurse Category ...... 28.7439 

The proposed national average hourly 

wage for the entire nurse category as 

computed in Step 5 of the occupational 

mix calculation is $28.7439. Hospitals 

with a nurse category average hourly 

wage (as calculated in Step 4) of greater 

than the national nurse category average 

hourly wage receive an occupational 

mix adjustment factor (as calculated in 

Step 6) of less than 1.0. Hospitals with 

a nurse category average hourly wage (as 

calculated in Step 4) of less than the 

national nurse category average hourly 

wage receive an occupational mix 

adjustment factor (as calculated in Step 

6) of greater than 1.0. 

Based on the January through June 

2006 occupational mix survey data, we 

determined (in Step 7 of the 

occupational mix calculation) that the 

proposed national percentage of 

hospital employees in the Nurse 

category is 42.9 percent, and the 

proposed national percentage of 

hospital employees in the All Other 

Occupations category is 57.1 percent. At 

the CBSA level, the percentage of 

hospital employees in the Nurse 

category ranged from a low of 27.3 

percent in one CBSA, to a high of 85.3 

percent in another CBSA. 

We compared the final FY 2007 

occupational mix adjusted wage indices 

for each CBSA to the proposed FY 2008 

wage indices adjusted for occupational 

mix. In proposing to implement an 

occupational mix adjusted wage index 

based on the above calculation using 6 

months of survey data for FY 2008 as 

opposed to 3 months of survey data 

used for FY 2007, the final wage index 

values for 17 rural areas (36.2 percent) 

and 189 urban areas (48.7 percent) 

would decrease as a result of the 

adjustment. Nine rural areas (19.1 

percent) and 127 urban areas (32.7 

percent) would experience a decrease of 

1 percent or greater in their wage index 

values. The largest negative impacts 

would be 3.40 percent and 14.82 

percent for a rural and urban area, 

respectively. In addition, 30 rural areas 

(63.8 percent) and 197 urban areas (50.8 

percent) would experience an increase 

in their wage index values. Twelve rural 

areas (25.5 percent) and 131 urban areas 

(33.8 percent) would experience an 

increase of 1 percent or greater in their 

wage index values. The largest increase 

for a rural area would be 10.75 percent 

and the largest increase for an urban 

area would be 16.87 percent. Two urban 

areas would be unaffected. These results 

indicate that a larger percentage of rural 

areas benefit from an occupational mix 

adjustment than do urban areas. 

However, as was the case with the FY 

2007 occupational mix data, 

approximately a third of rural CBSAs 

(36.2 percent) continue to experience a 

decrease in their wage indices as a 

result of the occupational mix 

adjustment. 

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The proposed wage index values for 

FY 2008 (except those for hospitals 

receiving wage index adjustments under 

section 1886(d)(13) of the Act) are 

shown in Tables 4A, 4B, 4C, and 4F in 

the Addendum to this proposed rule. 

Tables 3A and 3B in the Addendum 

to this proposed rule list the 3-year 

average hourly wage for each labor 

market area before the redesignation of 

hospitals based on FYs 2006, 2007, and 

2008 cost reporting periods. Table 3A 

lists these data for urban areas and 

Table 3B lists these data for rural areas. 

In addition, Table 2 in the Addendum 

to this proposed rule includes the 

adjusted average hourly wage for each 

hospital from the FY 2002 and FY 2003 

cost reporting periods, as well as the FY 

2004 period used to calculate the 

proposed FY 2008 wage index. The 3- 

year averages are calculated by dividing 

the sum of the dollars (adjusted to a 

common reporting period using the 

method described previously) across all 

3 years, by the sum of the hours. If a 

hospital is missing data for any of the 

previous years, its average hourly wage 

for the 3-year period is calculated based 

on the data available during that period. 

The proposed wage index values in 

Tables 4A, 4B, 4C, and 4F and the 

average hourly wages in Tables 2, 3A, 

and 3B in the Addendum to this 

proposed rule include the proposed 

occupational mix adjustment as well as 

the budget neutrality adjustment for the 

rural floor. 

I. Revisions to the Proposed Wage Index 

Based on Hospital Redesignations 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Hospital Reclassifications and 

Redesignations’’ at the beginning of 

your comment.) 

1. General 

Under section 1886(d)(10) of the Act, 

the Medicare Geographic Classification 

Review Board (MGCRB) considers 

applications by hospitals for geographic 

reclassification for purposes of payment 

under the IPPS. Hospitals must apply to 

the MGCRB to reclassify by September 

1 of the year preceding the year during 

which reclassification is sought. 

Generally, hospitals must be proximate 

to the labor market area to which they 

are seeking reclassification and must 

demonstrate characteristics similar to 

hospitals located in that area. The 

MGCRB issues its decisions by the end 

of February for reclassifications that 

become effective for the following fiscal 

year (beginning October 1). The 

regulations applicable to 

reclassifications by the MGCRB are 

located in § § 412.230 through 412.280. 

Section 1886(d)(10)(D)(v) of the Act 

provides that, beginning with FY 2001, 

a MGCRB decision on a hospital 

reclassification for purposes of the wage 

index is effective for 3 fiscal years, 

unless the hospital elects to terminate 

the reclassification. Section 

1886(d)(10)(D)(vi) of the Act provides 

that the MGCRB must use the 3 most 

recent years’ average hourly wage data 

in evaluating a hospital’s 

reclassification application for FY 2003 

and any succeeding fiscal year. Section 304(b) of Pub. L. 106–554 

provides that the Secretary must 

establish a mechanism under which a 

statewide entity may apply to have all 

of the geographic areas in the State 

treated as a single geographic area for 

purposes of computing and applying a 

single wage index, for reclassifications 

beginning in FY 2003. The 

implementing regulations for this 

provision are located at § 412.235. Section 1886(d)(8)(B) of the Act 

requires the Secretary to treat a hospital 

located in a rural county adjacent to one 

or more urban areas as being located in 

the MSA to which the greatest number 

of workers in the county commute, if 

the rural county would otherwise be 

considered part of an urban area under 

the standards for designating MSAs and 

if the commuting rates used in 

determining outlying counties were 

determined on the basis of the aggregate 

number of resident workers who 

commute to (and, if applicable under 

the standards, from) the central county 

or counties of all contiguous MSAs. In 

light of the new CBSA definitions and 

the Census 2000 data that we 

implemented for FY 2005 (69 FR 

49027), we undertook to identify those 

counties meeting these criteria. The 

eligible counties are identified under 

section III.I.8. of this preamble. 

2. Effects of Reclassification/ 

Redesignation 

Section 1886(d)(8)(C) of the Act 

provides that the application of the 

wage index to redesignated hospitals is 

dependent on the hypothetical impact 

that the wage data from these hospitals 

would have on the wage index value for 

the area to which they have been 

redesignated. These requirements for 

determining the wage index values for 

redesignated hospitals is applicable 

both to the hospitals located in rural 

counties deemed urban under section 

1886(d)(8)(B) of the Act and hospitals 

that were reclassified as a result of the 

MGCRB decisions under section 

1886(d)(10) of the Act. Therefore, as 

provided in section 1886(d)(8)(C) of the 

Act, the wage index values were 

determined by considering the 

following: 

<bullet≤ If including the wage data for 

the redesignated hospitals would reduce 

the wage index value for the area to 

which the hospitals are redesignated by 

1 percentage point or less, the area wage 

index value determined exclusive of the 

wage data for the redesignated hospitals 

applies to the redesignated hospitals. 

<bullet≤ If including the wage data for 

the redesignated hospitals reduces the 

wage index value for the area to which 

the hospitals are redesignated by more 

than 1 percentage point, the area wage 

index determined inclusive of the wage 

data for the redesignated hospitals (the 

combined wage index value) applies to 

the redesignated hospitals. 

<bullet≤ If including the wage data for 

the redesignated hospitals increases the 

wage index value for the urban area to 

which the hospitals are redesignated, 

both the area and the redesignated 

hospitals receive the combined wage 

index value. Otherwise, the hospitals 

located in the urban area receive a wage 

index excluding the wage data of 

hospitals redesignated into the area. 

Rural areas whose wage index values 

would be reduced by excluding the 

wage data for hospitals that have been 

redesignated to another area continue to 

have their wage index values calculated 

as if no redesignation had occurred 

(otherwise, redesignated rural hospitals 

are excluded from the calculation of the 

rural wage index). The wage index value 

for a redesignated rural hospital cannot 

be reduced below the wage index value 

for the rural areas of the State in which 

the hospital is located. 

CMS has also adopted the following 

policies by regulation: 

<bullet≤ The wage data for a 

reclassified urban hospital is included 

in both the wage index calculation of 

the area to which the hospital is 

reclassified (subject to the rules 

described above) and the wage index 

calculation of the urban area where the 

hospital is physically located. 

<bullet≤ In cases where urban 

hospitals have reclassified to rural areas 

under 42 CFR 412.103, the urban 

hospital wage data are: (a) Included in 

the rural wage index calculation, unless 

doing so would reduce the rural wage 

index; and (b) included in the urban 

area where the hospital is physically 

located. 

3. FY 2008 MGCRB Reclassifications 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘MGCRB’’ at the beginning of 

your comment.) 

Under section 1886(d)(10) of the Act, 

the MGCRB considers applications by 

hospitals for geographic reclassification 

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for purposes of payment under the IPPS. 

The specific procedures and rules that 

apply to the geographic reclassification 

process are outlined in § 412.230 

through § 412.280. 

At the time this proposed rule was 

constructed, the MGCRB had completed 

its review of FY 2008 reclassification 

requests. There were 365 hospitals 

approved for wage index 

reclassifications by the MGCRB for FY 

2008. Because MGCRB wage index 

reclassifications are effective for 3 years, 

hospitals reclassified during FY 2006 or 

FY 2007 are eligible to continue to be 

reclassified based on prior 

reclassifications to current MSAs during 

FY 2008. There were 299 hospitals 

reclassified for wage index in FY 2006 

and 214 hospitals reclassified for wage 

index in FY 2007. Some of the hospitals 

that reclassified for FY 2006 and FY 

2007 have elected not to continue their 

reclassifications in FY 2008 because, 

under the revised labor market area 

definitions, they are now physically 

located in the areas to which they 

previously reclassified. Of all of the 

hospitals approved for reclassification 

for FY 2006, FY 2007, and FY 2008, 866 

hospitals are in a reclassification status 

for FY 2008. 

Prior to FY 2004, hospitals had been 

able to apply to be reclassified for 

purposes of either the wage index or the 

standardized amount. Section 401 of 

Pub. L. 108–173 established that all 

hospitals will be paid on the basis of the 

large urban standardized amount, 

beginning with FY 2004. Consequently, 

all hospitals are paid on the basis of the 

same standardized amount, which made 

such reclassifications moot. Although 

there could still be some benefit in 

terms of payments for some hospitals 

under the DSH payment adjustment for 

operating IPPS, section 402 of Pub. L. 

108–173 equalized DSH payment 

adjustments for rural and urban 

hospitals, with the exception that the 

rural DSH adjustment is capped at 12 

percent (except that rural referral 

centers and, effective for discharges 

occurring on or after October 1, 2006, 

MDHs have no cap). (A detailed 

discussion of this application appears in 

section IV.I. of the preamble of the FY 

2005 IPPS final rule (69 FR 49085). The 

exclusion of MDHs from the 12 percent 

DSH cap under Pub. L. 109–171 was 

discussed under section IV.F.4. of the 

preamble of the FY 2007 IPPS final rule 

(71 FR 48066.) 

Under § 412.273, hospitals that have 

been reclassified by the MGCRB are 

permitted to withdraw their 

applications within 45 days of the 

publication of a proposed rule. The 

request for withdrawal of an application 

for reclassification or termination of an 

existing 3-year reclassification that 

would be effective in FY 2008 must be 

received by the MGCRB within 45 days 

of the publication of this proposed rule. 

If a hospital elects to withdraw its wage 

index application after the MGCRB has 

issued its decision, but prior to the 

above date, it may later cancel its 

withdrawal in a subsequent year and 

request the MGCRB to reinstate its wage 

index reclassification for the remaining 

fiscal year(s) of the 3-year period (§

412.273(b)(2)(i)). The request to cancel a 

prior withdrawal or termination must be 

in writing to the MGCRB no later than 

the deadline for submitting 

reclassification applications for the 

following fiscal year (§ 412.273(d)). For 

further information about withdrawing, 

terminating, or canceling a previous 

withdrawal or termination of a 3-year 

reclassification for wage index 

purposes, we refer the reader to §

412.273, as well as the August 1, 2002, 

IPPS final rule (67 FR 50065) and the 

August 1, 2001 IPPS final rule (66 FR 

39887). 

Changes to the wage index that result 

from withdrawals of requests for 

reclassification, wage index corrections, 

appeals, and the Administrator’s review 

process will be incorporated into the 

wage index values published in the final 

rule. These changes may affect not only 

the wage index value for specific 

geographic areas, but also the wage 

index value redesignated hospitals 

receive; that is, whether they receive the 

wage index that includes the data for 

both the hospitals already in the area 

and the redesignated hospitals. Further, 

the wage index value for the area from 

which the hospitals are redesignated 

may be affected. 

Applications for FY 2009 

reclassifications are due to the MGCRB 

by September 4, 2007 (the first working 

day of September 2007). We note that 

this is also the deadline for canceling a 

previous wage index reclassification 

withdrawal or termination under §

412.273(d). Applications and other 

information about MGCRB 

reclassifications may be obtained, 

beginning in mid-July 2007, via the 

CMS Internet Web site at: http:// 

cms.hhs.gov/providers/prrb/ 

mgcinfo.asp, or by calling the MGCRB at 

(410) 786–1174. The mailing address of 

the MGCRB is: 2520 Lord Baltimore 

Drive, Suite L, Baltimore, MD 21244– 

2670. 

4. Hospitals That Applied for 

Reclassification Effective in FY 2008 

and Reinstating Reclassifications in FY 

2008 

Applications for FY 2008 

reclassifications were due to the 

MGCRB by September 1, 2006. We note 

that this deadline also applied for 

canceling a previous wage index 

reclassification withdrawal or 

termination under § 412.273(d). The 

MGCRB, in evaluating a hospital’s 

request for reclassification for FY 2008 

for the wage index, utilized the official 

data used to develop the FY 2007 wage 

index. The wage data used to support 

the hospital’s wage comparisons were 

from the CMS hospital wage survey. 

Generally, the source for these data is 

the IPPS final rule to be published on 

or before August 1, 2006. However, the 

wage tables identifying the 3-year 

average hourly wage of hospitals were 

not available in time to include them in 

the FY 2007 IPPS final rule. Therefore, 

we made the data available subsequent 

to the publication of the FY 2007 IPPS 

final rule. 

Section 1886(d)(10)(C)(ii) of the Act 

indicates that a hospital requesting a 

change in geographic classification for a 

fiscal year must submit its application 

to the MGCRB not later than the first 

day of the 13-month period ending on 

September 30 of the preceding fiscal 

year. Thus, the statute requires that FY 

2008 reclassification applications were 

to be submitted to the MGCRB by no 

later than September 1, 2006. For this 

reason, we required hospitals to file an 

FY 2008 reclassification application by 

the September 1, 2006 deadline even 

though the average hourly wage data 

used to develop the final FY 2007 wage 

indices were not yet available. However, 

as outlined in § 412.256(c)(2), we also 

allowed hospitals with incomplete 

applications submitted by the deadline 

to request an extension beyond 

September 1, 2006, to complete their 

applications. We also allowed hospitals 

30 days from the date the final wage 

data were posted on the CMS Web site 

to request to cancel a withdrawal or 

termination in order to reinstate a 

reclassification for FY 2008 or FY 2009, 

or both fiscal years. For a more detailed 

discussion of the procedures used for 

the FY 2008 MGCRB applications we 

refer readers to the FY 2007 IPPS final 

rule (71 FR 48022–48023). 

5. Clarification of Policy on Reinstating 

Reclassifications 

Under § 412.273(a) of our regulations, 

a hospital or group of hospitals may 

withdraw its application for 

reclassification at any time before the 

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MGCRB issues its decision or, if after 

the MGCRB issues its decision, within 

45 days after publication of CMS’s 

annual notice of proposed rulemaking 

for the upcoming fiscal year. In 

addition, a hospital may terminate a 

reclassification that is already in effect 

within 45 days after publication of the 

notice of proposed rulemaking for the 

upcoming fiscal year. Once a 

withdrawal or termination has been 

made, the hospital or group of hospitals 

will not be reclassified for purposes of 

the wage index to the same area for that 

year. The hospital also will not be 

reclassified to the withdrawn or 

terminated reclassification area in 

subsequent fiscal years unless the 

hospital subsequently cancels its 

withdrawal or termination. The 

procedures for making a withdrawal or 

termination, as well as for canceling a 

withdrawal or termination are specified 

at § 412.273. In the FY 2003 IPPS final 

rule (67 FR 50065–50066), we clarified 

our existing policy stating that a 

previous 3-year reclassification may not 

be reinstated after a subsequent 3-year 

reclassification to another area takes 

effect. Therefore, a hospital can only 

have one active 3-year reclassification at 

a time. 

We have been asked whether a 

hospital (or group of hospitals) can 

reinstate the two remaining years of a 

previously approved 3-year 

reclassification to one area, while at the 

same time the individual hospital (or 

group) request a new 3-year 

reclassification from the MGCRB to a 

different area and be approved for both 

at the same time. In this case, the 

hospital or group of hospitals is 

permitted to apply to a different area 

than the previously approved 

reclassification but, as stated in §

412.273(b)(2), once they accept a newly 

approved reclassification, a previously 

terminated and reinstated 3-year 

reclassification would be permanently 

terminated. 

Following the policy set forth at §

412.273(d), a hospital may cancel a 

previous withdrawal or termination by 

submitting written notice of its intent to 

the MGCRB no later than September 1 

for reclassifications effective at the start 

of the second following fiscal year 13 

months later. At the same time (because 

the deadline for geographic 

reclassification applications for the 

second following fiscal year 13 months 

later is also September 1), a hospital or 

group of hospitals could apply for 

reclassification to a different area. If the 

application is denied, the hospital or 

group of hospitals can select between 

the reinstated geographic 

reclassification and the home area wage 

index for the following fiscal year. The 

hospital or group of hospitals must file 

a written request to the MGCRB within 

45 days after publication of the notice 

of proposed rulemaking to terminate the 

reinstated reclassification and receive 

the home area wage index. If the 

hospital or group of hospitals takes no 

action, the pending geographic 

reclassification will go into effect. If the 

new geographic reclassification 

application is approved, the hospital or 

group of hospitals will have 45 days 

from publication of the notice of 

proposed rulemaking to accept either of 

the two pending geographic 

reclassifications or revert to the home 

area wage index. If the hospital or group 

of hospitals takes no action, the most 

recent approved geographic 

reclassification will go into effect and 

the prior reclassification will be 

permanently terminated. Alternatively, 

the hospital or group of hospitals can 

withdraw the most recent approved 

reclassification and accept the 

previously approved and reinstated 

reclassification within 45 days of 

publication of the notice of proposed 

rulemaking. Such an action will 

permanently terminate the most 

recently approved geographic 

reclassification. Finally, the hospital or 

group hospitals can write to the MGCRB 

within 45 days of publication of the 

notice of proposed rulemaking to 

withdraw both geographic 

reclassifications in order to receive the 

home area wage index. In this case, the 

hospital or group of hospitals can only 

reinstate one of the two geographic 

reclassifications. The other geographic 

reclassification is permanently 

terminated. Once a hospital or group of 

hospitals makes a decision for the 

following fiscal year within 45 days of 

publication of the notice of proposed 

rulemaking, the hospital or group of 

hospitals cannot change the decision for 

that fiscal year. It is also important to 

note that the reinstatement of a 

reclassification only applies to those 

withdrawals which were made after the 

MGCRB issued an approved 3-year 

decision, not a withdrawal made prior 

to the MGCRB issuing an approval 

decision. 

For example, a hospital has been 

reclassified to area ‘‘A’’ for FYs 2007 

through 2009. The hospital accepts this 

geographic reclassification for FY 2007. 

The hospital also applies for 

reclassification to a different area ‘‘B’’ 

for FYs 2008 through 2010 by 

September 1, 2006. If reclassification to 

area ‘‘B’’ is denied, the hospital can 

either withdraw or terminate its 

reclassification to area ‘‘A’’ within 45 

days of publication of the proposed rule 

for FY 2008 and receive the home area 

wage index for FY 2008 or receive the 

reclassification to area ‘‘A’’ for FY 2008. 

If the hospital does nothing, it will 

receive the area ‘‘A’’ reclassification. If 

the hospital’s reclassification 

application to area ‘‘B’’ is approved by 

the MGCRB, the hospital can (1) do 

nothing (and, therefore, receives the 

reclassification to area ‘‘B’’ for FY 2008, 

permanently terminating the 

reclassification to area ‘‘A’’); (2) within 

45 days of publication of the notice of 

proposed rulemaking, withdraw the 

reclassification to area ‘‘B’’ and receive 

the reclassification to area ‘‘A’’ for FY 

2008 (permanently terminating the 

reclassification to area ‘‘B’’); or (3) 

withdraw or terminate both the 

reclassifications to both areas ‘‘A’’ and 

‘‘B’’ and receive the home area wage 

index for FY 2008). If the latter option 

is selected, the hospital can only 

reinstate one of the withdrawn/ 

terminated reclassifications by 

September 1, 2007 (to take effect for FY 

2009). Upon the sunset of the 45-day 

window, the reclassification selection is 

final and the hospital will receive that 

wage index for the fiscal year, in this 

case for FY 2008. 

6. ‘‘Fallback’’ Reclassifications 

As indicated in section III.I.3. of this 

preamble, the regulations at § 412.273 

provide the process that a hospital 

wishing to withdraw or terminate a 

reclassification must follow. If a 

hospital has an existing reclassification 

and then applies to the MGCRB to a 

second area and is approved, it has a 

choice between two reclassifications 

and its home area wage index for the 

following fiscal year. We have been 

asked a procedural question about how 

the hospital accepts its previously 

approved reclassification (its ‘‘fall back’’ 

reclassification) or how it can ‘‘fall 

back’’ to its home area wage index. As 

the example provided in the section 

III.I.5. of this preamble illustrates, a 

hospital will automatically be given its 

most recently approved reclassification 

(thereby permanently terminating any 

previously approved reclassifications) 

unless it provides written notice to the 

MGCRB within 45 days of publication of 

the notice of proposed rulemaking that 

it wishes to withdraw its most recently 

approved reclassification and ‘‘fall 

back’’ to either its prior reclassification 

or its home area wage index for the 

following fiscal year. If the hospital 

wishes to accept its home area wage 

index in preference to its previous ‘‘fall 

back’’ reclassification, the hospital must 

also state in its request to the MGCRB 

that it is not only withdrawing its most 

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recently approved reclassification but 

also terminating its previously approved 

reclassification. 

7. Geographic Reclassification Issues for 

Multicampus Hospitals 

(If you choose to comments on issues 

in this section, please include the 

caption ‘‘Multicampus Hospitals’’ at the 

beginning of your comment.] 

In FY 2005, we modified the 

reclassification rules at §

412.230(d)(2)(iii) to allow campuses of 

multicampus hospitals located in 

separate wage index areas to support a 

reclassification application to the 

geographic area in which another 

campus is located using the average 

hourly wage data submitted on the cost 

report for the entire hospital. This 

special rule applies for applications for 

reclassifications effective in FYs 2006 

through FY 2008. In the FY 2007 IPPS 

final rule, we decided not to extend this 

special rule for multicampus hospitals. 

However, we believe that the proposed 

change to how we allocate a 

multicampus hospital’s wage data has 

implications for multicampus hospitals’ 

reclassification requests. 

As stated above, we are proposing to 

allocate the multicampus hospital’s 

wage data across the different labor 

market areas where the campuses are 

located based upon FTEs. For this 

reason, an individual campus located in 

a geographic area distinct from the 

geographic area associated with the 

provider number of the multicampus 

hospital will now have published, 

hospital-specific wage data that it may 

use to support a request for individual 

reclassification. The campus’s wage data 

will be included in the wage data public 

use file and also provided to the 

MGCRB. These data will be considered 

appropriate wage data under § 412.230, 

because it will be part of the CMS 

hospital wage survey used to construct 

the wage index. We note, that where a 

multicampus hospital spanning two or 

more geographic areas does not provide 

us with appropriate FTE data, its 

campus-specific data will not be 

included in the public use files we use 

to construct the wage index. For this 

reason, unless a multicampus hospital 

has provided us with FTE data, we will 

not have appropriate campus-specific 

wage data that could be used to support 

an individual reclassification under §

412.230, and the reclassification request 

for the individual campus would be 

denied. In this sense, our policy 

allowing the allocation of wage data 

using FTEs is somewhat different from 

our prior policy on multicampus 

hospitals. 

We note that when a multicampus 

hospital’s wage data are divided by 

FTEs, the ratio of wages to hours 

remains constant. Thus, the effect of our 

policy, in some sense, is that the 

individual campus of a multicampus 

hospital effectively uses the average 

hourly wage of the entire multicampus 

institution to support its individual 

reclassification request. However, as 

stated in the paragraph above, 

appropriate wage data will exist, only if 

the hospital has provided FTE data that 

can be used to allocate institution-wide 

wages and hours. 

Under current policy, an individual 

campus of a multicampus hospital 

located in a different area than the one 

associated with the provider number 

does not have to provide any official 

wage index data to join a group 

reclassification. However, given that we 

are allocating a portion of the average 

hourly wage of the hospital’s data to the 

labor market area that includes this 

campus, we are also proposing that this 

same data be used as part of a group 

reclassification application. Again, these 

data will be published in a public use 

file and will be considered appropriate 

wage data under § § 412.232 and 

412.234. If a multicampus hospital 

spanning more than one geographic area 

has not provided us with FTE data, 

then, in accordance with our current 

policies for treating hospitals without 

official wage data, the individual 

campus would still be permitted to join 

the group application (and indeed 

would be required to join the 

application since all hospitals in a 

group must join in the application). In 

this case, the group application would 

omit the wage data from the individual 

campus of a multicampus hospital. 

8. Redesignations of Hospitals Under 

Section 1886(d)(8)(B) of the Act 

Beginning October 1, 1988, section 

1886 (d)(8)(B) of the Act required us to 

treat a hospital located in a rural county 

adjacent to one or more urban areas as 

being located in the MSA if certain 

criteria were met. Prior to FY 2005, the 

rule was that a rural county adjacent to 

one or more urban areas would be 

treated as being located in the MSA to 

which the greatest number of workers in 

the county commute, if the rural county 

would otherwise be considered part of 

an urban area under the standards 

published in the Federal Register on 

January 3, 1980 (45 FR 956) for 

designating MSAs (and New England 

County Metropolitan Areas (NECMAs)), 

and if the commuting rates used in 

determining outlying counties (or, for 

New England, similar recognized areas) 

were determined on the basis of the 

aggregate number of resident workers 

who commute to (and, if applicable 

under the standards, from) the central 

county or counties of all contiguous 

MSAs (or NECMAs). Hospitals that met 

the criteria using the January 3, 1980 

version of these OMB standards were 

deemed urban for purposes of the 

standardized amounts and for purposes 

of assigning the wage data index. 

Effective beginning FY 2005, we use 

OMB’s 2000 CBSA standards and the 

Census 2000 data to identify counties 

qualifying for redesignation under 

section 1886(d)(8)(B) for the purpose of 

assigning the wage index to the urban 

area. Hospitals located in these counties 

have been known as ‘‘Lugar’’ hospitals 

and the counties themselves are often 

referred to as ‘‘Lugar’’ counties. We 

provide the chart below with the listing 

of the rural counties designated as urban 

under section 1886(d)(8)(B) of the Act 

that we are proposing to use for FY 

2008. For discharges occurring on or 

after October 1, 2007, hospitals located 

in the first column of this chart will be 

redesignated for purposes of using the 

wage index of the urban area listed in 

the second column. 

RURAL COUNTIES REDESIGNATED AS

URBAN UNDER SECTION

1886(D)(8)(B) OF THE ACT

[Based on CBSAs and Census 2000 Data] 

Rural county CBSA 

Cherokee, AL Rome, GA. 

Macon, AL ...... Auburn-Opelika, AL. 

Talladega, AL Anniston-Oxford, AL. 

Hot Springs, 

AR.

Hot Springs, AR. 

Windham, CT Hartford-West Hartford-East 

Hartford, CT. 

Bradford, FL ... Gainesville, FL. 

Flagler, FL ...... Deltona-Daytona Beach-Ormond Beach, FL. 

Hendry, FL ..... West Palm Beach-Boca 

Raton-Boynton, FL. 

Levy, FL ......... Gainesville, FL. 

Walton, FL ..... Fort Walton BeachCrestview-Destin, FL. 

Banks, GA ...... Gainesville, GA. 

Chattooga, GA Chattanooga, TN–GA. 

Jackson, GA .. Atlanta-Sandy Springs-Marietta, GA. 

Lumpkin, GA .. Atlanta-Sandy Springs-Marietta, GA. 

Morgan, GA ... Atlanta-Sandy Springs-Marietta, GA. 

Peach, GA ..... Macon, GA. 

Polk, GA ......... Atlanta-Sandy Springs-Marietta, GA. 

Talbot, GA ...... Columbus, GA–AL. 

Bingham, ID ... Idaho Falls, ID. 

Christian, IL .... Springfield, IL. 

DeWitt, IL ....... Bloomington-Normal, IL. 

Iroquois, IL ..... Kankakee-Bradley, IL. 

Logan, IL ........ Springfield, IL. 

Mason, IL ....... Peoria, IL. 

Ogle, IL .......... Rockford, IL. 

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RURAL COUNTIES REDESIGNATED AS

URBAN UNDER SECTION

1886(D)(8)(B) OF THE ACT—Continued 

[Based on CBSAs and Census 2000 Data] 

Rural county CBSA 

Clinton, IN ...... Lafayette, IN. 

Henry, IN ........ Indianapolis-Carmel, IN. 

Spencer, IN .... Evansville, IN–KY. 

Starke, IN ....... Gary, IN. 

Warren, IN ..... Lafayette, IN. 

Boone, IA ....... Ames, IA. 

Buchanan, IA Waterloo-Cedar Falls, IA. 

Cedar, IA ........ Iowa City, IA. 

Allen, KY ........ Bowling Green, KY. 

Assumption 

Parish, LA.

Baton Rouge, LA. 

St. James Parish, LA.Baton Rouge, LA. 

Allegan, MI ..... Holland-Grand Haven, MI. 

Montcalm, MI Grand Rapids-Wyoming, MI. 

Oceana, MI .... Muskegon-Norton Shores, 

MI. 

Shiawassee, 

MI.

Lansing-East Lansing, MI. 

Tuscola, MI .... Saginaw-Saginaw Township 

North, MI. 

Fillmore, MN .. Rochester, MN. 

Dade, MO ...... Springfield, MO. 

Pearl River, 

MS.

Gulfport-Biloxi, MS. 

Caswell, NC ... Burlington, NC. 

Granville, NC Durham, NC. 

Harnett, NC .... Raleigh-Cary, NC. 

Lincoln, NC .... Charlotte-Gastonia-Concord, 

NC–SC. 

Polk, NC ......... Spartanburg, NC. 

Los Alamos, 

NM.

Santa Fe, NM. 

Lyon, NV ........ Carson City, NV. 

Cayuga, NY ... Syracuse, NY. 

Columbia, NY Albany-Schenectady-Troy, 

NY. 

Genesee, NY Rochester, NY. 

Greene, NY .... Albany-Schenectady-Troy, 

NY. 

Schuyler, NY .. Ithaca, NY. 

Sullivan, NY ... Poughkeepsie-NewburghMiddletown, NY. 

Wyoming, NY Buffalo-Niagara Falls, NY. 

Ashtabula, OH Cleveland-Elyria-Mentor, 

OH. 

Champaign, 

OH.

Springfield, OH. 

Columbiana, 

OH.

Youngstown-WarrenBoardman, OH–PA. 

Cotton, OK ..... Lawton, OK. 

Linn, OR ......... Corvallis, OR. 

Adams, PA ..... York-Hanover, PA. 

Clinton, PA ..... Williamsport, PA. 

Greene, PA .... Pittsburgh, PA. 

Monroe, PA .... Allentown-Bethlehem-Easton, PA–NJ. 

Schuylkill, PA Reading, PA. 

Susquehanna, 

PA.

Binghamton, NY. 

Clarendon, SC Sumter, SC. 

Lee, SC .......... Sumter, SC. 

Oconee, SC ... Greenville, SC. 

Union, SC ...... Spartanburg, SC. 

Meigs, TN ...... Cleveland, TN. 

Bosque, TX .... Waco, TX. 

Falls, TX ......... Waco, TX. 

RURAL COUNTIES REDESIGNATED AS

URBAN UNDER SECTION

1886(D)(8)(B) OF THE ACT—Continued 

[Based on CBSAs and Census 2000 Data] 

Rural county CBSA 

Fannin, TX ..... Dallas-Plano-Irving, TX. 

Grimes, TX ..... College Station-Bryan, TX. 

Harrison, TX ... Longview, TX. 

Henderson, TX Dallas-Plano-Irving, TX. 

Milam, TX ....... Austin-Round Rock, TX. 

Van Zandt, TX Dallas-Plano-Irving, TX. 

Willacy, TX ..... Brownsville-Harlingen, TX. 

Buckingham, 

VA.

Charlottesville, VA. 

Floyd, VA ....... Blacksburg-ChristiansburgRadford, VA. 

Middlesex, VA Virginia Beach-Norfolk-Newport News, VA. 

Page, VA ........ Harrisonburg, VA. 

Shenandoah, 

VA.

Winchester, VA–WV. 

Island, WA ..... Seattle-Bellevue-Everett, 

WA. 

Mason, WA .... Olympia, WA. 

Wahkiakum, 

WA.

Longview, WA. 

Jackson, WV .. Charleston, WV. 

Roane, WV .... Charleston, WV. 

Green, WI ...... Madison, WI. 

Green Lake, 

WI.

Fond du Lac, WI. 

Jefferson, WI .. Milwaukee-Waukesha-West 

Allis, WI. 

Walworth, WI Milwaukee-Waukesha-West 

Allis, WI. 

As in the past, hospitals redesignated 

under section 1886(d)(8)(B) of the Act 

are also eligible to be reclassified to a 

different area by the MGCRB. Affected 

hospitals are permitted to compare the 

reclassified wage index for the labor 

market area in Table 4C in the 

Addendum to this proposed rule into 

which they have been reclassified by the 

MGCRB to the wage index for the area 

to which they are redesignated under 

section 1886(d)(8)(B) of the Act. 

Hospitals may withdraw from an 

MCGRB reclassification within 45 days 

of the publication of this proposed rule. 

9. Reclassifications Under Section 

1886(d)(8)(B) of the Act 

We have been asked whether Lugar 

hospitals and counties (discussed above 

in section III.H.8. of this preamble) are 

considered urban or rural for MGCRB 

reclassification purposes. As stated in 

the regulations at 42 CFR 412.64(b)(3), 

as well as in section 1886(d)(8)(C) of the 

Act, Lugar hospitals and counties are 

deemed to be located in an urban area. 

Therefore, because they are physically 

located in a rural area and are deemed 

urban, they receive the reclassified wage 

index (Table 4C in the Addendum to 

this proposed rule) for the urban area to 

which they have been redesignated. 

Because Lugar hospitals are treated like 

reclassified hospitals, when they are 

seeking reclassification by the MCGRB, 

they are subject to the rural 

reclassification rules set forth at §

412.230. The procedural rules set forth 

at § 412.230 list the criteria which a 

hospital must meet in order to reclassify 

as a rural hospital. Lugar hospitals 

would be subject to the proximity 

criteria and payment thresholds that 

apply to rural hospitals. Specifically, 

the hospital would have to be no more 

than 35 miles from the area to which it 

seeks reclassification (§ 412.230(b)(1)); 

the hospital would have to show that its 

average hourly wage is at least 106 

percent of the average hourly wage of all 

other hospitals in the area in which the 

hospital is located (§

412.230(d)(1)(iii)(C)); and the hospital 

would have to demonstrate that its 

average hourly wage is equal to at least 

82 percent of the average hourly wage 

of hospitals in the area to which it seeks 

redesignation (§ 412.230(d)(1)(iv)(C)). 

Hospitals not located in a Lugar 

county seeking reclassification to the 

urban area where the Lugar hospitals 

have been redesignated are not 

permitted to measure to the Lugar 

county to demonstrate proximity (no 

more than 15 miles for an urban 

hospital, and no more than 35 miles for 

a rural hospital or the closest urban or 

rural area for RRCs or SCHs) in order to 

be reclassified to such urban area. These 

hospitals must measure to the urban 

area exclusive of the Lugar County to 

meet the proximity or nearest urban or 

rural area requirement. 

10. New England Deemed Counties 

Our regulations at 42 CFR 

412.64(b)(1)(ii)(B) list New England 

counties that are deemed to be parts of 

urban areas under section 601(g) of the 

Social Security Amendments of 1983 

(Pub. L. 98–21, 42 U.S.C. 

1395ww(note)). These counties include 

Litchfield County, Connecticut; York 

County, Maine; Sagadahoc County, 

Maine; Merrimack County, New 

Hampshire; and Newport County, 

Rhode Island. OMB standards designate 

and define two categories of CBSAs: 

Metropolitan Statistical Areas (MSAs) 

and Micropolitan Statistical Areas (65 

FR 82235). For our labor market area 

definitions, we treat micropolitan areas 

as rural. 

Of these five counties, three (York 

County, Sagadahoc County, and 

Newport County) are also included in 

metropolitan areas by OMB, whereas the 

remaining two, Litchfield County and 

Merrimack County, are located in 

micropolitan statistical areas and would 

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24798 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

be treated as rural under our labor 

market area definitions were they not 

deemed urban under §

412.64(b)(1)(ii)(B) of the regulations. 

Litchfield County and Merrimack 

County have been listed as being part of 

urban CBSA 25540 Hartford-West 

Hartford-East Hartford, CT, and urban 

CBSA 31700 Manchester-Nashua, NH, 

respectively. Even though hospitals 

located in Litchfield County and 

Merrimack County are in micropolitan 

statistical areas, they have been treated 

as urban for reclassification purposes. 

Under our regulations, we have deemed 

both of these two New England counties 

and the hospitals within them as urban. 

Because the counties themselves were 

deemed urban, the hospitals within 

them have also been treated as urban for 

reclassification purposes, even though 

Litchfield and Merrimack counties are 

in micropolitan statistical areas. 

However, upon further consideration of 

this issue, we believe the hospitals 

located within these New England 

counties should be treated the same as 

Lugar hospitals. That is, the area would 

be considered rural but the hospitals 

within them would be deemed to be 

urban. Therefore, we are proposing to 

change our policy and consider 

Litchfield County and Merrimack 

County as rural but would continue to 

consider the hospitals within them as 

being redesignated to urban CBSA 

25540 Hartford-West Hartford-East 

Hartford, CT, and urban CBSA 31700 

Manchester-Nashua, NH, respectively. 

Under our proposal, hospitals located in 

these counties—like the Lugar hospitals 

described in section III.I.8. of this 

preamble—must meet the rural 

requirements set forth at § 412.230 for 

individual reclassifications and §

412.232 for group reclassifications. We 

are proposing to revise §

412.64(b)(1)(ii)(B) accordingly. 

Hospitals not located inside one of these 

deemed New England counties are not 

permitted to measure to these counties 

to demonstrate close proximity in order 

to be reclassified to the CBSA(s) to 

which the hospitals in Litchfield and 

Merrimack counties are redesignated. 

We note that Tables 2, 3A, 3B, 4A, and 

4B in the Addendum to this proposed 

rule do not reflect this proposed change; 

rather, they reflect the wage index based 

on the current policy. 

11. Reclassifications Under Section 508 

of Pub. L. 108–173 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘508 Reclassifications’’ at the 

beginning of your comment.) 

Under section 508 of Pub. L. 108–173, 

a qualifying hospital could appeal the 

wage index classification otherwise 

applicable to the hospital and apply for 

reclassification to another area of the 

State in which the hospital is located 

(or, at the discretion of the Secretary, to 

an area within a contiguous State). We 

implemented this process through 

notices published in the Federal 

Register on January 6, 2004 (69 FR 661), 

and February 13, 2004 (69 FR 7340). 

Such reclassifications were applicable 

to discharges occurring during the 3- 

year period beginning April 1, 2004, and 

ending March 31, 2007. Section 106(a) 

of the MIEA–TRHCA (Pub. L. 109–432), 

extended any geographic 

reclassifications of hospitals that were 

made under section 508 and that would 

expire on March 31, 2007, by 6 months 

until September 30, 2007. On March 23, 

2007, we published a notice in the 

Federal Register (72 FR 13799) that 

indicated how we are implementing 

section 106(a) of the MIEA–TRHCA 

through September 30, 2007. Because 

the section 508 provision will expire on 

September 30, 2007, and will not be 

applicable in FY 2008, in this proposed 

rule, we are not making any proposals 

related to the provision. 

12. Other Issues 

We have been advised of a 

reclassification scenario of concern to a 

particular hospital. In this scenario, two 

hospitals were approved by the 

Medicare Geographic Classification 

Review Board (MGCRB) for a 3-year 

group reclassification. Prior to the 

second year of the 3-year 

reclassification, one of the hospitals 

reclassified individually to another area. 

Consistent with our policy, the second 

hospital retained its group geographic 

reclassification for the two remaining 

years (see 66 FR 39888, August 1, 2001). 

However, once the group 

reclassification expires, the second 

hospital does not qualify to reclassify 

individually to another area. We have 

been asked to consider potential 

regulatory options that would allow this 

hospital to either reclassify or receive a 

declining blend of its home area and 

reclassified wage index as a transition to 

its post-reclassified wage index. 

There are no options under our 

current regulations that would allow 

this hospital to reclassify individually 

or as a group. The hospital does not 

meet the well established wage data 

comparison criteria to reclassify as an 

individual hospital. In order for a group 

reclassification to be approved, all 

hospitals in the county must apply as a 

group. We have been informed that one 

hospital will not join the group 

reclassification because it qualifies 

individually to reclassify to a different 

area with a higher wage index than 

where the group applied. 

We considered whether to change our 

regulations for this type of situation. 

However, we decided not to propose a 

change to our regulations given the need 

to gather additional information and 

better understand the policy issues in 

such a case. In this regard, we would be 

interested in receiving comments on 

whether such a situation is consistent 

with the purpose of reclassification. In 

particular, we would like to receive 

comments on how a hospital that is 

applying to reclassify would 

demonstrate similarity to hospitals in 

the neighboring area when the hospital 

would qualify to be part of a group 

reclassification if all other hospitals in 

the county the hospital is located agreed 

to apply. 

In addition, we would be interested in 

comments on how we could make a 

determination that a hospitals own area 

wage index is inappropriate when the 

hospital does not meet the current 

criteria for reclassification on its own, 

but would meet the criteria for a group 

reclassification in the event all hospitals 

in the county in which the hospital is 

located would agree to submit a group 

application. Finally, given that 

reclassifications are in effect for three 

years, we request comments on whether 

or how we could address this situation 

while simultaneously maintaining the 

distinction between group and 

individual reclassifications— 

particularly the rule that all members of 

a group must apply for a group 

reclassification. 

For all the above reasons, we decided, 

as noted, not to propose changes to the 

regulations to address the situation 

brought to our attention. Rather, we 

think it is appropriate to gather 

additional information and seek 

comment on this or similar situations. If 

commenters wish to raise issues with 

the points described in this section or 

comment on other issues we did not 

consider in the questions raised above, 

we welcome such public comments. 

J. Proposed FY 2008 Wage Index 

Adjustment Based on Commuting 

Patterns of Hospital Employees 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Out-Migration Adjustment’’ at 

the beginning of your comment.) 

In accordance with the broad 

discretion under section 1886(d)(13) of 

the Act, as added by section 505 of Pub. 

L. 108–173, beginning with FY 2005, we 

established a process to make 

adjustments to the hospital wage index 

based on commuting patterns of 

hospital employees. The process, 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24799 

outlined in the FY 2005 IPPS final rule 

(69 FR 49061), provides for an increase 

in the wage index for hospitals located 

in certain counties that have a relatively 

high percentage of hospital employees 

who reside in the county but work in a 

different county (or counties) with a 

higher wage index. Such adjustments to 

the wage index are effective for 3 years, 

unless a hospital requests to waive the 

application of the adjustment. A county 

will not lose its status as a qualifying 

county due to wage index changes 

during the 3-year period, and counties 

will receive the same wage index 

increase for those 3 years. However, a 

county that qualifies in any given year 

may no longer qualify after the 3-year 

period, or it may qualify but receive a 

different adjustment to the wage index 

level. Hospitals that receive this 

adjustment to their wage index are not 

eligible for reclassification under 

section 1886(d)(8) or section 1886(d)(10) 

of the Act. Adjustments under this 

provision are not subject to the budget 

neutrality requirements under section 

1886(d)(3)(E) of the Act. 

Hospitals located in counties that 

qualify for the wage index adjustment 

are to receive an increase in the wage 

index that is equal to the average of the 

differences between the wage indices of 

the labor market area(s) with higher 

wage indices and the wage index of the 

resident county, weighted by the overall 

percentage of hospital workers residing 

in the qualifying county who are 

employed in any labor market area with 

a higher wage index. To date, we have 

used pre-reclassified wage indices when 

determining the out-migration 

adjustment. In the FY 2005 IPPS final 

rule (69 FR 49061 through 49063), we 

stated that it was reasonable to interpret 

the term ‘‘wage index’’ in section 

1886(d)(13)(D) of the Act to mean the 

pre-reclassified, pre-adjusted wage 

index. At the time, we stated that it was 

unclear whether to use the pre- or postreclassified wage index as the basis for 

comparison to determine the outmigration adjustment. We also cited 

complicating factors such as the use of 

blended wage indices as a result of the 

labor market area transition as another 

reason to base the out-migration 

adjustment on the pre-reclassified wage 

index. However, we indicated that we 

will continue to examine the possibility 

of employing post-reclassification wage 

indexes as we refine our policy for 

future adjustments. 

We have reconsidered our policy in 

this proposed rule and are proposing to 

calculate the out-migration adjustment 

using the post-reclassified wage index. 

First, the labor-market area transition 

has ended and the use of blended wage 

indexes is no longer a complicating 

factor in determining whether to use 

pre- or post-reclassified wage indexes to 

determine the out-migration adjustment. 

Second, we are proposing to apply 

budget neutrality for application of the 

rural floor to area wage indices rather 

than to the standardized amount 

beginning in FY 2008. The budget 

neutrality adjustment for the rural floor 

is being applied to the postreclassification wage indices and is a 

component of the wage index that is 

being used to adjust for area differences 

in wages. Therefore, we believe the outmigration adjustment should be 

determined using post-reclassified wage 

index that reflects the budget neutrality 

adjustment for application of the rural 

floor. 

We are proposing to use the same 

formula described in the FY 2005 final 

rule (69 FR 49064), with the addition of 

now using the post-reclassified wage 

indices, to calculate the out-migration 

adjustment. This adjustment is 

calculated as follows: 

Step 1. Subtract the wage index for 

the qualifying county from the wage 

index of each of the higher wage area(s) 

to which hospital workers commute. 

Step 2. Divide the number of hospital 

employees residing in the qualifying 

county who are employed in such 

higher wage index area by the total 

number of hospital employees residing 

in the qualifying county who are 

employed in any higher wage index 

area. For each of the higher wage areas, 

multiply this result by the result 

obtaining in Step 1. 

Step 3. Sum the products resulting 

from Step 2 (if the qualifying county has 

workers commuting to more than one 

higher wage area). 

Step 4. Multiply the result from Step 

3 by the percentage of hospital 

employees who are residing in the 

qualifying county and who are 

employed in any higher wage index 

area. 

These adjustments will be effective 

for each county for a period of 3 fiscal 

years. Hospitals that received the 

adjustment in FY 2007 will be eligible 

to retain that same adjustment for FY 

2008. For hospitals in newly qualified 

counties, adjustments to the wage index 

are effective for 3 years, beginning with 

discharges occurring on or after October 

1, 2007. 

Hospitals receiving the wage index 

adjustment under section 1886(d)(13)(F) 

of the Act are not eligible for 

reclassification under sections 

1886(d)(8) or (d)(10) of the Act unless 

they waive the out-migration 

adjustment. Consistent with our FY 

2005, 2006, and 2007 final rules, we are 

proposing that hospitals redesignated 

under section 1886(d)(8) of the Act or 

reclassified under section 1886(d)(10) of 

the Act will be deemed to have chosen 

to retain their redesignation or 

reclassification. Section 1886(d)(10) 

hospitals that wish to receive the outmigration adjustment, rather than their 

reclassification, should follow the 

termination/withdrawal procedures 

specified in 42 CFR 412.273 and section 

III.I.3. of the preamble of this proposed 

rule. Otherwise, they will be deemed to 

have waived the out-migration 

adjustment. Hospitals redesignated 

under section 1886(d)(8) of the Act will 

be deemed to have waived the outmigration adjustment, unless they 

explicitly notify CMS that they elect to 

receive the out-migration adjustment 

instead within 45 days from the 

publication of this proposed rule. These 

notifications should be sent to the 

following address: Centers for Medicare 

and Medicaid Services, Center for 

Medicare Management, Attention: Wage 

Index Adjustment Waivers, Division of 

Acute Care, Room C4–08–06, 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

Table 4J in the Addendum to this 

proposed rule lists the proposed outmigration wage index adjustments for 

FY 2008. Hospitals that are not 

otherwise reclassified or redesignated 

under section 1886(d)(8) or section 

1886(d)(10) of the Act will 

automatically receive the listed 

adjustment. In accordance with the 

procedures discussed above, 

redesignated/reclassified hospitals will 

be deemed to have waived the outmigration adjustment unless CMS is 

otherwise notified. Hospitals that are 

eligible to receive the out-migration 

wage index adjustment and that 

withdraw their application for 

reclassification automatically receive 

the wage index adjustment listed in 

Table 4J in the Addendum to this 

proposed rule. Hospitals should 

carefully review the wage index 

adjustment that they would receive 

under this provision (as listed in Table 

4J) and the area wage index value as 

listed in Table 4A (both included in the 

Addendum to this proposed rule) in 

comparison to the wage index value that 

they would receive under the MGCRB 

reclassification (Table 4C in the 

Addendum to this proposed rule). 

K. Process for Requests for Wage Index 

Data Corrections 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Wage Index Data Corrections’’ 

at the beginning of your comment.) 

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The preliminary Worksheet S–3 wage 

data and occupational mix survey data 

files (1st and 2nd quarter 2006) for the 

FY 2008 wage index were made 

available on October 6, 2006, through 

the Internet on the CMS Web site at: 

http://cms.hhs.gov/AcuteInpatientPPS/. 

In a memorandum dated October 6, 

2006, we instructed all fiscal 

intermediaries to inform the IPPS 

hospitals they service of the availability 

of the wage index data files and the 

process and timeframe for requesting 

revisions (including the specific 

deadlines listed below). We also 

instructed the fiscal intermediaries to 

advise hospitals that these data are also 

made available directly through their 

representative hospital organizations. 

If a hospital wished to request a 

change to its data as shown in the 

October 6, 2006 wage and occupational 

mix data files, the hospital was to 

submit corrections along with complete, 

detailed supporting documentation to 

its fiscal intermediary by December 4, 

2006. Hospitals were notified of this 

deadline and of all other possible 

deadlines and requirements, including 

the requirement to review and verify 

their data as posted on the preliminary 

wage index data file on the Internet, 

through the October 6, 2006 

memorandum referenced above. 

In the October 6, 2006 memorandum, 

we also specified that a hospital could 

request revisions to 1st and/or 2nd 

quarter occupational mix survey data if 

they missed the previous deadlines 

(June 1, 2006, for the 1st quarter data 

collection and August 31, 2006, for the 

2nd quarter collection) for submitting 

occupational mix survey data to their 

fiscal intermediaries. A hospital 

requesting revisions to its 1st and/or 

2nd quarter occupational mix survey 

data was to copy its record(s) from the 

CY 2006 occupational mix preliminary 

files posted to our website in October, 

highlight the revised cells on its 

spreadsheet, and submit its 

spreadsheet(s) and complete 

documentation to its fiscal intermediary 

no later than December 4, 2006. 

The fiscal intermediaries (or, if 

applicable, the MAC) notified the 

hospitals by mid-February 2007 of any 

changes to the wage index data as a 

result of the desk reviews and the 

resolution of the hospitals’ earlyDecember revision requests. The fiscal 

intermediaries or MAC also submitted 

the revised data to CMS by midFebruary 2007. CMS published the 

proposed wage index public use files 

that included hospitals’ revised wage 

data on February 23, 2007. In a 

memorandum also dated February 23, 

2007, we instructed fiscal 

intermediaries and the MAC to notify all 

hospitals regarding the availability of 

the proposed wage index public use 

files and the criteria and process for 

requesting corrections and revisions to 

the wage index data. Hospitals had until 

March 12, 2007 to submit requests to the 

fiscal intermediaries or the MAC for 

reconsideration of adjustments made by 

the fiscal intermediaries or the MAC as 

a result of the desk review, and to 

correct errors due to CMS’s or the fiscal 

intermediary’s (or, if applicable, the 

MAC’s) mishandling of the wage index 

data. Hospitals were also required to 

submit sufficient documentation to 

support their requests. 

After reviewing requested changes 

submitted by hospitals, fiscal 

intermediaries or the MAC are to 

transmit any additional revisions 

resulting from the hospitals’ 

reconsideration requests by April 13, 

2007. The deadline for a hospital to 

request CMS intervention in cases 

where the hospital disagreed with the 

fiscal intermediary’s (or, if applicable, 

the MAC’s) policy interpretations is 

April 20, 2007. 

Hospitals should also examine Table 

2 in the Addendum to this proposed 

rule. Table 2 of this proposed rule 

contained each hospital’s adjusted 

average hourly wage used to construct 

the wage index values for the past 3 

years, including the FY 2004 data used 

to construct the proposed FY 2008 wage 

index. We note that the hospital average 

hourly wages shown in Table 2 only 

reflect changes made to a hospital’s data 

and transmitted to CMS by February 21, 

2007. 

We will release the final wage index 

data public use files in early May 2007 

on the Internet at http:/ 

www.cms.hhs.gov/AcuteInpatientPPS/. 

The May 2007 public use files will be 

made available solely for the limited 

purpose of identifying any potential 

errors made by CMS or the fiscal 

intermediary or MAC in the entry of the 

final wage index data that result from 

the correction process described above 

(revisions submitted to CMS by the 

fiscal intermediaries or the MAC by 

April 13, 2007). If, after reviewing the 

May 2007 final files, a hospital believes 

that its wage or occupational mix data 

are incorrect due to a fiscal intermediary 

or MAC or CMS error in the entry or 

tabulation of the final data, the hospital 

should send a letter to both its fiscal 

intermediary or MAC and CMS that 

outlines why the hospital believes an 

error exists and to provide all 

supporting information, including 

relevant dates (for example, when it first 

became aware of the error). CMS and the 

fiscal intermediaries (or, if applicable, 

the MAC) must receive these requests 

no later than June 08, 2007. Requests 

mailed to CMS should be sent to: 

Centers for Medicare & Medicaid 

Services, Center for Medicare 

Management, Attention: Wage Index 

Team, Division of Acute Care, C4–08– 

06, 7500 Security Boulevard, Baltimore, 

MD 21244–1850. 

Each request also must be sent to the 

fiscal intermediary or the MAC. The 

fiscal intermediary or the MAC will 

review requests upon receipt and 

contact CMS immediately to discuss its 

findings. 

At this point in the process, that is, 

after the release of the May 2007 wage 

index data files, changes to the wage 

and occupational mix data will only 

made in those very limited situations 

involving an error by the fiscal 

intermediary or the MAC or CMS that 

the hospital could not have known 

about before its review of the final wage 

index data files. Specifically, neither the 

fiscal intermediary or the MAC nor CMS 

will approve the following types of 

requests: 

<bullet≤ Requests for wage index data 

corrections that were submitted too late 

to be included in the data transmitted to 

CMS by fiscal intermediaries or the 

MAC on or before April 13, 2007. 

<bullet≤ Requests for correction of 

errors that were not, but could have 

been, identified during the hospital’s 

review of the February 23, 2007 wage 

index public use files. 

<bullet≤ Requests to revisit factual 

determinations or policy interpretations 

made by the fiscal intermediary or the 

MAC or CMS during the wage index 

data correction process. 

Verified corrections to the wage index 

data received timely by CMS and the 

fiscal intermediaries or the MAC (that 

is, by June 08, 2007) will be 

incorporated into the final wage index 

to be published by August 1, 2007, to be 

effective October 1, 2007. 

We created the processes described 

above to resolve all substantive wage 

index data correction disputes before we 

finalize the wage and occupational mix 

data for the FY 2008 payment rates. 

Accordingly, hospitals that do not meet 

the procedural deadlines set forth above 

will not be afforded a later opportunity 

to submit wage index data corrections or 

to dispute the fiscal intermediary’s (or, 

if applicable the MAC’s) decision with 

respect to requested changes. 

Specifically, our policy is that hospitals 

that do not meet the procedural 

deadlines set forth above will not be 

permitted to challenge later, before the 

Provider Reimbursement Review Board, 

the failure of CMS to make a requested 

data revision. (See W.A. Foote Memorial 

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Hospital v. Shalala, No. 99–CV–75202– 

DT (E.D. Mich. 2001) and Palisades 

General Hospital v. Thompson, No. 99– 

1230 (D.D.C. 2003.) We refer the reader 

also to the FY 2000 final rule (64 FR 

41513) for a discussion of the 

parameters for appealing to the PRRB 

for wage index data corrections. 

Again, we believe the wage index data 

correction process described above 

provides hospitals with sufficient 

opportunity to bring errors in their wage 

and occupational mix data to the fiscal 

intermediary’s (or, if applicable, the 

MAC’s) attention. Moreover, because 

hospitals will have access to the final 

wage index data by early May 2007, 

they have the opportunity to detect any 

data entry or tabulation errors made by 

the fiscal intermediary or the MAC or 

CMS before the development and 

publication of the final FY 2008 wage 

index by August 1, 2007, and the 

implementation of the FY 2008 wage 

index on October 1, 2007. If hospitals 

avail themselves of the opportunities 

afforded to provide and make 

corrections to the wage and 

occupational mix data, the wage index 

implemented on October 1 should be 

accurate. Nevertheless, in the event that 

errors are identified by hospitals and 

brought to our attention after June 08, 

2007, we retain the right to make 

midyear changes to the wage index 

under very limited circumstances. 

Specifically, in accordance with §

412.64(k)(1) of our existing regulations, 

we make midyear corrections to the 

wage index for an area only if a hospital 

can show that: (1) The fiscal 

intermediary or the MAC or CMS made 

an error in tabulating its data; and (2) 

the requesting hospital could not have 

known about the error or did not have 

an opportunity to correct the error, 

before the beginning of the fiscal year. 

For purposes of this provision, ‘‘before 

the beginning of the fiscal year’’ means 

by the June deadline for making 

corrections to the wage data for the 

following fiscal year’s wage index. This 

provision is not available to a hospital 

seeking to revise another hospital’s data 

that may be affecting the requesting 

hospital’s wage index for the labor 

market area. As indicated earlier, since 

CMS makes the wage index data 

available to hospitals on the CMS Web 

site prior to publishing both the 

proposed and final IPPS rules, and the 

fiscal intermediaries or the MAC notify 

hospitals directly of any wage index 

data changes after completing their desk 

reviews, we do not expect that midyear 

corrections will be necessary. However, 

under our current policy, if the 

correction of a data error changes the 

wage index value for an area, the 

revised wage index value will be 

effective prospectively from the date the 

correction is made. 

In the FY 2006 IPPS final rule (70 FR 

47385), we revised § 412.64(k)(2) to 

specify that, effective on October 1, 

2005, that is beginning with the FY 2006 

wage index, a change to the wage index 

can be made retroactive to the beginning 

of the Federal fiscal year only when: (1) 

the fiscal intermediary (or, if applicable, 

the MAC) or CMS made an error in 

tabulating data used for the wage index 

calculation; (2) the hospital knew about 

the error and requested that the fiscal 

intermediary (or if applicable the MAC) 

and CMS correct the error using the 

established process and within the 

established schedule for requesting 

corrections to the wage index data, 

before the beginning of the fiscal year 

for the applicable IPPS update (that is, 

by the June 08, 2007 deadline for the FY 

2008 wage index); and (3) CMS agreed 

that the fiscal intermediary (or if 

applicable, the MAC) or CMS made an 

error in tabulating the hospital’s wage 

index data and the wage index should 

be corrected. 

In those circumstances where a 

hospital requests a correction to its wage 

index data before CMS calculates the 

final wage index (that is, by the June 

deadline), and CMS acknowledges that 

the error in the hospital’s wage index 

data was caused by CMS’s or the fiscal 

intermediary’s (or, if applicable, the 

MAC’s) mishandling of the data, we 

believe that the hospital should not be 

penalized by our delay in publishing or 

implementing the correction. As with 

our current policy, we indicated that the 

provision is not be available to a 

hospital seeking to revise another 

hospital’s data. In addition, the 

provision cannot be used to correct 

prior years’ wage index data; it can only 

be used for the current Federal fiscal 

year. In other situations where our 

policies would allow midyear 

corrections, we continue to believe that 

it is appropriate to make prospectiveonly corrections to the wage index. 

We note that, as with prospective 

changes to the wage index, the final 

retroactive correction will be made 

irrespective of whether the change 

increases or decreases a hospital’s 

payment rate. In addition, we note that 

the policy of retroactive adjustment will 

still apply in those instances where a 

judicial decision reverses a CMS denial 

of a hospital’s wage index data revision 

request. 

L. Labor-Related Share for the Proposed 

Wage Index for FY 2008 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Labor-Related Share’’ at the 

beginning of your comment.) 

Section 1886(d)(3)(E) of the Act 

directs the Secretary to adjust the 

proportion of the national prospective 

payment system base payment rates that 

are attributable to wages and wagerelated costs by a factor that reflects the 

relative differences in labor costs among 

geographic areas. It also directs the 

Secretary to estimate from time to time 

the proportion of hospital costs that are 

labor-related: ‘‘The Secretary shall 

adjust the proportion (as estimated by 

the Secretary from time to time) of 

hospitals’ costs which are attributable to 

wages and wage-related costs of the 

DRG prospective payment rates* * *’’ 

We refer to the portion of hospital costs 

attributable to wages and wage-related 

costs as the labor-related share. The 

labor-related share of the prospective 

payment rate is adjusted by an index of 

relative labor costs, which is referred to 

as the wage index. 

Section 403 of Pub. L. 108–173 

amended section 1886(d)(3)(E) of the 

Act to provide that the Secretary must 

employ 62 percent as the labor-related 

share unless this ‘‘would result in lower 

payments to a hospital than would 

otherwise be made.’’ However, this 

provision of Pub. L. 108–173 did not 

change the legal requirement that the 

Secretary estimate ‘‘from time to time’’ 

the proportion of hospitals’ costs that 

are ‘‘attributable to wages and wagerelated costs.’’ We believe that this 

reflected Congressional intent that 

hospitals receive payment based on 

either a 62-percent labor-related share, 

or the labor-related share estimated from 

time to time by the Secretary, depending 

on which labor-related share resulted in 

a higher payment. 

We have continued our research into 

the assumptions employed in 

calculating the labor-related share. Our 

research involves analyzing the 

compensation share separately for urban 

and rural hospitals, using regression 

analysis to determine the proportion of 

costs influenced by the area wage index, 

and exploring alternative methodologies 

to determine whether all or only a 

portion of professional fees and 

nonlabor intensive services should be 

considered labor-related. 

In the FY 2006 IPPS final rule (70 FR 

47392), we presented our analysis and 

conclusions regarding the frequency and 

methodology for updating the laborrelated share for FY 2006. We also 

recalculated a labor-related share of 

69.731 percent, using the FY 2002-based 

PPS market basket for discharges 

occurring on or after October 1, 2005. In 

addition, we implemented this revised 

and rebased labor-related share in a 

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24802 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

budget neutral manner, but consistent 

with section 1886(d)(3)(E) of the Act, we 

did not take into account the additional 

payments that would be made as a 

result of hospitals with a wage index 

less than or equal to 1.0 being paid 

using a labor-related share lower than 

the labor-related share of hospitals with 

a wage index greater than 1.0. 

The labor-related share is used to 

determine the proportion of the national 

PPS base payment rate to which the area 

wage index is applied. In this proposed 

rule, we are not proposing to make any 

changes to the national average 

proportion of operating costs that are 

attributable to wages and salaries, fringe 

benefits, professional fees, contract 

labor, and labor intensive services. 

Therefore, we are proposing to continue 

to use a labor-related share of 69.731 

percent for discharges occurring on or 

after October 1, 2007. Tables 1A and 1B 

will reflect this proposed labor-related 

share. We note that section 403 of Pub. 

L. 108–173 amended sections 

1886(d)(3)(E) and 1886(d)(9)(C)(iv) of 

the Act to provide that the Secretary 

must employ 62 percent as the laborrelated share unless this employment 

‘‘would result in lower payments to a 

hospital than would otherwise be 

made.’’ 

We also are proposing to continue to 

use a labor-related share for the Puerto 

Rico-specific standardized amounts of 

58.7 percent for discharges occurring on 

or after October 1, 2007. Consistent with 

our methodology for determining the 

national labor-related share, we added 

the Puerto Rico-specific relative weights 

for wages and salaries, fringe benefits, 

contract labor, nonmedical professional 

fees, and other labor-intensive services 

to determine the labor-related share. 

Puerto Rico hospitals are paid based on 

75 percent of the national standardized 

amounts and 25 percent of the Puerto 

Rico-specific standardized amounts. For 

Puerto Rico hospitals, the national 

labor-related share will always be 62 

percent because the wage index for all 

Puerto Rico hospitals is less than 1.0. A 

Puerto Rico-specific wage index is 

applied to the Puerto Rico-specific 

portion of payments to the hospitals. 

The labor-related share of a hospital’s 

Puerto Rico-specific rate will be either 

62 percent or the Puerto Rico-specific 

labor-related share depending on which 

results in higher payments to the 

hospital. If the hospital has a Puerto 

Rico-specific wage index of greater than 

1.0, we will set the hospital’s rates using 

a labor-related share of 62 percent for 

the 25 percent portion of the hospital’s 

payment determined by the Puerto Rico 

standardized amounts because this 

amount will result in higher payments. 

Conversely, a hospital with a Puerto 

Rico-specific wage index of less than 1.0 

will be paid using the Puerto Ricospecific labor-related share of 58.7 

percent of the Puerto Rico-specific rates 

because the lower labor-related share 

will result in higher payments. The 

Puerto Rico labor-related share of 58.7 

percent for FY 2007 is reflected in the 

Table 1C of the Addendum to this 

proposed rule. 

M. Wage Index Study Required Under 

Pub. L. 109–432 

Section 106(b)(1) of the MIEA– 

TRHCA (Pub. L. 109–432) requires 

MedPAC to submit to Congress, not later 

than June 30, 2007, a report on the 

Medicare wage index classification 

system applied under the Medicare 

Prospective Payment System. Section 

106(b) of MIEA–TRHCA requires the 

report to include any alternatives that 

MedPAC recommends to the method to 

compute the wage index under section 

1886(d)(3)(E) of the Act. 

In addition, section 106(b)(2) of Pub. 

L. 109–432 instructs the Secretary of 

Health and Human Services, taking into 

account MedPAC’s recommendations on 

the Medicare wage index classification 

system, to include in the FY 2009 IPPS 

proposed rule one or more proposals to 

revise the wage index adjustment 

applied under section 1886(d)(3)(E) of 

the Act for purposes of the IPPS. The 

proposal (or proposals) must consider 

each of the following: 

<bullet≤ Problems associated with the 

definition of labor markets for the wage 

index adjustment; 

<bullet≤ The modification or 

elimination of geographic 

reclassifications and other adjustments; 

<bullet≤ The use of Bureau of Labor 

of Statistics data or other data or 

methodologies to calculate relative 

wages for each geographic area; 

<bullet≤ Minimizing variations in 

wage index adjustments between and 

within MSAs and statewide rural areas; 

<bullet≤ The feasibility of applying all 

components of CMS’ proposal to other 

settings; 

<bullet≤ Methods to minimize the 

volatility of wage index adjustments 

while maintaining the principle of 

budget neutrality; 

<bullet≤ The effect that the 

implementation of the proposal would 

have on health care providers on each 

region of the country; 

<bullet≤ Methods for implementing 

the proposal(s) including methods to 

phase in such implementations; and 

<bullet≤ Issues relating to 

occupational mix such as staffing 

practices and any evidence on quality of 

care and patient safety including any 

recommendation for alternative 

calculations to the occupational mix. 

We look forward to reviewing the 

MedPAC report on the wage index later 

this year. As required by the law, we 

will consider MedPAC’s 

recommendations and each of the 

factors specified above in making a 

proposal (or proposals) in the FY 2009 

IPPS proposed rule. 

N. Proxy for the Hospital Market Basket 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Hospital Market Basket’’ at the 

beginning of your comment.) 

In the FY 2006 IPPS final rule (70 FR 

47387), we changed the base year cost 

structure for the IPPS hospital index for 

the hospital market basket for operating 

costs from FY 1997 to FY 2002. As 

discussed in that final rule, the IPPS 

hospital index primarily uses the BLS 

data as price proxies, which are grouped 

in one of the three BLS categories. The 

categories are Producer Price Indexes 

(PPIs), Consumer Price Indexes (CPIs), 

and Employment Cost Indexes (ECIs), 

discussed in detail in the FY 2006 IPPS 

final rule (70 FR 47388 through 47391). 

We evaluate the price proxies using the 

criteria of reliability, timeliness, 

availability, and relevance. The PPIs, 

CPIs, and ECIs selected by us and used 

for this proposed rule meet these criteria 

as described in the FY 2006 IPPS final 

rule. We believe they continue to be the 

best measures of price changes for the 

cost categories. 

Beginning April 2006 with the 

publication of March 2006 data, the 

BLS’ ECI began using a different 

classification system, the North 

American Industrial Classification 

System (NAICS), instead of the Standard 

Industrial Codes (SIC), which no longer 

exists. We have consistently used the 

ECI as the data source for our wages and 

salaries and other price proxies in the 

IPPS market basket and are not making 

any changes to the usage at this time. 

Thus, we propose to use the BLS– 

NAICS-based ECIs as price proxies in 

the market basket. 

IV. Other Decisions and Proposed 

Changes to the IPPS for Operating Costs 

and GME Costs 

A. Reporting of Hospital Quality Data 

for Annual Hospital Payment Update (§

412.64(d)(2)) 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Hospital Quality Data’’ at the 

beginning of your comment.) 

1. Background 

Section 5001(a) of the Deficit 

Reduction Act of 2005, Pub. L. 109–171 

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17 Institute of Medicine, ‘‘Performance 

Measurement: Accelerating Improvement,’’ 

December 1, 2005, available at http://www.iom.edu/ 

CMS/3809/ 19805/31310.aspx. 

(DRA), set out new requirements for the 

Reporting Hospital Quality Data for 

Annual Payment Update (RHQDAPU) 

program. We established the RHQDAPU 

program in order to implement section 

501(b) of Pub. L. 108–173. It builds on 

our ongoing voluntary Hospital Quality 

Initiative which is intended to empower 

consumers with quality of care 

information to make more informed 

decisions about their health care while 

also encouraging hospitals and 

clinicians to improve their quality of 

care. Section 5001(a) of the DRA revised 

the mechanism used to update the 

standardized amount for payment for 

hospital inpatient operating costs. 

Specifically, sections 

1886(b)(3)(B)(viii)(I) and (II) of the Act 

provide that the payment update for FY 

2007 and each subsequent fiscal year 

will be reduced by 2.0 percentage points 

for any ‘‘subsection (d) hospital’’ (that 

is, a hospital paid under the IPPS) that 

does not submit certain quality data in 

a form and manner, and at a time, 

specified by the Secretary. Sections 1886(b)(3)(B)(viii)(III) and 

(IV) of the Act required that we expand 

the ‘‘starter set’’ of 10 quality measures 

established by the Secretary as of 

November 1, 2003, provided certain 

requirements were met. In expanding 

this set of measures, section 

1886(b)(3)(B)(viii)(IV) of the Act 

provides that we must begin to adopt 

the baseline set of performance 

measures as set forth in a 2005 report 

issued by the Institute of Medicine 

(IOM) of the National Academy of 

Sciences under section 238(b) of the 

MMA,17 effective for payments 

beginning with FY 2007. The IOM measures include: Hospital 

Quality Alliance (HQA) quality 

measures (the HQA is a public-private 

collaboration to improve the quality of 

care provided by the nation’s hospitals 

by measuring and publicly reporting on 

that care), the HCAHPS patient 

perspective survey, and three structural 

measures. The structural measures are: 

(1) Implementation of computerized 

provider order entry for prescriptions, 

(2) staffing of intensive care units with 

intensivists, and (3) evidence-based 

hospital referrals. These structural 

measures constitute the Leapfrog 

Group’s original ‘‘three leaps,’’ and are 

part of the National Quality Forum’s 30 

Safe Practices for Better Healthcare. 

Sections 1886(b)(3)(B)(viii)(V) and 

(VI) of the Act require that, effective for 

payments beginning with FY 2008, we 

add other quality measures that reflect 

consensus among affected parties, and 

provide the Secretary with the 

discretion to replace any quality 

measures or indicators in appropriate 

cases, such as where all hospitals are 

effectively in compliance with a 

measure, or the measures or indicators 

have been subsequently shown to not 

represent the best clinical practice. 

Thus, the Secretary has broad discretion 

to replace measures on the basis that 

they are not appropriate. Section 1886(b)(3)(B)(viii)(VII) of the 

Act requires that we establish 

procedures for making quality data 

available to the public after ensuring 

that a hospital has the opportunity to 

review, in advance, its data that are to 

be made public. In addition, this section 

requires that we report quality measures 

of process, structure, outcome, patients’ 

perspective on care, efficiency, and 

costs of care that relate to services 

furnished in inpatient settings on the 

CMS Web site. 

Section 1886(b)(3)(B)(viii)(I) of the 

Act also provides that any reduction in 

a hospital’s payment update will apply 

only with respect to the fiscal year 

involved, and will not be taken into 

account for computing the applicable 

percentage increase for a subsequent 

fiscal year. The starter set of 10 quality measures 

we established as of November 1, 2003 

are as follows: 

Heart Attack (Acute Myocardial 

Infarction or AMI) 

<bullet≤ Was aspirin given to the 

patient upon arrival to the hospital? <bullet≤ Was aspirin prescribed when 

the patient was discharged? <bullet≤ Was a beta-blocker given to 

the patient upon arrival to the hospital? <bullet≤ Was a beta-blocker 

prescribed when the patient was 

discharged? <bullet≤ Was an ACE inhibitor given 

for the patient with heart failure? Heart Failure (HF) 

<bullet≤ Did the patient get an 

assessment of his or her heart function? 

<bullet≤ Was an ACE inhibitor given 

to the patient? Pneumonia (PNE) 

<bullet≤ Was an antibiotic given to 

the patient in a timely way? <bullet≤ Had the patient received a 

pneumococcal vaccination? <bullet≤ Was the patient’s oxygen 

level assessed? 

We adopted these measures after the 

Secretary of HHS joined in a partnership 

with several collaborators intended to 

promote hospital quality improvement 

and public reporting of hospital quality 

information. These collaborators 

included the American Hospital 

Association, the Federation of American 

Hospitals, the Association of American 

Medical Colleges, the Joint Commission 

on Accreditation of Healthcare 

Organizations (the Joint Commission), 

the National Quality Forum (NQF), the 

American Medical Association, the 

Consumer-Purchaser Disclosure Project, 

the AARP, the American Federation of 

Labor-Congress of Industrial 

Organizations, the Agency for 

Healthcare Research and Quality 

(AHRQ), as well as CMS and others. 

This collaboration, originally known as 

the National Voluntary Hospital 

Reporting Initiative, is now known as 

the HQA. 

This starter set of 10 quality measures 

was endorsed by the NQF. NQF is a 

voluntary consensus standard-setting 

organization established to standardize 

health care quality measurement and 

reporting through its consensus 

development process. In addition, this 

starter set is a subset of measures 

currently collected for The Joint 

Commission as part of its certification 

program. 

We chose these 10 quality measures 

in order to collect data that will: (1) 

Provide useful and valid information 

about hospital quality to the public; (2) 

provide hospitals with a sense of 

predictability about public reporting 

expectations; (3) begin to standardize 

data and data collection mechanisms; 

and (4) foster hospital quality 

improvement. 

Hospitals submit quality data through 

the QualityNet Exchange secure Web 

site (http://www.qnetexchange.org). We 

believe that this Web site meets or 

exceeds all current Health Insurance 

Portability and Accountability Act 

requirements for security of personal 

health information. Data from this 

initiative are used to populate the 

Hospital Compare Web site, http:// 

www.hospitalcompare.hhs.gov. This 

Web site assists beneficiaries and the 

general public by providing information 

on hospital quality of care for 

consumers who need to select a 

hospital. It further serves to encourage 

consumers to work with their doctors 

and hospitals to discuss the quality of 

care they provide to patients, thereby 

providing an additional incentive to 

improve their quality of that care. 

In the FY 2007 IPPS final rule (71 FR 

48137), we amended our regulations at 

§ 412.64(d)(2) to reflect the 2.0 

percentage point reduction in the 

payment update for FY 2007 and 

subsequent fiscal years for hospitals that 

do not comply with requirements for 

reporting quality data as provided for 

under section 5001(a) of the DRA. We 

also added 11 additional quality 

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measures to the 10 measure starter set 

to establish an expanded set of 21 

quality measures (71 FR 48029 through 

48037). These 21 measures are as 

follows: 

Topic Quality measure 

Heart Attack (Acute Myocardial Infarction) .............................................. <bullet≤ Aspirin at arrival.* 

<bullet≤ Aspirin prescribed at discharge.* 

<bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) 

for left ventricular systolic dysfunction.* 

<bullet≤ Beta blocker at arrival.* 

<bullet≤ Beta blocker prescribed at discharge.* 

<bullet≤ Thrombolytic agent received within 30 minutes of hospital arrival. 

<bullet≤ Percutaneous Coronary Intervention (PCI) received within 120 

minutes of hospital arrival. 

<bullet≤ Adult smoking cessation advice/counseling. 

Heart Failure (HF) .................................................................................... <bullet≤ Left ventricular function assessment.* 

<bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) 

for left ventricular systolic dysfunction.* 

<bullet≤ Discharge instructions. 

<bullet≤ Adult smoking cessation advice/counseling. 

Pneumonia (PNE) ..................................................................................... <bullet≤ Initial antibiotic received within 4 hours of hospital arrival.* 

<bullet≤ Oxygenation assessment.* 

<bullet≤ Pneumococcal vaccination status.* 

<bullet≤ Blood culture performed before first antibiotic received in hospital. 

<bullet≤ Adult smoking cessation advice/counseling. 

<bullet≤ Appropriate initial antibiotic selection. 

<bullet≤ Influenza vaccination status. 

Surgical Care Improvement Project (SCIP)—named SIP for discharges 

prior to July 2006 (3Q06).

<bullet≤ Prophylactic antibiotic received within 1 hour prior to surgical 

incision. 

<bullet≤ Prophylactic antibiotics discontinued within 24 hours after surgery end time. 

*Measure included in 10 measure starter set. 

In addition, in the FY 2007 IPPS final 

rule (71 FR 48031 through 48044), we 

set out RHQDAPU program procedures 

for data submission, program 

withdrawal, data validation, attestation, 

public display of hospitals’ quality data, 

and reconsiderations. In response to 

public comments, we required that 

reporting of the expanded quality 

measures begin with discharges 

occurring on or after the third calendar 

quarter of 2006 (July through September 

discharges). We also responded to 

public comments regarding whether we 

should establish more structured 

reconsideration procedures for FY 2008 

and what such procedures might 

include. 

Under section 1886(b)(3)(B)(viii)(V) of 

the Act, for payments beginning with 

FY 2008, we are required to add other 

measures that reflect consensus among 

affected parties, and, to the extent 

feasible and practicable, we must 

include measures set forth by one or 

more national consensus building 

entities. 

2. FY 2008 Quality Measures 

Commenters on the FY 2007 IPPS 

proposed rule requested that we notify 

the public as far in advance as possible 

of any proposed expansions of the 

measurement set and program 

procedures in order to encourage broad 

collaboration and to give hospitals time 

to prepare for any anticipated change. 

Taking these concerns into account, in 

the CY 2007 OPPS final rule (71 FR 

68201), we adopted additional quality 

measures for the FY 2008 update. The 

six additional measures we adopted are 

as follows: 

<bullet≤ HCAHPS survey 

<bullet≤ SCIP Quality Measures 

—SCIP–VTE 1: Venous 

thromboembolism (VTE) 

prophylaxis ordered for surgery 

patient 

—SCIP–VTE 2: VTE prophylaxis 

within 24 hours pre/post surgery 

—SCIP Infection 2: Prophylactic 

antibiotic selection for surgical 

patients 

<bullet≤ Mortality (Medicare Patients) 

—Acute Myocardial Infarction 30-day 

mortality Medicare patients 

—Heart Failure 30-day mortality 

Medicare patients 

For the FY 2008 payment 

determination, hospitals are required to 

report the following 27 measures: 

Topic Quality measure 

Heart Attack (Acute Myocardial Infarction) .............................................. <bullet≤ Aspirin at arrival.* 

<bullet≤ Aspirin prescribed at discharge.* 

<bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) 

for left ventricular systolic dysfunction.* 

<bullet≤ Beta blocker at arrival.* 

<bullet≤ Beta blocker prescribed at discharge.* 

<bullet≤ Thrombolytic agent received within 30 minutes of hospital arrival.** 

<bullet≤ Percutaneous Coronary Intervention (PCI) received within 120 

minutes of hospital arrival.** 

<bullet≤ Adult smoking cessation advice/counseling.** 

Heart Failure (HF) .................................................................................... <bullet≤ Left ventricular function assessment.* 

<bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) 

for left ventricular systolic dysfunction.* 

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Topic Quality measure 

<bullet≤ Discharge instructions.** 

<bullet≤ Adult smoking cessation advice/counseling.** 

Pneumonia (PNE) ..................................................................................... <bullet≤ Initial antibiotic received within 4 hours of hospital arrival.* 

<bullet≤ Oxygenation assessment.* 

<bullet≤ Pneumococcal vaccination status.* 

<bullet≤ Blood culture performed before first antibiotic received in hospital.** 

<bullet≤ Adult smoking cessation advice/counseling.** 

<bullet≤ Appropriate initial antibiotic selection.** 

<bullet≤ Influenza vaccination status.** 

Surgical Care Improvement Project (SCIP)—named SIP for discharges 

prior to July 2006 (3Q06).

<bullet≤ Prophylactic antibiotic received within 1 hour prior to surgical 

incision.** 

<bullet≤ Prophylactic antibiotics discontinued within 24 hours after surgery end time.** 

<bullet≤ SCIP–VTE 1: Venous thromboembolism (VTE) prophylaxis ordered for surgery patients.*** 

<bullet≤ SCIP–VTE 2: VTE prophylaxis within 24 hours pre/post surgery.*** 

<bullet≤ SCIP Infection 2: Prophylactic antibiotic selection for surgical 

patients.*** 

Mortality Measures (Medicare patients) ................................................... <bullet≤ Acute Myocardial Infarction 30-day mortality Medicare patients.*** 

<bullet≤ Heart Failure 30-day mortality Medicare patients.*** 

Patients’ Experience of Care .................................................................... <bullet≤ HCAHPS patient survey.*** 

*Measure included in 10 measure starter set. 

**Measure included in 21 measure expanded set. 

*** Measure added in CY 2007 OPPS final rule. 

We did not adopt any other new 

RHQDAPU measures for FY 2008. 

3. New Quality Measures and Program 

Requirements for FY 2009 and 

Subsequent Years 

a. Proposed New Quality Measures for 

FY 2009 and Subsequent Years 

We are proposing to add 1 outcome 

measure and 4 process measures to the 

existing 27 measure set to establish a 

new set of 32 quality measures to be 

used for the FY 2009 annual payment 

determination. We plan to adopt these 

measures a year in advance in order to 

provide additional time for hospitals to 

prepare for changes related to the 

RHQDAPU program. We are proposing 

to add the following quality measures 

for the FY 2009 RHQDAPU program. 

<bullet≤ Pneumonia 30-day Mortality 

(Medicare patients) 

<bullet≤ SCIP Infection 4: Cardiac 

Surgery Patients with Controlled 6AM 

Postoperative Serum Glucose 

<bullet≤ SCIP Infection 6: Surgery 

Patients with Appropriate Hair Removal 

<bullet≤ SCIP Infection 7: Colorectal 

Patients with Immediate Postoperative 

Normothermia 

<bullet≤ SCIP Cardiovascular 2: 

Surgery Patients on a Beta-Blocker Prior 

to Arrival Who Received a Beta-Blocker 

During the Perioperative Period 

The above measures reflect our 

continuing commitment to quality 

improvement in both clinical care and 

patient safety. These additional 

measures also demonstrate our 

commitment to include in the 

RHQDAPU program only those quality 

measures that reflect consensus among 

the affected parties and that have been 

reviewed by a consensus building 

process. The proposed measures have 

been put forth by the HQA for inclusion 

in its public reporting set, contingent on 

endorsement by the NQF. (In the case of 

SCIP Infection 7, the HQA recently 

withdrew its previous support unless 

the measure receives NQF 

endorsement.) We anticipate that the 

NQF will endorse these measures prior 

to the publication of the FY 2008 IPPS 

final rule. Any measure that has not 

been endorsed by that time will not be 

finalized in that rule. 

CMS requests public comment on 

these five measures, as well as whether 

to add other measures to the RHQDAPU 

program measure set for FY 2009 and 

subsequent years. CMS may, based on 

comments received, include one or 

more of the measures discussed below 

in the RHQDAPU program measure set 

for FY 2009 payments. We will finalize 

the FY 2009 RHQDAPU measure set in 

the FY 2008 IPPS final rule. 

The following table contains a list of 

18 measures and 8 measure sets from 

which additional quality measures 

could be selected for inclusion in the 

RHQDAPU program. It includes 

measures and measure sets that 

highlight CMS’ interest in improving 

patient safety and outcomes of care, 

with a particular focus on the quality of 

surgical care and patient outcomes. In 

order to engender a broad review of 

potential performance measures, the list 

includes measures that have not yet 

been considered for approval by the 

HQA or endorsement by the NQF 

consensus review process for public 

reporting. It also includes measures 

developed by organizations other than 

CMS as well as measures that are to be 

derived from administrative data (such 

as claims) that may need to be modified 

for specific use by the Medicare 

program if implemented under the 

RHQDAPU program. 

We hope to receive comment from a 

broad set of stakeholders on the 

measures and measure sets that are 

listed, as well as any critical gaps or 

‘‘missing’’ measures or measure sets. We 

specifically requests input concerning 

the following: 

<bullet≤ Which of the measures or 

measure sets should be included in the 

FY 2009 RHQDAPU program or in 

subsequent years? 

<bullet≤ What challenges for data 

collection and reporting are posed by 

the identified measures and measure 

sets? What improvements could be 

made to data collection or reporting that 

might offset or otherwise address those 

challenges? 

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POSSIBLE MEASURES AND MEASURE SETS FOR THE RHQDAPU PROGRAM FOR FY 2009 AND SUBSEQUENT YEARS

Measure Clinical condition 

Intensive Care Unit (ICU) Critical Care Measures 

1 ....... Stress Ulcer Disease Prophylaxis ..................................................................................................................... ICU/critical care. 

2 ....... Urinary Catheter-Associated Urinary Tract Infection For Intensive Care Unit (ICU) Patients .......................... ICU/critical care. 

Readmission Measures 

3 ....... Readmission Heart Failure (HF) Within 30 Days Rate—Medicare Only (CMS Methodology) ......................... Efficiency/HF. 

4 ....... Readmission (same hospital) Acute Myocardial Infarction (AMI) Within 30 Days Rate ................................... Efficiency/AMI. 

5 ....... Readmission (same hospital) PNE Within 30 Days Rate ................................................................................. Efficiency/PNE. 

6 ....... Readmission Within 30 Days Of Surgery—Medicare Only (SCIP Global–2) ................................................... Surgical Care. 

NQF—Nursing Sensitive Condition Set (Outcomes Measures Only) 

7 ....... Failure To Rescue—Nursing Sensitive Measure .............................................................................................. Patient centered. 

8 ....... Pressure Ulcer Prevalence—Nursing Sensitive Measure ................................................................................. Patient centered. 

9 ....... Patient Falls Prevalence—Nursing Sensitive Measure ..................................................................................... Patient centered. 

10 ..... Patient Falls With Injury—Nursing Sensitive Measure ...................................................................................... Patient centered. 

Cancer (Inpatient) Measures 

11 ..... Patients With Early Stage Breast Cancer Who Have Evaluation Of The Axilla ............................................... Cancer—Breast. 

12 ..... College Of American Pathologists Breast Cancer Protocol .............................................................................. Cancer—Breast. 

13 ..... Surgical Resection Includes At Least 12 Nodes (ACOS–02) ........................................................................... Cancer—Colon. 

14 ..... College Of American Pathologists Colon And Rectum Protocol ....................................................................... Cancer—Colon. 

15 ..... Completeness Of Pathologic Reporting (CCO–04) ........................................................................................... Cancer—Colon. 

Leapfrog Leaps, identified by IOM and Deficit Reduction Act 

16 ..... Use Of Computerized Physician Order Entry (CPOE) Systems ....................................................................... Patient safety. 

17 ..... Use of Intensivists in ICUs/ICU Physician Staffing (IPS) .................................................................................. Patient safety. 

18 ..... Evidence-Based Hospital Referrals ................................................................................................................... Patient Safety. 

Measure Sets of Potential Interest (Individual measures not specified in this proposed rule) 

Sets Under Active Review by National Quality Forum (NQF) 

1 ....... Healthcare-Associated Infection measures—under consideration by the NQF National Voluntary Consensus Standards for Reporting of Healthcare-associated Infections Data Project.Patient Safety. 

2 ....... Readmission Rates by Condition—under consideration by NQF National Voluntary Consensus Standards 

for Hospital Care: Additional Priorities, 2007 Project.

Efficiency. 

3 ....... Average Length of Stay (ALOS) by Condition—under consideration by NQF National Voluntary Consensus 

Standards for Hospital Care: Additional Priorities, 2007 Project.

Efficiency. 

4 ....... AHRQ Quality Indicators, including Patient Safety Indicators—under consideration by NQF National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2007 Project.Patient Safety, various 

conditions. 

Measure Sets/Practices Previously Endorsed by NQF 

5 ....... Safe Practices for Better Healthcare ................................................................................................................. Patient Safety. 

6 ....... Serious Reportable Events in Healthcare (‘‘Never Events’’) ............................................................................. Patient Safety. 

Other Hospital Measure Sets 

7 ....... Hospital Emergency Department Measures ...................................................................................................... Various. 

8 ....... Vascular Surgery Complications (for Carotid Endarterectomy, Lower Extremity Bypass, Open Surgery Abdominal Aortic Aneurysm Repair, Endovascular Abdominal Aortic Aneurysm Repair).Surgical Care. 

b. Data Submission 

In order to be eligible for the full FY 

2009 market basket update, we are 

proposing that hospitals will be 

required to submit data on 32 measures 

(the 27 existing measures plus the 5 

proposed new measures). The technical 

specifications for this requirement are 

published in the CMS/Joint Commission 

Specifications Manual for National 

Hospital Quality Measures. This manual 

can be found on the QualityNet.org Web 

site. 

For the additional SCIP measures that 

we are proposing to add through this 

rule, (SCIP Infection 4, 6, and 7 and 

SCIP–Card–2), hospitals will be 

required to submit data to the QIO 

Clinical Warehouse starting with 

discharges that occur in CY 2008. We 

are proposing that the deadline for 

hospitals to submit this data for first 

calendar quarter of 2008 would be 

August 15, 2008. Data must be 

submitted for each subsequent quarter 

by 4.5 months after the end of the 

quarter. 

We are proposing this time period to 

allow hospitals sufficient time to 

prepare for the data collection. The 

three SCIP Infection measures that we 

are proposing to include for FY 2009 

were added to the Manual in version 

2.0, effective with third calendar quarter 

of 2006 (3Q06) and the proposed SCIP 

Cardiovascular measure was added in 

version 2.1d of the Manual, effective 

with fourth calendar quarter of 2006 

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(4Q06). Hospitals may report data on 

these measures for discharges prior to 

CY 2008 discharges, if they so choose. 

For the proposed Pneumonia 30-day 

Mortality measure, we are proposing to 

use claims data that are already being 

collected for index hospitalizations to 

calculate the mortality rates. As is the 

case with the other 30-day mortality 

(outcome) measures already associated 

with the RHQDAPU program (AMI, HF), 

hospitals need not submit additional 

data. Claims data submitted to CMS for 

index hospitalizations occurring from 

July 2006 through June 2007 (3Q06 

through 2Q07) will be used to calculate 

the Pneumonia 30-day mortality rate 

that will be used for FY 2009 annual 

payment determination. 

All measures that we have previously 

finalized, and that we finalize in the 

future through the rulemaking process, 

will be required for the RHQDAPU 

program annual payment determination 

each year until further notice. CMS, 

working in conjunction with The Joint 

Commission, maintains the 

specifications for the set of measures 

used both for the RHQDAPU program 

and for reporting under the HQA 

initiative. The specifications are 

updated semiannually and changes are 

made prospectively, except in 

exceptional circumstances. Revised 

specifications can be found at http:// 

www.qualitynet.org. 

4. Retiring or Replacing RHQDAPU 

Program Quality Measures 

Over time, CMS expects that the set 

of measures used for the RHQDAPU 

program will evolve and change. New 

measures will be added to reflect 

clinical and other program goals. 

Measures that are no longer supported 

by clinical evidence would be modified 

or dropped. Through its public 

reporting and RHQDAPU program 

activities, CMS seeks to balance the 

competing goals of assuring the 

development of a comprehensive yet 

parsimonious set of quality measures 

while reducing reporting burden on 

hospitals. Section 1886(b)(3)(B)(viii)(VI) 

of the Act gives the Secretary authority 

to replace any measures or indicators in 

appropriate cases, such as where all 

hospitals are effectively in compliance 

or the measures or indicators have been 

subsequently shown not to represent the 

best clinical practice. CMS recognizes 

the need to develop a process related to 

the retirement and/or replacement of 

measures that comprise the RHQDAPU 

program measure set. In this proposed 

rule, we solicit public comment and 

suggestions concerning the criteria and 

mechanism for a process that would 

identify and, where appropriate, retire 

or replace measures that comprise the 

RHQDAPU program measure set. 

5. Procedures for the RHQDAPU 

Program for FY 2008 and FY 2009 

a. Procedures for Participating in the 

RHQDAPU Program 

The ‘‘Reporting Hospital Quality Data 

for Annual Payment Update Reference 

Checklist’’ section of the QualityNet 

Exchange Web site contains all of the 

forms to be completed by hospitals 

participating in the program. In order to 

participate in the hospital reporting 

initiative for FY 2008, hospitals must 

follow these steps: 

<bullet≤ Identify a QualityNet 

Exchange Administrator who follows 

the registration process and submits the 

information through the QIO Clinical 

Warehouse. This must be done 

regardless of whether the hospital uses 

a vendor for transmission of data. 

<bullet≤ Complete the revised 

‘‘Reporting Hospital Quality Data for 

Annual Payment Update Notice of 

Participation’’ form. These hospitals 

must send this form to their QIO, no 

later than August 15, 2007. In effort to 

alleviate the burden associated with 

submitting this form annually, we are 

proposing that a hospital that submits 

this form will be considered an active 

RHQDAPU program participant until 

such time as the hospital submits a 

withdrawal form to CMS. 

In addition, before participating 

hospitals initially begin reporting data, 

they must register with the QualityNet 

Exchange, regardless of the method used 

for submitting data. 

<bullet≤ Collect and report data for 24 

of the 27 required measures (listed in 

Table—under the following headings: 

Acute Myocardial Infarction, Heart 

Failure, Pneumonia and SCIP). A 

hospital must report this data for 

discharges occurring in or after first 

quarter CY 2007. Hospitals must submit 

the data to the QIO Clinical Warehouse 

either using the CMS Abstraction & 

Reporting Tool (CART), the JCAHO 

ORYX[reg] Core Measures Performance 

Measurement System, or using another 

third-party vendor tool that has met the 

measurement specification requirements 

for data transmission to QualityNet 

Exchange. All submissions will be 

executed through QualityNet Exchange. 

Because the information in the QIO 

Clinical Warehouse is considered QIO 

information, it is subject to the stringent 

QIO confidentiality regulations in 42 

CFR part 480. The QIO Clinical 

Warehouse will submit the data to CMS 

on behalf of the hospitals. 

<bullet≤ For each quality measure 

that requires hospitals to collect and 

report data, submit complete data 

regarding the quality measures in 

accordance with the joint CMS/Joint 

Commission sampling requirements 

located on the QualityNet Exchange 

Web site. These requirements specify 

that hospitals must submit a random 

sample or complete population of cases 

for each of topics covered by the quality 

measures. Hospitals must meet these 

sampling requirements for these quality 

measures for discharges in each quarter. 

<bullet≤ Submit aggregate population 

and sample size counts for Medicare 

and non-Medicare discharges for the 

four topic areas (AMI, HF, PNE, and 

SCIP) on a quarterly basis to CMS. 

<bullet≤ Continuously collect 

HCAHPS data beginning with July 2007 

discharges in accordance with the 

HCAHPS Quality Assurance Guidelines, 

Version 2.0, located at http:// 

www.hcahpsonline.org. The CY 2007 

OPPS rule required HCAHPS-eligible 

hospitals to participate in the March 

2007 dry run of the HCAHPS survey, if 

they have not already participated in a 

previous dry run. Hospitals must submit 

HCAHPS dry run data to the QIO 

Clinical Warehouse by July 13, 2007. As 

part of the March 2007 dry run, 

hospitals were required to survey 

HCAHPS-eligible discharges between 48 

hours and 6 weeks following hospital 

discharge. 

<bullet≤ For the AMI 30-day and HF 

30-day mortality measures, CMS will 

use Part A and Part B claims for 

Medicare fee-for-service patients to 

calculate the mortality measures. For FY 

2008, hospital inpatient claims (Part A) 

from July 1, 2005 to June 30, 2006 will 

be used to identify the relevant patients 

and the index hospitalizations. Inpatient 

claims for the index hospitalization and 

Part A and Part B claims for all 

inpatient, outpatient and physician 

services received one year prior to the 

index hospitalizations are used to 

determine patient comorbidity, which is 

used in the risk adjustment calculation 

(see http://www.qualitynet.org/ dcs/ 

ContentServer?cid=1163010398556 

&pagename=QnetPublic%2FPage 

%2FQnetTier2&c=Page). No other 

hospital data submission is required to 

calculate the mortality rates. 

b. Procedures for Participating in the 

RHQDAPU Program for FY 2009 

For FY 2009, the requirements for FY 

2008 discussed above will apply, except 

that hospitals will be required to collect 

and report data on any additional 

measures that we finalize through the 

rulemaking process and for which we 

specify that data submission is required. 

Mortality measures will be expanded to 

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include pneumonia pending final NQF 

endorsement. 

c. Chart Validation Requirements 

(1) FY 2008 Validation Requirements 

For the FY 2008 update, and until 

further notice, we will continue to 

require that hospitals meet the chart 

validation requirements that we 

implemented in the FY 2006 IPPS final 

rule. There were no chart-audit 

validation criteria in place for FY 2005. 

Based upon our experience with the FY 

2005 submissions and our requirement 

for reliable and validated data, in the FY 

2006 IPPS final rule we discussed 

additional requirements that we had 

established for the data that hospitals 

were required to submit in order to 

receive the full FY 2006 payment 

update (70 FR 47421 and 47422). These 

requirements, as well as additional 

information on validation requirements, 

will continue and are being placed on 

the QualityNet Exchange Web site. For the FY 2008 payment update, and 

until further notice, hospitals must pass 

our validation requirement of a 

minimum of 80 percent reliability, 

based upon our chart-audit validation 

process, for the first three quarters of 

data from CY 2006. These data are due 

to the QIO Clinical Warehouse by 

August 15, 2006 (first quarter CY 2006 

discharges), November 15, 2006 (second 

quarter CY 2006 discharges), and 

February 15, 2007 (third quarter CY 

2006 discharges). We use confidence intervals to 

determine if a hospital has achieved an 

80-percent reliability aggregated over 

the three quarters. The use of 

confidence intervals allows us to 

establish an appropriate range below the 

80-percent reliability threshold that 

demonstrates a sufficient level of 

reliability to allow the data to still be 

considered validated. We estimate the 

percent reliability based upon a review 

of five charts, and then calculate the 

upper 95-percent confidence limit for 

that estimate. If this upper limit is above 

the required 80-percent reliability, the 

hospital data are considered validated. We are using the design-specific 

estimate of the variance for the 

confidence interval calculation, which, 

in this case, is a stratified single stage 

cluster sample, with unequal cluster 

sizes. (For reference, see Cochran, 

William G.: Sampling Techniques, John 

Wiley & Sons, New York, chapter 3, 

section 3.12 (1977); and Kish, Leslie.: 

Survey Sampling, John Wiley & Sons, 

New York, chapter 3, section 3.3 

(1964).) Each quarter is treated as a 

stratum for variance estimation 

purposes. We will use a two-step process to 

determine if a hospital is submitting 

valid data. In the first step, we calculate 

the percent agreement for all of the 

variables submitted in all of the charts. 

If a hospital falls below the 80-percent 

cutoff, we proceed to the second step 

and restrict the comparison to those 

variables associated with payment. For 

first and second quarter CY 2006 

discharges (1Q06, 2Q06), that means we 

limit the calculations to the 10-measure 

starter set. For third quarter CY 2006 

discharges (3Q06), we include 21 

measures. We recalculate the percent 

agreement and the estimated 95-percent 

confidence interval and again compare 

to the 80-percent cutoff point. If a 

hospital passes under this restricted set 

of variables, the hospital is considered 

to be submitting valid data for purposes 

of the RHQDAPU program. Due to time constraints, we will not 

apply the validation requirement for the 

FY 2008 update to 3 SCIP measures that 

are included in the RHQDAPU measure 

set, Infection 2, VTE 1 and VTE 2. 

For HCAHPS, hospitals and survey 

vendors must participate in a quality 

oversight process conducted by the 

HCAHPS project team. Prior to July 

2007, the purpose of the oversight 

activities will be to provide feedback to 

hospitals and survey vendors on data 

collection procedures. Starting in July 

2007, we may ask hospitals/survey 

vendors to correct any problems that are 

found and provide follow-up 

documentation of corrections for review 

within a defined time period. If the 

HCAHPS project team finds that the 

hospital has not made these corrections, 

CMS may determine that the hospital is 

not submitting appropriate HCAHPS 

data for the RHQDAPU program. As part 

of these activities, HCAHPS project staff 

will review and discuss with survey 

vendors and hospitals selfadministering the survey their specific 

Quality Assurance Plans, survey 

management procedures, sampling and 

data collection protocols, and data 

preparation and submission. This 

review may take place in-person or 

through other means of communication. 

(2) FY 2009 Chart Validation 

Requirements 

For the FY 2009 update, all 2008 

requirements apply, except for the 

following modifications. We will 

modify the validation requirement to 

pool the quarterly validation estimates 

for 4th quarter CY 2006 through 3rd 

quarter 2007 discharges. We will also 

expand the list of validated measures in 

the FY 2009 update to add SCIP 

Infection-2, SCIP VTE–1, and SCIP 

VTE–2 starting with 4th quarter CY 

2006 discharges. We will also drop the 

current two-step process to determine if 

the hospital is submitting valid data. We 

propose for the FY 2009 update to pool 

validation estimates covering the 4 

quarters (4th quarter CY 2006 discharges 

through 3rd quarter 2007 discharges) in 

a similar manner to the current 3 quarter 

pooled confidence interval. 

(3) Validation and Submission 

Requirements 

We plan to apply the validation and 

submission requirements for FY 2008 

and FY 2009 payment determination for 

the quality measures. For the validation 

and submission requirements for the FY 

2008 payment year, we plan to use the 

following: 

<bullet≤ The 10 measure starter set for 

both submission and validation for 1st 

through 3rd quarters CY 2006 

discharges. 

<bullet≤ The additional 11 measures 

that make up the expanded measure set 

for both submission and validation for 

3rd quarter CY 2006 discharges. 

<bullet≤ SCIP VTE 1, 2, and SCIP 

Infection 2 submission only for 1Q 2007 

discharges only. 

<bullet≤ HCAHPS measures, both 

submission of dry run data and 

continuous submission beginning with 

July 2007 discharges. 

<bullet≤ AMI and HF 30-day 

mortality measures as described 

previously. For FY 2009 payment year, 

we plan to use the following: 

<bullet≤ The 21 expanded measure 

set for submission and validation 

starting with fourth quarter CY 2006 

(4Q06) through third quarter CY 2007 

discharges. 

<bullet≤ SCIP VTE 1, 2, and SCIP 

Infection 2 submission and validation 

second quarter CY 2007 and 3rd Quarter 

CY 2007 discharges. 

<bullet≤ HCAHPS measures, 

continuous submission. 

<bullet≤ AMI, HF, and PN 30-day 

mortality measures as described 

previously. 

As additional measures are finalized 

for inclusion in the FY 2009 payment 

decision, we anticipate making changes 

to the above plan to incorporate those 

measures. 

c. Data Validation and Attestation 

For the FY 2008 update and in 

subsequent years, we will revise and 

post up-to-date confidence interval 

information on the QualityNet Exchange 

Web site explaining the application of 

the confidence interval to the overall 

validation results. The data are being 

validated at several levels. There are 

consistency and internal edit checks to 

ensure the integrity of the submitted 

data; there are external edit checks to 

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verify expectations about the volume of 

the data received. 

We will require for FY 2008 and 

subsequent years that hospitals attest 

each quarter to the completeness and 

accuracy of their data, including the 

volume of data, submitted to the QIO 

Clinical Warehouse in order to improve 

aspects of the validation checks. We 

will provide additional information to 

explain this attestation requirement, as 

well as provide the relevant form to be 

completed on the QualityNet Exchange 

Web site. 

d. Public Display 

We will continue to display quality 

information for public viewing as 

required by section 

1886(b)(3)(B)(viii)(VII) of the Act. Before 

we display this information, hospitals 

will be permitted to review their 

information as recorded in the QIO 

Clinical Warehouse. 

Currently, hospitals that share the 

same Medicare Provider Number (MPN) 

must combine data collection and 

submission across their multiple 

campuses (for both clinical measures 

and for HCAHPS). These measures are 

then publicly reported as if they apply 

to a single hospital. We estimate that 

approximately 5 to 10 percent of the 

hospitals reported on the Hospital 

Compare Web site share MPNs. For FY 

2008 and subsequent years, we are 

proposing to require hospitals to begin 

to report the name and address of each 

hospital that shares the same MPN. This 

information will be gathered through 

the RHQDAPU program Notice of 

Participation form, which hospitals will 

submit to their QIOs by August 15, 

2007. To increase transparency in 

public reporting and improve the 

usefulness of Hospital Compare, CMS 

plans to note on the Web site where 

publicly reported measures combine 

results from two or more hospitals. 

e. Reconsideration and Appeal 

Procedures 

If we deny a hospital the full market 

basket update, the hospital may submit 

a letter requesting that we reconsider 

our decision that the hospital did not 

meet the RHQDAPU program 

requirements. For FY 2008, a hospital 

must submit such a request for 

reconsideration on or before November 

1, 2007. We also are establishing 

additional procedural rules that will 

govern RHQDAPU program 

reconsiderations. We will post these 

rules on the QualityNet Exchange Web 

site. 

If a hospital is dissatisfied with the 

result of a RHQDAPU program 

reconsideration, the hospital may file a 

claim under 42 CFR Part 405, Subpart 

R (a Provider Reimbursement Review 

Board (PRRB) appeal). 

In this proposed rule we are again 

soliciting public comment and 

suggestions related to reconsideration. 

f. RHQDAPU Program Withdrawal 

Requirements 

For the FY 2008 update, hospitals 

may withdraw from the RHQDAPU 

program at any time up to August 15, 

2007. If a hospital withdraws from the 

program, it will receive a 2.0 percentage 

point reduction in its payment update. 

6. Electronic Medical Records 

In the FY 2006 IPPS final rule, we 

encouraged hospitals to take steps 

toward the adoption of electronic 

medical records (EMRs) that will allow 

for reporting of clinical quality data 

from the EMRs directly to a CMS data 

repository (70 FR 47420). We intend to 

begin working toward creating measures 

specifications and a system or 

mechanism, or both, that will accept the 

data directly without requiring the 

transfer of the raw data into an XML file 

as is currently done. The Department 

continues to work cooperatively with 

other Federal agencies in the 

development of Federal health 

architecture data standards. We 

encouraged hospitals that are 

developing systems to conform them to 

both industry standards and, when 

developed, the Federal Health 

Architecture Data standards, and to 

ensure that the data necessary for 

quality measures are captured. Ideally, 

such systems will also provide point-ofcare decision support that enables high 

levels of performance on the measures. 

Hospitals using EMRs to produce data 

on quality measures will be held to the 

same performance expectations as 

hospitals not using EMRs. 

Due to the low volume of comments 

we received on this issue in response to 

the FY 2006 proposed IPPS rule, in the 

proposed IPPS rule for FY 2007 (71 FR 

24095), we again invited comments on 

these requirements and options. In the 

FY 2007 IPPS final rule, we summarized 

and addressed the additional comments 

we received. We would welcome 

additional comments on this issue. 

7. New Hospitals 

In addition, we are proposing a minor 

change to our policies regarding new 

hospitals. In the FY 2006 IPPS final 

rule, we noted that a new hospital 

should begin collecting and reporting 

data immediately and complete the 

registration requirements for the 

RHQDAPU. (70 FR 47421 and 47428). 

We also explained that a new hospital 

would be held to the same standard as 

established facilities when determining 

the expected number of discharges for 

the calendar quarters covered for each 

fiscal year. We also stated that fiscal 

intermediaries would provide 

information on new hospitals to the QIO 

in the state in which the hospital has 

opened for operations as a Medicare 

provider as soon as possible so that the 

QIO can enter the provider information 

into its Program Resource System (PRS) 

and follow through with ensuring 

provider participation with the 

requirements for quality data reporting 

under this rule. 

We believe that some new hospitals 

have found it difficult to start reporting 

RHQDAPU measures immediately after 

signing up to participate in the 

RHADAPU program. Therefore, we are 

proposing a modification to our policy 

to reduce burden on new hospitals. We 

are proposing that the fiscal 

intermediary would continue to provide 

information on the new hospital to the 

QIO in the state in which the hospital 

is located as soon as possible so that the 

QIO could enter the provider 

information into its PRS and follow 

through with ensuring provider 

participation with the requirements for 

quality data reporting. However, for a 

new hospital that receives a provider 

number on or after October 1st of each 

year (beginning with October 1, 2007), 

we are proposing that the hospital 

would be required to report RHQDAPU 

data beginning with the first day of the 

quarter following the date the hospital 

registers to participate in the RHQDAPU 

program. For example, a hospital that 

receives its MPN on October 2, 2007 and 

signs up to participate in RHQDAPU on 

November 1, 2007 will be expected to 

meet all data submission requirements 

for discharges on or after January 1, 

2008. 

B. Development of the Medicare 

Hospital Value-Based Purchasing Plan 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Value-Based Purchasing Plan’’ 

at the beginning of your comment.) 

Section 5001(b) of the DRA specifies 

that CMS develop a plan to implement 

a Value-Based Purchasing (VBP) 

Program for payments under the 

Medicare program for subsection (d) 

hospitals beginning with FY 2009. 

Congress specified that the ‘‘plan’’ 

include consideration of the following 

issues: 

<bullet≤ The ongoing development, 

selection, and modification process for 

measures of quality and efficiency in 

hospital inpatient settings. 

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<bullet≤ The reporting, collection, 

and validation of quality data. <bullet≤ The structure of value-based 

payment adjustments, including the 

determination of thresholds or 

improvements in quality that would 

substantiate a payment adjustment, the 

size of such payments, and the sources 

of funding for the value-based 

payments. <bullet≤ The disclosure of 

information on hospital performance. In developing the plan, we must 

consult with relevant affected parties 

and consider experience with 

demonstrations that are relevant to the 

value-based purchasing program. We have created an internal Hospital 

Pay-for-Performance Workgroup that is 

charged with developing the VBP Plan 

for Medicare hospital services. The 

workgroup is organized into four 

subgroups to address each of the 

required planning issues: (1) measures; 

(2) data collection and validation; (3) 

incentive structure; and (4) public 

reporting. The workgroup has been 

charged with preparing a set of design 

options, narrowing the set of design 

options to prepare a draft plan, and 

preparing the final plan for 

implementing VBP for Medicare 

hospital services that will be provided 

to Congress. CMS is hosting two public ‘‘Listening 

Sessions’’ in early 2007 to solicit 

comments from relevant affected parties 

on outstanding design questions 

associated with development of the final 

plan. The first listening session was 

held on January 17, 2007, to consider 

design questions posed in an issues 

paper that has been posted since 

December 22, 2006, on the Medicare 

Web site, Hospital Center, under 

Spotlights at: http://www.cms.hhs.gov/ 

center/ hospital.asp. An audio 

download of the listening session and 

the PowerPoint slides used during the 

session are also posted on this Web site. The second listening session will be 

held on April 12, 2007, to consider the 

draft plan, which will be posted on the 

Medicare Web site, Hospital Center, on 

March 22, 2007. A notice announcing 

this listening session was published in 

the Federal Register on February 23, 

2007 (71 FR 8179). It is hoped that 

hospitals, hospital associations, and 

other interested parties will attend and 

make comments on the draft plan in 

person. It will also be possible to 

participate by teleconference, and 

limited time will be allocated for verbal 

comments by telephone participants. 

Registration to participate in person or 

by telephone is open until April 5, 2007. 

The agenda and PowerPoint slides for 

the session will be posted by April 9, 

2007. An audio download of the second 

listening session will be posted by April 

17, 2007. Written comments are 

welcomed and will be accepted until 5 

PM EDT on April 19, 2007. The 

perspectives expressed during this 

session and in writing will assist CMS 

in making revisions to the draft plan to 

create the final Medicare Hospital 

Value-Based Purchasing Plan expected 

to be completed by June 2007. While section 5001(b) of the DRA 

authorized development of this plan, 

additional legislation will be required to 

establish and implement the Medicare 

Hospital Value-Based Purchasing 

Program. As described in the draft plan, 

we proposed that the current RHQDAPU 

Program will provide the foundation for 

and be incorporated into the new 

Medicare Hospital Value-Based 

Purchasing Program. 

C. Rural Referral Centers (RRCs) (§

412.96) 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘RRCs’’ at the beginning of your 

comment.) 

Under the authority of section 

1886(d)(5)(C)(i) of the Act, the 

regulations at § 412.96 set forth the 

criteria that a hospital must meet in 

order to qualify under the IPPS as an 

RRC. For discharges occurring before 

October 1, 1994, RRCs received the 

benefit of payment based on the other 

urban standardized amount rather than 

the rural standardized amount. 

Although the other urban and rural 

standardized amounts are the same for 

discharges occurring on or after October 

1, 1994, RRCs continue to receive 

special treatment under both the DSH 

payment adjustment and the criteria for 

geographic reclassification. Section 402 of Pub. L. 108–173 raised 

the DSH adjustment for other rural 

hospitals with less than 500 beds and 

RRCs. Other rural hospitals with less 

than 500 beds are subject to a 12-percent 

cap on DSH payments. RRCs are not 

subject to the 12-percent cap on DSH 

payments that is applicable to other 

rural hospitals (with the exception of 

rural hospitals with 500 or more beds). 

RRCs are not subject to the proximity 

criteria when applying for geographic 

reclassification, and they do not have to 

meet the requirement that a hospital’s 

average hourly wage must exceed 106 

percent of the average hourly wage of 

the labor market area where the hospital 

is located. 

Section 4202(b) of Pub. L. 105–33 

states, in part, ‘‘[a]ny hospital classified 

as an RRC by the Secretary * * * for 

fiscal year 1991 shall be classified as 

such an RRC for fiscal year 1998 and 

each subsequent year.’’ In the August 

29, 1997 final rule with comment period 

(62 FR 45999), we also reinstated RRC 

status for all hospitals that lost the 

status due to triennial review or MGCRB 

reclassification, but not to hospitals that 

lost RRC status because they were now 

urban for all purposes because of the 

OMB designation of their geographic 

area as urban. However, subsequently, 

in the August 1, 2000 final rule (65 FR 

47089), we indicated that we were 

revisiting that decision. Specifically, we 

stated that we would permit hospitals 

that previously qualified as an RRC and 

lost their status due to OMB 

redesignation of the county in which 

they are located from rural to urban to 

be reinstated as an RRC. Otherwise, a 

hospital seeking RRC status must satisfy 

the applicable criteria. We used the 

definitions of ‘‘urban’’ and ‘‘rural’’ 

specified in Subpart D of 42 CFR Part 

412. 

1. Proposed Annual Update of RRC 

Status Criteria 

One of the criteria under which a 

hospital may qualify as a RRC is to have 

275 or more beds available for use (§

412.96(b)(1)(ii)). A rural hospital that 

does not meet the bed size requirement 

can qualify as an RRC if the hospital 

meets two mandatory prerequisites (a 

minimum CMI and a minimum number 

of discharges) and at least one of three 

optional criteria (relating to specialty 

composition of medical staff, source of 

inpatients, or referral volume) (§

412.96(c)(1) through (c)(5)). (See also the 

September 30, 1988 Federal Register (53 

FR 38513).) With respect to the two 

mandatory prerequisites, a hospital may 

be classified as an RRC if— 

<bullet≤ The hospital’s CMI is at least 

equal to the lower of the median CMI for 

urban hospitals in its census region, 

excluding hospitals with approved 

teaching programs, or the median CMI 

for all urban hospitals nationally; and 

<bullet≤ The hospital’s number of 

discharges is at least 5,000 per year, or, 

if fewer, the median number of 

discharges for urban hospitals in the 

census region in which the hospital is 

located. (The number of discharges 

criterion for an osteopathic hospital is at 

least 3,000 discharges per year, as 

specified in section 1886(d)(5)(C)(i) of 

the Act.) 

a. Case-Mix Index 

Section 412.96(c)(1) provides that 

CMS will establish updated national 

and regional CMI values in each year’s 

annual notice of prospective payment 

rates for purposes of determining RRC 

status. The methodology we use to 

determine the national and regional CMI 

values is set forth in regulations at §

412.96(c)(1)(ii). The proposed national 

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median CMI value for FY 2008 includes 

all urban hospitals nationwide, and the 

regional values for FY 2008 are the 

median CMI values of urban hospitals 

within each census region, excluding 

those hospitals with approved teaching 

programs (that is, those hospitals 

receiving indirect medical education 

payments as provided in § 412.105(f)). 

These values are based on discharges 

occurring during FY 2006 (October 1, 

2005 through September 30, 2006) and 

include bills posted to CMS’ records 

through December 2006. 

We are proposing that, in addition to 

meeting other criteria, if they are to 

qualify for initial RRC status for cost 

reporting periods beginning on or after 

October 1, 2007, rural hospitals with 

fewer than 275 beds must have a CMI 

value for FY 2006 that is at least— 

<bullet≤ 1.2258; or 

<bullet≤ The median CMI value (not 

transfer-adjusted) for urban hospitals 

(excluding hospitals with approved 

teaching programs as identified in §

412.105(f)) calculated by CMS for the 

census region in which the hospital is 

located. 

The proposed median CMI values by 

region are set forth in the following 

table: 

Region Case-mix index 

value 

1. New England (CT, ME, MA, NH, RI, VT) .................................................................................................................................... 1.2389 

2. Middle Atlantic (PA, NJ, NY) ....................................................................................................................................................... 1.2675 

3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ........................................................................................................... 1.3524 

4. East North Central (IL, IN, MI, OH, WI) ...................................................................................................................................... 1.3499 

5. East South Central (AL, KY, MS, TN) ......................................................................................................................................... 1.2909 

6. West North Central (IA, KS, MN, MO, NE, ND, SD) .................................................................................................................. 1.2780 

7. West South Central (AR, LA, OK, TX) ........................................................................................................................................ 1.4013 

8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ........................................................................................................................... 1.4260 

9. Pacific (AK, CA, HI, OR, WA) ..................................................................................................................................................... 1.3722 

The preceding numbers will be 

revised in the final rule to the extent 

required to reflect the updated FY 2006 

MEDPAR file, which will contain data 

from additional bills received through 

March 2007. 

Hospitals seeking to qualify as RRCs 

or those wishing to know how their CMI 

value compares to the criteria should 

obtain hospital-specific CMI values (not 

transfer-adjusted) from their fiscal 

intermediaries. Data are available on the 

Provider Statistical and Reimbursement 

(PS&R) System. In keeping with our 

policy on discharges, these CMI values 

are computed based on all Medicare 

patient discharges subject to the IPPS 

DRG-based payment. 

b. Discharges 

Section 412.96(c)(2)(i) provides that 

CMS will set forth the national and 

regional numbers of discharges in each 

year’s annual notice of prospective 

payment rates for purposes of 

determining RRC status. As specified in 

section 1886(d)(5)(C)(ii) of the Act, the 

national standard is set at 5,000 

discharges. We are proposing to update 

the regional standards based on 

discharges for urban hospitals’ cost 

reporting periods that began during FY 

2004 (that is, October 1, 2003 through 

September 30, 2004), which is the latest 

available cost report data we have at this 

time. 

Therefore, we are proposing that, in 

addition to meeting other criteria, a 

hospital, if it is to qualify for initial RRC 

status for cost reporting periods 

beginning on or after October 1, 2007, 

must have as the number of discharges 

for its cost reporting period that began 

during FY 2004 a figure that is at least— 

<bullet≤ 5,000 (3,000 for an 

osteopathic hospital); or 

<bullet≤ The median number of 

discharges for urban hospitals in the 

census region in which the hospital is 

located, as indicated in the following 

table: 

Region Number of discharges 

1. New England (CT, ME, MA, NH, RI, VT) .................................................................................................................................... 7,749 

2. Middle Atlantic (PA, NJ, NY) ....................................................................................................................................................... 10,603 

3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ........................................................................................................... 10,562 

4. East North Central (IL, IN, MI, OH, WI) ...................................................................................................................................... 9,209 

5. East South Central (AL, KY, MS, TN) ......................................................................................................................................... 7,596 

6. West North Central (IA, KS, MN, MO, NE, ND, SD) .................................................................................................................. 7,963 

7. West South Central (AR, LA, OK, TX) ........................................................................................................................................ 7,167 

8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ........................................................................................................................... 9,116 

9. Pacific (AK, CA, HI, OR, WA) ..................................................................................................................................................... 8,420 

These numbers will be revised in the 

FY 2008 IPPS final rule based on the 

latest available cost report data. 

We note that the median number of 

discharges for hospitals in each census 

region is greater than the national 

standard of 5,000 discharges. Therefore, 

5,000 discharges is the minimum 

criterion for all hospitals. 

We reiterate that if an osteopathic 

hospital is to qualify for RRC status for 

cost reporting periods beginning on or 

after October 1, 2007, the hospital 

would be required to have at least 3,000 

discharges for its cost reporting period 

that began during FY 2004. 

2. Acquired Rural Status and RRCs (§

412.103(g)) 

With the following exceptions, a 

hospital must be rural to qualify as an 

RRC: 

<bullet≤ Consistent with section 

4202(b) of Pub. L. 105–33, any hospital 

designated as an RRC in FY 1991 retains 

that status for FY 1998 and each 

subsequent year. 

<bullet≤ Hospitals located in a rural 

county that would have lost their RRC 

status as a result of an OMB 

redesignation of the area from rural to 

urban were permitted to remain as RRCs 

(69 FR 49056). 

<bullet≤ Hospitals located in urban 

areas that apply for reclassification as 

rural under § 412.103 (that is, the 

hospital is located in an urban area but 

it 

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‘‘acquires’’ rural status under the 

regulations) also may qualify as RRCs. 

Under § 412.103(g), a hospital may 

cancel its rural reclassification by 

submitting a written request to the CMS 

Regional Office no less than 120 days 

prior to the end of its current cost 

reporting period. A hospital may choose 

to cancel its acquired rural status if it 

determines it may be more financially 

beneficial to return to urban status and 

the associated IPPS payments rather 

than remain rural and receive the 

special treatments of certain rural 

providers such as RRCs, SCHs and 

CAHs. The hospital’s acquired rural 

status is canceled beginning with its 

next cost reporting period. We have 

received inquiries asking whether a 

hospital retains its RRC status once it 

voluntarily cancels its acquired rural 

status. 

As indicated above, a hospital 

generally must be rural to be classified 

as an RRC. However, a hospital may 

retain its RRC status only in the special 

circumstances where it would have lost 

status due to OMB redesignation of its 

area from rural to urban, or where it was 

already designated as an RRC in 1991. 

In these situations, there were either 

special statutory provisions that require 

the hospital to retain its RRC status or 

the hospital’s geographic status changed 

from rural to urban through no action of 

its own. We do not believe that an urban 

hospital that acquires rural status under 

§ 412.103 and subsequently is approved 

as an RRC should be able to retain the 

benefits of being an RRC when it 

voluntarily cancels that acquired rural 

status. For this reason, Medicare’s 

policy has been that a hospital cannot 

continue to be an RRC once it cancels 

acquired rural status under § 412.103. 

It follows from the requirement that an 

RRC must be located in a rural area that 

cancellation of acquired rural status 

negates a hospital’s RRC designation. 

In this proposed rule, we are 

clarifying our current policy that a 

hospital that cancels its acquired rural 

status, received under § 412.103, would 

also lose its RRC designation under §

412.96. In this situation, the hospital 

would lose its RRC designation under §

412.96 as of the date the cancellation of 

its acquired rural status takes effect. As 

indicated above, RRCs are not subject to 

a maximum DSH adjustment of 12 

percent that applies to other rural 

hospitals with less than 500 beds. 

Further, RRCs are not subject to the 

proximity criteria when applying for 

geographic reclassification (§

412.230(a)(3)), and they do not have to 

meet certain wage comparison tests for 

reclassification (§ 412.230(d)(1)(iii)). A 

hospital located in an urban area that 

cancels its acquired rural status under §

412.103 loses its RRC status and would 

become subject to a 12-percent cap on 

the DSH adjustment applicable to urban 

hospitals with less than 100 beds (if the 

hospital has 100 beds or more, it would 

not be subject to the cap on the DSH 

adjustment). Further, the hospital would 

also have to meet the proximity 

requirement for geographic 

reclassification at § 412.230(a)(3). 

We note that the hospital would 

maintain the benefit of being exempt 

from the average hourly wage criterion 

for geographic reclassification requiring 

the comparison of the hospital’s wages 

to the wages of the area in which it is 

located, as stated in section 

1886(d)(10)(D)(iii) of the Act. 

We are also proposing to revise the 

regulations at § 412.103(g) with respect 

to when cancellation of acquired rural 

status becomes effective. Currently, §

412.103(g)(2) states ‘‘The hospital’s 

cancellation of the classification is 

effective beginning with the hospital’s 

next full cost reporting period following 

the date of its request for cancellation.’’ 

While this policy is appropriate for 

hospitals paid under reasonable costs, 

such as CAHs, it is inconsistent with the 

IPPS that makes changes prospectively 

on the basis of a Federal fiscal year. In 

addition, to address concerns that some 

IPPS hospitals are acquiring rural status 

solely to benefit from reclassification 

rules applying to hospitals that were 

once RRCs and then canceling that rural 

status within a short period of time, 

such as a few months, we are proposing 

to require IPPS hospitals to retain 

acquired rural status for at least one 12- 

month cost reporting period. If the 

hospital chooses to cancel its rural 

reclassification, the effective date of that 

cancellation would occur both after at 

least one 12-month cost reporting period 

and at the start of the next Federal fiscal 

year. Thus, for example, if a hospital 

with a cost reporting period from July 1, 

2008, to June 30, 2009, becomes rural on 

May 30, 2008, its acquired rural status 

under § 412.103 would remain in effect 

from May 30, 2008, through at least 

September 30, 2009 (that is, the date it 

acquired rural status through the end of 

the fiscal year containing a full cost 

reporting period). We believe this policy 

is reasonable, given that acquired rural 

status for IPPS hospitals should be a 

considered decision for hospitals that 

truly wish to be considered as rural, and 

not purely as a mechanism for 

reclassifying. We are not proposing a 

duration requirement for hospitals paid 

under cost reimbursement because we 

are not aware of similar manipulations 

of rural status in these cases. Therefore, 

we are proposing to change our current 

policy by revising § 412.103(g) to 

specify that a hospital’s cancellation of 

its acquired rural status under §

412.103 is effective for hospitals under 

reasonable cost reimbursement (such as 

CAHs) with the hospital’s next cost 

reporting period and for hospitals under 

the IPPS after at least one 12-month cost 

reporting period as rural and not until 

the beginning of a Federal fiscal year 

following both the request for 

cancellation and the 12-month cost 

reporting period. Under the proposed 

revised regulations, an IPPS hospital 

(such as an RRC or SCH) that cancels its 

acquired rural status would continue to 

be paid as rural until the beginning of 

the next fiscal year after at least one 12- 

month cost reporting period as rural. In 

addition, for these IPPS hospitals, the 

deadline for seeking cancellation of the 

acquired rural status would be not less 

than 120 days before the end of the 

fiscal year. 

D. Indirect Medical Education (IME) 

Adjustment (§ 412.105) 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘IME Adjustment’’ at the 

beginning of your comment.) 

1. Background 

Section 1886(d)(5)(B) of the Act 

provides that prospective payment 

hospitals that have residents in an 

approved graduate medical education 

(GME) program receive an additional 

payment to reflect the higher indirect 

patient care costs of teaching hospitals 

relative to nonteaching hospitals. The 

regulations regarding the calculation of 

this additional payment, known as the 

indirect medical education (IME) 

adjustment, are located at § 412.105. 

The Balanced Budget Act of 1997 

(Pub. L. 105–33) established a limit on 

the number of allopathic and 

osteopathic residents that a hospital 

may include in its full-time equivalent 

(FTE) resident count for direct GME and 

IME payment purposes. Under section 

1886(h)(4)(F) of the Act, a hospital’s 

unweighted FTE count of residents may 

not exceed the hospital’s unweighted 

FTE count for its most recent cost 

reporting period ending on or before 

December 31, 1996. Under section 

1886(d)(5)(B)(v) of the Act, the limit on 

the FTE resident count for IME purposes 

is effective for discharges occurring on 

or after October 1, 1997. A similar limit 

is effective for direct GME purposes for 

cost reporting periods beginning on or 

after October 1, 1997. 

2. IME Adjustment Factor for FY 2008 

The IME adjustment to the DRG 

payment is based in part on the 

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applicable IME adjustment factor. The 

IME adjustment factor is calculated 

using a hospital’s ratio of residents to 

beds, which is represented as r, and a 

formula multiplier, which is 

represented as c, in the following 

equation: c x [●1 + rb .405–1]. The 

formula is traditionally described in 

terms of a certain percentage increase in 

payment for every 10-percent increase 

in the resident-to-bed ratio. 

Section 502(a) of Pub. L. 108–173 

modified the formula multiplier (c) to be 

used in the calculation of the IME 

adjustment. Prior to the enactment of 

Pub. L. 108–173, the formula multiplier 

was fixed at 1.35 for discharges 

occurring during FY 2003 and 

thereafter. Section 502(a) modified the 

formula multiplier beginning midway 

through FY 2004 and provided for a 

new schedule of formula multipliers for 

FY 2005 and thereafter. In the FY 2005 

IPPS rule, we announced the schedule 

of formula multipliers to be used in the 

calculation of the IME adjustment and 

incorporated the schedule in our 

regulations at § 412.105(d)(3)(viii) 

through (d)(3)(xii). In this proposed 

rule, we are specifying that, for any 

discharges occurring during FY 2008, 

the statutorily mandated formula 

multiplier is 1.35. Previously, for 

discharges occurring during FY 2007, 

the mandated formula multiplier was 

1.32. We estimate that application of the 

mandated formula multiplier for FY 

2008 will result in an increase of 5.5 

percent in IME payment for every 

approximately 10-percent increase in 

the resident-to-bed ratio. 

3. Time Spent by Residents on Vacation 

or Sick Leave and in Orientation 

a. Background 

In the FY 2007 IPPS final rule (71 FR 

48080), we clarified our policy with 

respect to the time that residents spend 

in nonpatient care activities (such as 

conferences and seminars) as part of 

approved residency programs. We 

amended our regulations concerning the 

FTE resident count at 42 CFR 

412.105(f)(1)(iii)(C) to state, ‘‘In order to 

be counted, a resident must be spending 

time in patient care activities, as defined 

in § 413.75(b) * * *’’ The regulations at 

§ 413.75(b) define patient care activities 

as ‘‘the care and treatment of particular 

patients, including services for which a 

physician or other practitioner may 

bill.’’ In light of this clarification, during 

the past year, we have received 

questions from the teaching hospital 

community as to whether the time that 

residents spend on vacation or sick 

leave, and in orientation activities that 

typically occur at the beginning of a 

residency training program, is counted 

for IME payment purposes. 

Historically, time spent by residents 

on vacation or sick leave and in initial 

orientation activities has been included 

in the FTE resident count for IME and 

direct GME. (The sick leave we are 

referring to throughout this discussion 

is sick leave that does not require the 

resident to make up for his or her 

absence by adding additional training 

time at the end of the program.) The 

practice of allowing vacation and sick 

leave to be included in the IME count 

appears to be based on a provision in 

the Provider Reimbursement Manual, 

Part I, at section 2405.3.H.2. This 

manual provision discusses the 

treatment of residents who are on 

vacation or sick leave in the context of 

our prior ‘‘one day count’’ policy for 

counting residents for IME payment. 

Generally, effective with cost reporting 

periods beginning on or after October 1, 

1984, and before July 1, 1991, residents 

were counted for IME purposes on a 

uniform reporting date of September 1. 

A hospital’s FTE residents were counted 

based on their assignment to that 

hospital’s IPPS or outpatient areas on 

September 1 of an academic year. 

Because it was possible that a resident 

might not actually be present in the 

hospital on September 1 because he or 

she was on approved vacation or sick 

leave, to ensure that the hospital’s IME 

FTE count would not be understated for 

the entire year, section 2405.3.H.2 of the 

PRM–I states that ‘‘interns and residents 

using vacation and sick leave on the day 

of the count may be included in the 

count.’’ Although the regulations were 

changed effective for cost reporting 

periods beginning on or after July 1, 

1991 (55 FR 36059) to reflect the current 

resident-counting methodology (that is, 

to count the number of FTE residents 

based on the amount of time required to 

fill a residency slot as specified at §

412.105(f)(1)(iii)(A)), the fiscal 

intermediary (or MAC) have continued 

to include time spent by residents on 

vacation and sick leave in the FTE 

resident counts for purposes of both 

IME and direct GME payments. 

Orientation time is time spent by 

residents in activities that typically take 

place at the beginning of a resident’s 

training program, and include 

orientation regarding hospital 

employment, the hospital’s policies and 

procedures in general, as well as 

policies and procedures specific to the 

residency training program. As is the 

case for vacation and sick leave, time 

spent by residents in orientation has 

continued to be included by 

intermediaries/MACs in the FTE 

resident counts for purposes of both 

IME and direct GME. 

We understand why we have received 

numerous questions regarding whether 

FTE resident time spent on vacation or 

sick leave, or in orientation activities, 

should be counted for purposes of IME 

payment. The time a resident spends on 

vacation or sick leave is not addressed 

within the current definition of ‘‘patient 

care activities’’ at § 413.75(b). In fact, 

time spent on vacation or sick leave 

would not be spent at the hospital 

location at all, so no patient care 

activities would occur during this time. 

Time spent in orientation might be 

spent in the hospital complex (or at a 

nonhospital setting), but would not 

involve the care and treatment of 

particular patients. Thus, although time 

spent by residents on vacation or sick 

leave or in orientation has historically 

been included in the IME and direct 

GME FTE counts, it seems apparent that 

this time should be carefully considered 

in light of our clarified policy and 

current regulations. We believe these 

types of activities (vacation time, sick 

leave, and orientation) are inherently 

different from the types of ‘‘patient care 

activities’’ and ‘‘nonpatient care 

activities’’ we have discussed in depth 

in previous rules, and most recently in 

the FY 2007 IPPS final rule. We believe 

the aforementioned activities should be 

distinguished from other activities, 

patient care or otherwise, in which the 

resident participates as part of the 

approved program. 

b. Vacation and Sick Leave Time 

We believe that approved vacation 

time and sick leave are not 

appropriately categorized as patient care 

activities, or as didactic, research, or 

other nonpatient care activities. In 

addition, although the Accreditation 

Council for Graduate Medical Education 

(ACGME) has some rules regarding 

resident duty hours and work 

environment, the ACGME is not explicit 

regarding resident vacation and sick 

leave policies. Rather, vacation and sick 

leave policies are determined by the 

resident’s employer and can vary by 

residency training program. 

Consequently, although vacation and 

sick leave are fringe benefits to which 

every employee, hospital or otherwise, 

is typically entitled, vacation and sick 

leave are not, in fact, part of the training 

time spent by residents in an approved 

program. Therefore, we believe vacation 

and sick leave are not properly 

considered as either patient care time or 

nonpatient care time, but are within a 

distinct third category of time. As we 

noted above, it has been our policy to 

include the time spent by residents on 

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vacation or sick leave in the FTE 

resident count for IME and direct GME. 

However, we do not believe the 

continuation of this policy is 

appropriate in light of our current 

policy as clarified in the FY 2007 IPPS 

final rule and expressed in revised 

regulations that permit only time spent 

by residents in patient care activities to 

be counted for purposes of IME. We 

initially considered proposing a policy 

to no longer count the time spent by 

residents on vacation or sick leave for 

purposes of IME on the ground that this 

time is not spent in patient care 

activities in accordance with our 

regulations. However, we do not believe 

such a policy would have recognized 

the unique character of vacation and 

sick time as time that is not spent in any 

aspect of residency training—patient 

care or nonpatient care. Because we 

believe time spent by residents on 

vacation and sick leave is not properly 

considered patient care time or 

nonpatient care time, but fit within a 

distinct third category of time that is 

neither patient care nor nonpatient care, 

we believe it would be more appropriate 

to remove the time altogether from the 

FTE calculation for each resident for 

both IME and direct GME payment 

purposes. Accordingly, we are 

proposing to remove vacation and sick 

leave from the total time considered to 

constitute an FTE resident for purposes 

of IME payment effective for cost 

reporting periods beginning on or after 

October 1, 2007. Further, in order to 

have a consistent conception of an FTE 

resident for purposes of IME and direct 

GME payment, we are proposing to 

remove vacation and sick leave from the 

total FTE resident time for purposes of 

direct GME payment as well effective 

for cost reporting periods beginning on 

or after October 1, 2007. We 

acknowledge that removing vacation 

and sick leave time from the 

denominator of the FTE count for both 

IME and direct GME could have some 

impact on the FTE count, but the impact 

is fact-specific. In some cases, it would 

result in a lower FTE count, and in 

some cases, it would result in a higher 

FTE count. In addition, we note that 

under our current policy, residents who 

are on maternity leave or other 

approved sick leave of extended 

duration that prolongs the total time a 

resident is participating in the approved 

program beyond the normal duration of 

the program are not counted while they 

are out on extended sick or maternity 

leave. This is because the FTE time 

spent by such residents is counted in 

accordance with our FTE counting 

policies during the training time they 

spend to make up for their absence. For 

example, a resident in an internal 

medicine program who takes 3 months 

of approved maternity leave and, 

therefore, must stay an additional 3 

months beyond the normal 3 years to 

complete her training, would not be 

counted while she is on maternity leave 

for IME and direct GME payment 

purposes. Rather, time spent during the 

additional 3 months of training in 

which she must participate to make up 

for her 3 month absence will be counted 

in accordance with our FTE-counting 

policies for IME and direct GME. We are 

not proposing to change our policy with 

respect to time spent by residents on 

maternity leave or other approved sick 

leave of extended duration. 

c. Orientation Activities 

As discussed above, we believe that 

orientation activities in which residents 

participate, often prior to the start of 

their residency training program, are 

also distinct from the typical ‘‘patient 

care’’ and ‘‘nonpatient care’’ activities in 

which residents participate as part of 

their training program. For example, 

before residents begin training in an 

approved residency program, the 

hospital (or in many cases, the medical 

school as the employer of the residents) 

is required to provide orientation for 

their residents. Most of these orientation 

activities involve neither patient care 

nor the typical didactic or research 

activities that comprise the residency 

training program. Instead, such 

orientation consists of basic 

informational sessions in which all new 

employees, residents and other staff, 

must participate at the beginning of 

employment. There could also be other 

orientation activities designed 

specifically to prepare residents to 

furnish patient care in a particular 

setting or to participate in a particular 

approved residency training program. 

We recognize that certain portions of 

orientation activities are specific to 

residents in particular approved 

programs and are required by the 

accrediting organizations. Other 

components of orientation relate to 

employment and are common to all 

employees. Still other components of 

orientation may involve training 

regarding particular hospital policies 

and procedures, some of which would 

relate to patient care and safety. In many 

ways, these orientation activities 

resemble ‘‘didactic’’ activities. However, 

we believe there are important 

differences between the ‘‘didactic’’ 

activities that are part of orientation and 

the other conferences and seminars in 

which the residents engage throughout 

the course of their training. That is, we 

do not envision orientation activities as 

including scholarly didactic activities 

such as conferences or seminars that 

may occur throughout a residency 

training program. Rather, we believe 

orientation activities would occur either 

at the beginning of a particular specialty 

program, or when a resident goes to 

another facility for training. In 

orientation sessions, much of the 

information being imparted to the 

residents is essential knowledge for the 

residents in order to furnish patient care 

services in a particular hospital facility 

or approved program. Thus, the 

information furnished during 

orientation is not information that 

merely enhances the resident’s patient 

care delivery knowledge and skills 

during the residency program, but it is 

a necessary prerequisite for the 

residents as they commence (or 

continue) their training program and is 

often required as a term of employment. 

Because we recognize the distinct 

character of orientation activities as 

essential to the provision of patient care 

by residents, and the fundamental 

differences between orientation and the 

typical didactic activities in which a 

resident may participate throughout a 

residency training program, we are 

proposing to continue to count the time 

spent by residents in orientation 

activities, whether they occur in the 

hospital or nonhospital setting, and are 

proposing to amend our regulations 

accordingly. (We note that orientation 

activities in the hospital setting have 

historically been counted for direct 

GME payment purposes in accordance 

with the regulations at § 413.78(a) 

which state ‘‘Residents in an approved 

program working in all areas of the 

hospital complex may be counted.’’) We 

are proposing to amend § 413.75(b) to 

add a definition of the term ‘‘orientation 

activities,’’ to mean ‘‘activities that are 

principally designed to prepare an 

individual for employment as a resident 

in a particular setting, or for 

participation in a particular specialty 

program and patient care activities 

associated with that particular specialty 

program.’’ We understand that 

orientation activities typically occur at 

the beginning of a resident’s first 

program year. However, we are 

interested in hearing from commenters 

on whether orientation activities 

typically occur during other times 

during an approved residency training 

program. We are proposing to amend 

the definition of ‘‘patient care activities’’ 

at § 413.75(b) as follows: ‘‘the care and 

treatment of particular patients, 

including services for which a physician 

or other practitioner may bill, and 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24815 

orientation activities as defined at §

413.75(b).’’ In addition, we are 

proposing to amend the regulations at 

§ § 412.105(f)(1)(iii)(A) and 413.78(b) to 

specify that ‘‘Vacation and sick leave are 

not included in the determination of 

full-time equivalency.’’ 

d. Proposed Regulation Changes 

In summary, we are proposing, for 

cost reporting periods beginning on or 

after October, 1, 2007, for direct GME 

and IME, that time spent by residents on 

vacation or sick leave would not be 

included in the determination of what 

constitutes an FTE resident (or would be 

removed from both the numerator and 

denominator of the FTE count) for both 

IME and direct GME payment purposes. 

In addition, we are proposing to 

continue to count time spent by 

residents in orientation activities for 

both IME and direct GME payment 

purposes. We are proposing to amend 

the regulations at § §

412.105(f)(1)(iii)(A) and 413.78(b). 

Lastly, we are proposing to amend §

413.75(b) to include the definition of the 

term ‘‘orientation activities’’ and to 

amend the definition of ‘‘patient care 

activities’’ to add ‘‘orientation 

activities.’’ 

E. Hospital Emergency Services Under 

EMTALA (§ 489.24) 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘EMTALA’’ at the beginning of 

your comments.) 

1. Background 

Sections 1866(a)(1)(I), 1866(a)(1)(N), 

and 1867 of the Act impose specific 

obligations on certain Medicareparticipating hospitals and CAHs. 

(Throughout this section of this 

proposed rule, when we reference the 

obligation of a ‘‘hospital’’ under these 

sections of the Act and in our 

regulations, we mean to include CAHs 

as well.) These obligations concern 

individuals who come to a hospital 

emergency department and request 

examination or treatment for medical 

conditions, and apply to all of these 

individuals, regardless of whether they 

are beneficiaries of any program under 

the Act. 

The statutory provisions cited above 

are frequently referred to as the 

Emergency Medical Treatment and 

Labor Act (EMTALA), also known as the 

patient antidumping statute. EMTALA 

was passed in 1986 as part of the 

Consolidated Omnibus Budget 

Reconciliation Act of 1985 (COBRA), 

Pub. L. 99–272. Congress enacted these 

antidumping provisions in the Social 

Security Act to ensure that individuals 

with emergency medical conditions are 

not denied essential lifesaving services 

because of a perceived inability to pay. Under section 1866(a)(1)(I)(i) of the 

Act, a hospital that fails to fulfill its 

EMTALA obligations under these 

provisions may be liable for termination 

of its Medicare provider agreement, 

which would result in loss of all 

Medicare and Medicaid payments. Section 1867 of the Act sets forth 

requirements for medical screening 

examinations for individuals who come 

to the hospital and request examination 

or treatment for a medical condition. 

The section further provides that if a 

hospital finds that such an individual 

has an emergency condition, it is 

obligated to provide that individual 

with either necessary stabilizing 

treatment or an appropriate transfer to 

another medical facility where 

stabilization can occur. 

The EMTALA statute also outlines the 

obligation of hospitals to receive 

appropriate transfers from other 

hospitals. Section 1867(g) of the Act 

states that a participating hospital that 

has specialized capabilities or facilities 

(such as burn units, shock-trauma units, 

neonatal intensive care units or (with 

respect to rural areas) regional referral 

centers as identified by the Secretary in 

regulation) shall not refuse to accept an 

appropriate transfer of an individual 

who requires these specialized 

capabilities or facilities if the hospital 

has the capacity to treat the individual. The regulations implementing section 

1867 of the Act are found at 42 CFR 

489.24. 

2. Recent Legislation Affecting 

EMTALA Implementation 

a. Secretary’s Authority To Waive 

Requirements During National 

Emergencies 

Section 1135 of the Act authorizes the 

Secretary to temporarily waive or 

modify the application of several 

requirements of titles XVIII, XIX, or XXI 

of the Act (the Medicare, Medicaid, and 

State Children’s Health Insurance 

Program provisions) and their 

implementing regulations in an 

emergency area during an emergency 

period. Section 1135(g)(1) of the Act 

defines an ‘‘emergency area’’ as the 

geographical area in which there exists 

an emergency or disaster declared by 

the President pursuant to the National 

Emergencies Act or the Robert T. 

Stafford Disaster Relief and Emergency 

Assistance Act (subsection A) and a 

public health emergency declared by the 

Secretary pursuant to section 247d of 

Title 42 of the United States Code. 

Section 1135(g)(1) of the Act also 

defines an ‘‘emergency period’’ as the 

period during which such a disaster 

exists. 

Section 1135(b) of the Act lists the 

actions for which the otherwise 

applicable statutory provisions and 

implementing regulations may be 

waived. Included among these actions 

are, in subparagraph (b)(3)(A), a transfer 

of an individual who has not been 

stabilized in violation of the EMTALA 

requirements restricting transfer until an 

individual has been stabilized (section 

1867(c) of the Act) and, in subparagraph 

(b)(3)(B), the direction or relocation of 

an individual to receive medical 

screening in an alternate location, in 

accordance with an appropriate State 

emergency preparedness plan. 

Section 1135(b) of the Act further 

states that a waiver or modification 

provided for under section 1135(b)(3) of 

the Act shall be limited to a 72-hour 

period beginning upon implementation 

of a hospital disaster protocol. All other 

waivers arising out of section 1135(b) of 

the Act (except for section 1135(b)(7)) 

ordinarily may continue in effect for the 

duration of the declaration of emergency 

or disaster, or the declaration of a public 

health emergency, or for 60-day periods 

as described in section 1135(e)(1) of the 

Act. 

To take into account the effect of 

section 1135 waivers on the EMTALA 

requirements, § 489.24(a)(2) of our 

regulations specifies that sanctions 

under the EMTALA regulations for 

inappropriate transfer during a national 

emergency do not apply to a hospital 

with a dedicated emergency department 

located in an emergency area, as 

specified in section 1135(g)(1) of the 

Act. 

For further information about section 

1135 of the Act and its applicability, we 

refer readers to the CMS Web site: 

http://www.cms.hhs.gov/Emergency/ 

02—Hurricanes.asp. 

b. Provisions of the Pandemic and AllHazards Preparedness Act 

On December 19, 2006, Congress 

enacted the Pandemic and All-Hazards 

Preparedness Act, Pub. L. 109–417. 

Section 302(b) of Pub. L. 109–417 makes 

two specific changes that affect 

EMTALA implementation in emergency 

areas during an emergency period. 

As noted above, section 1135(b)(3) of 

the Act authorizes the Secretary to 

waive sanctions for either the transfer of 

an unstabilized individual in violation 

of the requirements of section 1867(c) of 

the Act where such transfer is 

necessitated by the circumstances of the 

declared emergency in the emergency 

area during the emergency period or the 

direction or relocation of an individual 

to receive medical screening in an 

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24816 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

alternate location in accordance with an 

appropriate State emergency 

preparedness plan. Section 302(b)(1)(A) 

of Pub. L. 109–417 amended section 

1135(b)(3)(B) of the Act to state that 

sanctions for the direction or relocation 

of an individual for screening may be 

waived where, in the case of a public 

health emergency that involves a 

pandemic infectious disease, that 

direction or relocation occurs pursuant 

to a State pandemic preparedness plan 

or to an appropriate State emergency 

preparedness plan. In addition, sections 

302(b)(1)(B) and (b)(1)(C) of Pub. L. 109– 

417 amended section 1135(b) of the Act 

to state that, if a public health 

emergency involves a pandemic 

infectious disease (such as pandemic 

influenza), the duration of a waiver or 

modification for such emergency shall 

be determined in accordance with 

section 1135(e) of the Act as that 

subsection applies to public health 

emergencies. The amendments to 

section 1135(b) of the Act made by 

section 302(b) of Pub. L. 109–417 are 

effective as of the date of enactment of 

that legislation (December 19, 2006) and 

apply to public health emergencies 

declared pursuant to section 247(d) of 

Title 42 of the United States Code. 

c. Proposed Revisions to the EMTALA 

Regulations 

Currently, the EMTALA regulation at 

42 CFR 489.24(a)(2) specifies that 

sanctions under this section (§ 489.24) 

for inappropriate transfer during a 

national emergency do not apply to a 

hospital with a dedicated emergency 

department located in an emergency 

area, as specified in section 1135(g)(1) of 

the Act. To implement the changes 

made by section 302(b) of Pub. L. 109– 

417 and to ensure that our regulations 

accurately reflect section 1135 of the 

Act, we are proposing to make two 

changes to paragraph (a)(2) of § 489.24. 

First, we would specify that the 

sanctions that do not apply are those for 

either the inappropriate transfer of an 

individual who has not been stabilized 

or those for the direction or relocation 

of an individual to receive medical 

screening at an alternate location. We 

also are proposing to revise § 489.24 by 

adding a second sentence to paragraph 

(a)(2) to state that a waiver of these 

sanctions for EMTALA violations is 

limited to a 72-hour period beginning 

upon the implementation of a hospital 

disaster protocol, except that if a public 

health emergency involves a pandemic 

infectious disease (such as pandemic 

influenza), the duration of the waiver 

will be determined in accordance with 

subsection (e) of section 1135 of the Act 

as that subsection applies to public 

health emergencies. This proposed 

change would clarify that, in the case of 

public health emergencies involving 

pandemic infectious diseases, the 

waiver of EMTALA sanctions is not 

limited to 72 hours, but will remain in 

effect until the termination of the 

applicable declaration of a public health 

emergency as described in section 

1135(e)(1)(B) of the Act. 

F. Disclosure of Physician Ownership in 

Hospitals and Patient Safety Measures 

1. Disclosure of Physician Ownership in 

Hospitals 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Physician Ownership in 

Hospitals’’ at the beginning of your 

comment.) 

Section 1866 of the Act states that any 

provider of services (except a fund 

designated for purposes of section 

1814(g) and section 1835(e) of the Act) 

shall be qualified to participate in the 

Medicare program and shall be eligible 

for Medicare payments if it files a 

Medicare provider agreement and 

abides by the requirements applicable to 

Medicare provider agreements. These 

requirements are incorporated into our 

regulations in 42 CFR part 489, subparts 

A and B (Provider Agreements and 

Supplier Approval). Section 1861(e) of 

the Act defines the term ‘‘hospital.’’ 

Section 1861(e)(9) of the Act defines a 

hospital and authorizes the Secretary to 

establish requirements as he finds 

necessary in the interest of patient 

health and safety. Section 1820(e)(3) of 

the Act authorizes the Secretary to 

establish criteria necessary for an 

institution to be certified as a critical 

access hospital. 

Section 5006 of Pub. L. 109–171 

(DRA) required the Secretary to develop 

a ‘‘strategic and implementing plan’’ to 

address certain issues related to 

physician investment in ‘‘specialty 

hospitals.’’ In the strategic and 

implementing plan included in our 

‘‘Final Report to the Congress and 

Strategic and Implementing Plan 

Required under Section 5006 of the 

Deficit Reduction Act of 2005’’ issued 

on August 8, 2006 (page 69), available 

on our Web site at: http://www.cms. 

hhs.gov/PhysicianSelfReferral/06a— 

DRA—Reports.asp (hereinafter referred 

to as the ‘‘DRA Report to Congress’’), we 

stated that our plan for addressing 

issues related to physician investment 

in specialty hospitals involved 

promoting transparency of investment. 

Consistent with that approach, we 

stated that we would adopt a disclosure 

requirement that would require 

hospitals to disclose to patients whether 

they are physician-owned, and if so, 

disclose the names of the physician 

owners. Accordingly, we are proposing 

changes to regulations governing 

Medicare provider agreements to 

effectuate this change, under our 

authority at sections 1861(e)(9), 1820(e) 

and 1866 of the Act and under our 

rulemaking authority at sections 1871 

and 1102 of the Act. We are seeking 

comment as to whether these changes 

best effectuated through changes to the 

Medicare provider agreement 

regulations or whether it would be more 

appropriate to include these changes in 

the conditions of participation 

requirements applicable to hospitals 

and critical access hospitals. 

Specifically, we are proposing to 

amend § 489.3 to define a ‘‘physicianowned hospital’’ as any participating 

hospital (as defined in § 489.24) in 

which a physician or physicians have 

an ownership or investment interest. We 

solicit comments on whether, for 

purposes of the ownership disclosure 

requirements only, the definition of 

‘‘physician-owned hospital’’ should 

exclude certain physician ownership or 

investment interests based on the nature 

of the interest or the relative size of the 

interest or the entity’s assets (for 

example, whether the interest would 

satisfy the exception at § 4111.356(a) 

for physician ownership or investment 

interest in public-traded securities and 

mutual funds). 

We are proposing to add a new 

provision at § 489.20(u)(1) to require 

that patients be given written notice that 

a hospital is physician-owned and that 

the list of physician owners is available 

upon request. We are proposing to 

require that the notice, in a manner 

reasonably designed to be understood 

by all patients, disclose the fact that the 

hospital meets the Federal definition of 

a ‘‘physician-owned hospital’’ and that 

patients will be provided the list of the 

hospital’s physician owners upon 

request. In addition, we are proposing to 

add a new provision at § 489.20(u)(2) 

which will require hospitals to require 

that all physician owners who are also 

members of the hospital’s medical staff 

disclose, in writing, their ownership 

interest in the hospital to all patients 

they refer to the hospital, as a condition 

of continued medical staff membership. 

Patient disclosure would be required at 

the time a physician makes a referral. 

We believe that these provisions are in 

the interest of the health and safety of 

individuals who are furnished services 

in these institutions. This notice 

requirement will permit individuals to 

make more informed decisions 

regarding their treatment and to 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24817 

evaluate whether the existence of a 

financial relationship, in the form of an 

ownership interest, suggests a conflict of 

interest that is not in their best interest. 

In order to enforce these proposed 

requirements, we are proposing to 

amend § 489.12 to deny a provider 

agreement to a hospital that does not 

have procedures in place to notify 

patients of physician ownership in the 

hospital. In addition, we are proposing 

to amend § 489.53 to permit CMS to 

terminate a provider agreement with a 

physician-owned hospital if the hospital 

fails to comply with the requirements of 

§ 489.20(u). 

2. Patient Safety Measures 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Patient Safety Measures’’ at the 

beginning of your comment.) 

In the DRA Report to Congress (page 

67), we stated that it was appropriate to 

issue further guidance on what we 

expect of all hospitals with respect to 

the appraisal, initial treatment, and 

referral, when appropriate, of patients 

with medical emergencies. The 

Medicare hospital conditions of 

participation regulations at 42 CFR part 

482 impose requirements on hospitals 

that have emergency departments, as 

well as requirements on hospitals 

without emergency departments. We 

believe that hospitals should be 

required to disclose to patients at the 

time of inpatient admission or 

registration for an outpatient service 

information concerning whether a 

physician is available on the premises 

24 hours a days, 7 days a week. Under 

the authority at sections 1861(e)(9), 

1820(e)(3), 1866, 1871, and 1102 of the 

Act (described previously), we are 

proposing to add a new provision at §

489.20(v)(1) to require that hospitals 

furnish all patients notice at the 

beginning of their hospital stay or 

outpatient service if a doctor of 

medicine or a doctor of osteopathy is 

not present in the hospital 24 hours per 

day, 7 days a week, and to describe how 

the hospital will meet the medical needs 

of any patient who develops an 

emergency medical condition, at a time 

when no physician is present in the 

hospital. We are seeking comment as to 

whether this change best effectuated 

through changes to the Medicare 

provider agreement regulations or 

whether it would be more appropriate to 

include this change in the conditions of 

participation requirements applicable to 

hospitals and critical access hospitals. 

It has also come to our attention that 

some hospitals have called 9–1–1 when 

a patient has gone into respiratory 

arrest, a physician has not been on the 

premises, and the onsite clinical 

personnel have lacked the requisite 

equipment or training to provide the 

required assessment, initial treatment, 

and referral that are required of all 

hospitals. In some cases, required 

interventions to initiate emergency 

treatment may be outside the scope of 

practice of the clinical personnel onsite. 

This has occurred even in hospitals that 

operate emergency departments. 

Therefore, in this proposed rule, we are 

soliciting comments on whether current 

requirements for emergency service 

capability in hospitals with or without 

emergency departments should be 

strengthened in certain areas. 

Specifically, we are seeking feedback on 

whether present regulatory provisions 

should be expanded with respect to the 

type of clinical personnel that must be 

present at all times in hospitals with 

and without emergency departments; 

the competencies that such personnel 

must demonstrate, such as training in 

Advanced Cardiac Life Support, or 

successful completion of specified 

professional training programs; the type 

of emergency response equipment that 

must be available and the manner in 

which it must be available, such as in 

each emergency department, or 

inpatient unit, among others; and 

whether emergency departments must 

be operated 24 hours/day, 7 days a 

week. After evaluating the comments we 

receive, we will consider whether we 

should amend the Medicare hospital 

conditions of participation related to 

provision of emergency services in 

hospitals with and without emergency 

departments. 

G. Rural Community Hospital 

Demonstration Program 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Rural Community Hospital 

Demonstration’’ at the beginning of your 

comments.) 

In accordance with the requirements 

of section 410A(a) of Pub. L. 108–173, 

the Secretary has established a 5-year 

demonstration program (beginning with 

selected hospitals’ first cost reporting 

period beginning on or after October 1, 

2004) to test the feasibility and 

advisability of establishing ‘‘rural 

community hospitals’’ for Medicare 

payment purposes for covered inpatient 

hospital services furnished to Medicare 

beneficiaries. A rural community 

hospital, as defined in section 

410A(f)(1), is a hospital that— 

<bullet≤ Is located in a rural area (as 

defined in section 1886(d)(2)(D) of the 

Act) or is treated as being located in a 

rural area under section 1886(d)(8)(E) of 

the Act; 

<bullet≤ Has fewer than 51 beds 

(excluding beds in a distinct part 

psychiatric or rehabilitation unit) as 

reported in its most recent cost report; 

<bullet≤ Provides 24-hour emergency 

care services; and 

<bullet≤ Is not designated or eligible 

for designation as a CAH. 

As we indicated in the FY 2005 IPPS 

final rule (69 FR 49078), in accordance 

with sections 410A(a)(2) and (a)(4) of 

Pub. L. 108–173 and using 2002 data 

from the U.S. Census Bureau, we 

identified 10 States with the lowest 

population density from which to select 

hospitals: Alaska, Idaho, Montana, 

Nebraska, Nevada, New Mexico, North 

Dakota, South Dakota, Utah, and 

Wyoming (Source: U.S. Census Bureau 

Statistical Abstract of the United States: 

2003). Nine rural community hospitals 

located within these States are currently 

participating in the demonstration 

program for FY 2008. (Of the 13 

hospitals that participated in the first 2 

years of the demonstration program, 4 

hospitals located in Nebraska have 

withdrawn from the program; they have 

become CAHs.) 

Under the demonstration program, 

participating hospitals are paid the 

reasonable costs of providing covered 

inpatient hospital services (other than 

services furnished by a psychiatric or 

rehabilitation unit of a hospital that is 

a distinct part), applicable for 

discharges occurring in the first cost 

reporting period beginning on or after 

the October 1, 2004, implementation 

date of the demonstration program. 

Payments to the participating hospitals 

will be the lesser amount of the 

reasonable cost or a target amount in 

subsequent cost reporting periods. The 

target amount in the second cost 

reporting period is defined as the 

reasonable costs of providing covered 

inpatient hospital services in the first 

cost reporting period, increased by the 

inpatient prospective payment update 

factor (as defined in section 

1886(b)(3)(B) of the Act) for that 

particular cost reporting period. The 

target amount in subsequent cost 

reporting periods is defined as the 

preceding cost reporting period’s target 

amount, increased by the inpatient 

prospective payment update factor (as 

defined in section 1886(b)(3)(B) of the 

Act) for that particular cost reporting 

period. 

Covered inpatient hospital services 

are inpatient hospital services (defined 

in section 1861(b) of the Act), and 

include extended care services 

furnished under an agreement under 

section 1883 of the Act. 

Section 410A of Pub. L. 108–173 

requires that ‘‘in conducting the 

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24818 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

demonstration program under this 

section, the Secretary shall ensure that 

the aggregate payments made by the 

Secretary do not exceed the amount 

which the Secretary would have paid if 

the demonstration program under this 

section was not implemented.’’ 

Generally, when CMS implements a 

demonstration program on a budget 

neutral basis, the demonstration 

program is budget neutral in its own 

terms; in other words, the aggregate 

payments to the participating providers 

do not exceed the amount that would be 

paid to those same providers in the 

absence of the demonstration program. 

This form of budget neutrality is viable 

when, by changing payments or aligning 

incentives to improve overall efficiency, 

or both, a demonstration program may 

reduce the use of some services or 

eliminate the need for others, resulting 

in reduced expenditures for the 

demonstration program’s participants. 

These reduced expenditures offset 

increased payments elsewhere under 

the demonstration program, thus 

ensuring that the demonstration 

program as a whole is budget neutral or 

yields savings. However, the small scale 

of this demonstration program, in 

conjunction with the payment 

methodology, makes it extremely 

unlikely that this demonstration 

program could be viable under the usual 

form of budget neutrality. Specifically, 

cost-based payments to the nine 

participating small rural hospitals are 

likely to increase Medicare outlays 

without producing any offsetting 

reduction in Medicare expenditures 

elsewhere. Therefore, a rural 

community hospital’s participation in 

this demonstration program is unlikely 

to yield benefits to the participant if 

budget neutrality were to be 

implemented by reducing other 

payments for these providers. 

In order to achieve budget neutrality 

for this demonstration program for FY 

2008, we are proposing to adjust the 

national inpatient PPS rates by an 

amount sufficient to account for the 

added costs of this demonstration 

program. We are proposing to apply 

budget neutrality across the payment 

system as a whole rather than merely 

across the participants in this 

demonstration program. As we 

discussed in the FY 2005, FY 2006, and 

FY 2007 IPPS final rules (69 FR 49183; 

70 FR 47462; and 71 FR 48100), we 

believe that the language of the statutory 

budget neutrality requirements permits 

the agency to implement the budget 

neutrality provision in this manner. For 

FY 2008, using cost report data for FY 

2003, adjusted to account for the 

increased estimated costs for the 

remaining nine participating hospitals, 

we estimate that the adjusted amount 

would be $9,681,893. This proposed 

estimated adjusted amount reflects the 

estimated difference between the 

participating hospitals’ costs and the 

IPPS payment based on data from the 

hospitals’ cost reports. We discuss the 

proposed payment rate adjustment that 

would be required to ensure the budget 

neutrality of the demonstration program 

for FY 2008 in section II.A.4. of the 

Addendum to this proposed rule. 

V. Proposed Changes to the IPPS for 

Capital-Related Costs 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘Capital IPPS’’ at the beginning 

of your comment.) 

A. Background 

Section 1886(g) of the Act requires the 

Secretary to pay for the capital-related 

costs of inpatient acute hospital services 

‘‘in accordance with a prospective 

payment system established by the 

Secretary.’’ Under the statute, the 

Secretary has broad authority in 

establishing and implementing the IPPS 

for acute care hospital inpatient capitalrelated costs. We initially implemented 

the IPPS for capital-related costs in the 

August 30, 1991 IPPS final rule (56 FR 

43358), in which we established a 10- 

year transition period to change the 

payment methodology for Medicare 

hospital inpatient capital-related costs 

from a reasonable cost-based 

methodology to a prospective 

methodology (based fully on the Federal 

rate). 

Federal fiscal year (FFY) 2001 was the 

last year of the 10-year transition period 

established to phase in the IPPS for 

hospital inpatient capital-related costs. 

For cost reporting periods beginning in 

FY 2002, capital IPPS payments are 

based solely on the Federal rate for most 

acute care hospitals (other than certain 

new hospitals and hospitals receiving 

certain exception payments). The basic 

methodology for determining capital 

prospective payments using the Federal 

rate is set forth in § 412.312. For the 

purpose of calculating payments for 

each discharge, the standard Federal 

rate is adjusted as follows: 

(Standard Federal Rate) x (DRG 

Weight) x (Geographic Adjustment 

Factor (GAF)) x (Large Urban Add-on, if 

applicable) x (COLA for hospitals 

located in Alaska and Hawaii) x (1 + 

Capital DSH Adjustment Factor + 

Capital IME Adjustment Factor, if 

applicable). 

Hospitals also may receive outlier 

payments for those cases that qualify 

under the threshold established for each 

fiscal year as specified in § 412.312(c) 

of the regulations. 

The regulations at § 412.348(f) 

provide that a hospital may request an 

additional payment if the hospital 

incurs unanticipated capital 

expenditures in excess of $5 million due 

to extraordinary circumstances beyond 

the hospital’s control. This policy was 

originally established for hospitals 

during the 10-year transition period, but 

as we discussed in the August 1, 2002 

IPPS final rule (67 FR 50102), we 

revised the regulations at § 412.312 to 

specify that payments for extraordinary 

circumstances are also made for cost 

reporting periods after the transition 

period (that is, cost reporting periods 

beginning on or after October 1, 2001). 

Additional information on the exception 

payment for extraordinary 

circumstances in § 412.348(f) can be 

found in the FY 2005 IPPS final rule (69 

FR 49185 and 49186). 

During the transition period, under 

§ § 412.348(b) through (e), eligible 

hospitals could receive regular 

exception payments. These exception 

payments guaranteed a hospital a 

minimum payment percentage of its 

Medicare allowable capital-related costs 

depending on the class of hospital (§

412.348(c)), but were available only 

during the 10-year transition period. 

After the end of the transition period, 

eligible hospitals can no longer receive 

this exception payment. However, even 

after the transition period, eligible 

hospitals receive additional payments 

under the special exceptions provisions 

at § 412.348(g), which guarantees all 

eligible hospitals a minimum payment 

of 70 percent of its Medicare allowable 

capital-related costs provided that 

special exceptions payments do not 

exceed 10 percent of total capital IPPS 

payments. Special exceptions payments 

may be made only for the 10 years from 

the cost reporting year in which the 

hospital completes its qualifying 

project, and the hospital must have 

completed the project no later than the 

hospital’s cost reporting period 

beginning before October 1, 2001. Thus, 

an eligible hospital may receive special 

exceptions payments for up to 10 years 

beyond the end of the capital IPPS 

transition period. Hospitals eligible for 

special exceptions payments were 

required to submit documentation to the 

intermediary indicating the completion 

date of their project. (For more detailed 

information regarding the special 

exceptions policy under § 412.348(g), 

refer to the August 1, 2001 IPPS final 

rule (66 FR 39911 through 39914) and 

the August 1, 2002 IPPS final rule (67 

FR 50102).) 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24819 

Under the IPPS for capital-related 

costs, § 412.300(b) of the regulations 

defines a new hospital as a hospital that 

has operated (under current or previous 

ownership) for less than 2 years. (For 

more detailed information, we refer 

readers to the August 30, 1991 final rule 

(56 FR 43418).) During the 10-year 

transition period, a new hospital was 

exempt from the capital IPPS for its first 

2 years of operation and was paid 85 

percent of its reasonable costs during 

that period. Originally, this provision 

was effective only through the transition 

period and, therefore, ended with cost 

reporting periods beginning in FY 2002. 

Because we believe that special 

protection to new hospitals is also 

appropriate even after the transition 

period, as discussed in the August 1, 

2002 IPPS final rule (67 FR 50101), we 

revised the regulations at §

412.304(c)(2) to provide that, for cost 

reporting periods beginning on or after 

October 1, 2002, a new hospital (defined 

under § 412.300(b)) is paid 85 percent 

of its Medicare allowable capital-related 

costs through its first 2 years of 

operation, unless the new hospital 

elects to receive fully prospective 

payment based on 100 percent of the 

Federal rate. (We refer readers to the 

August 1, 2001 IPPS final rule (66 FR 

39910) for a detailed discussion of the 

statutory basis for the system, the 

development and evolution of the 

system, the methodology used to 

determine capital-related payments to 

hospitals both during and after the 

transition period, and the policy for 

providing exception payments.) Section 412.374 provides for the use 

of a blended payment amount for 

prospective payments for capital-related 

costs to hospitals located in Puerto Rico. 

Accordingly, under the capital IPPS, we 

compute a separate payment rate 

specific to Puerto Rico hospitals using 

the same methodology used to compute 

the national Federal rate for capitalrelated costs. In general, hospitals 

located in Puerto Rico are paid a blend 

of the applicable capital IPPS Puerto 

Rico rate and the applicable capital IPPS 

Federal rate. 

Prior to FY 1998, hospitals in Puerto 

Rico were paid a blended capital IPPS 

rate that consisted of 75 percent of the 

capital IPPS Puerto Rico specific rate 

and 25 percent of the capital IPPS 

Federal rate. However, effective October 

1, 1997 (FY 1998), in conjunction with 

the change to the operating IPPS blend 

percentage for Puerto Rico hospitals 

required by section 4406 of Pub. L. 105– 

33, we revised the methodology for 

computing capital IPPS payments to 

hospitals in Puerto Rico to be based on 

a blend of 50 percent of the capital IPPS 

Puerto Rico rate and 50 percent of the 

capital IPPS Federal rate. Similarly, in 

conjunction with the change in 

operating IPPS payments to hospitals in 

Puerto Rico for FY 2005 required by 

section 504 of Pub. L. 108–173, we again 

revised the methodology for computing 

capital IPPS payments to hospitals in 

Puerto Rico to be based on a blend of 

25 percent of the capital IPPS Puerto 

Rico rate and 75 percent of the capital 

IPPS Federal rate effective for 

discharges occurring on or after October 

1, 2004. 

B. Proposed Policy Change 

As we have noted above, the Secretary 

has broad authority under the statute in 

establishing and implementing the IPPS 

for hospital inpatient capital-related 

costs. We initially exercised that 

authority in the August 30, 1991 IPPS 

final rule (56 FR 43358). Among other 

provisions of that rule, we established 

the 10-year transition period to change 

the payment methodology for Medicare 

hospital inpatient capital-related costs 

from a reasonable cost-based 

methodology to a prospective 

methodology (based fully on the Federal 

rate). The purpose of that lengthy 

transition was to allow hospitals 

sufficient time to adjust to payment 

under a fully prospective system based 

on a uniform national rate. In that rule, 

we also established the initial standard 

Federal payment rate for capital-related 

costs, as well as the mechanism for 

updating that rate in subsequent years. 

For FY 1992, we computed the standard 

Federal payment rate for capital-related 

costs under the IPPS by updating the FY 

1989 Medicare inpatient capital cost per 

case by an actuarial estimate of the 

increase in Medicare inpatient capital 

costs per case. Each year after FY 1992, 

we update the capital standard Federal 

rate, as provided at § 412.308(c)(1), to 

account for capital input price increases 

and other factors. The regulations at §

412.308(c)(2) provide that the capital 

Federal rate is adjusted annually by a 

factor equal to the estimated proportion 

of outlier payments under the capital 

Federal rate to total capital payments 

under the capital Federal rate. In 

addition, § 412.308(c)(3) requires that 

the capital Federal rate be reduced by an 

adjustment factor equal to the estimated 

proportion of payments for (regular and 

special) exceptions under § 412.348. 

Section 412.308(c)(4)(ii) requires that 

the capital standard Federal rate be 

adjusted so that the effects of the annual 

DRG reclassification and the 

recalibration of DRG weights and 

changes in the geographic adjustment 

factor are budget neutral. Since the implementation of the IPPS 

for hospital inpatient capital-related 

costs, we have carefully monitored the 

adequacy of the standard Federal 

payment rate for capital-related costs 

and the updates provided under the 

existing regulations. On several 

occasions, the standard Federal 

payment rate has been adjusted. Section 

1886(g)(1)(A) of the Act required a 7.4 

percent reduction to the capital rate for 

discharges occurring after September 30, 

1993. (We implemented that reduction 

to the rate in § 412.308(b)(2) of our 

regulations, effective in FY 1994.) 

Section 412.308(b)(3) of the regulations 

describes the 0.28 percent reduction to 

the capital rate made in FY 1996 as a 

result of the revised policy of paying for 

transfers. In FY 1998, we implemented 

section 4402 of Pub. L. 105–33, which 

required that, for discharges occurring 

on or after October 1, 1997, and before 

October 1, 2002, the unadjusted capital 

standard Federal rate be reduced by 

17.78 percent (above the previous 

statutory reduction of 7.4 percent). (As 

a result of that reduction, the FY 1998 

standard Federal payment rate for 

capital-related costs was $371.51, 

compared to $438.92 in FY 1997.) As we 

discussed in the FY 2003 IPPS final rule 

(67 FR 50102) and implemented in §

412.308(b)(6), a small part of that 

reduction was restored effective October 

1, 2002. 

In general, under a PPS, standard 

payment rates should reflect the costs 

that an average, efficient provider would 

bear to provide the services required for 

quality patient care. Payment rate 

updates should also account for the 

changes necessary to continue providing 

such services. Updates should reflect, 

for example, the increased costs that are 

necessary to provide for the 

introduction of new technology that 

improves patient care. Updates should 

also take into account the productivity 

gains that, over time, allow providers to 

realize the same, or even improved, 

quality outcomes with reduced inputs 

and lower costs. Hospital margins, the 

difference between the costs of actually 

providing services and the payments 

received under a particular system, thus 

provide some evidence concerning 

whether payment rates have been 

established and updated at an 

appropriate level over time for efficient 

providers to provide necessary services. 

All other factors being equal, sustained 

substantial positive margins may 

suggest that payment rates and updates 

have exceeded what is required to 

provide those services. It is to be 

expected, under a PPS, that highly 

efficient providers might regularly 

realize positive margins, while less 

efficient providers might regularly 

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24820 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

realize negative margins. However, a 

PPS that is correctly calibrated should 

not necessarily experience sustained 

periods in which providers generally 

realize substantial positive Medicare 

margins. 

Under the capital IPPS in particular, 

it seems especially appropriate that 

there should not be sustained significant 

positive margins across the system as a 

whole. Prior to the implementation of 

the capital IPPS, Congress mandated 

that the Medicare program pay only 85 

percent of hospitals’ inpatient Medicare 

capital costs. During the first 5 years of 

the capital IPPS, Congress also 

mandated a budget neutrality 

adjustment, under which the standard 

Federal capital rate was set each year so 

that payments under the system as a 

whole equaled 90 percent of estimated 

hospitals’ inpatient Medicare capital 

costs for the year. Finally, as we 

discussed above, Congress has twice 

adjusted the standard Federal capital 

rate (a 7.4 percent reduction beginning 

in FY 1994, followed by a 17.78 percent 

reduction beginning in FY 1998). On the 

second occasion in particular, the 

specific congressional mandate was ‘‘to 

apply the budget neutrality factor used 

to determine the Federal capital 

payment rate in effect on September 30, 

1995 * * * to the unadjusted standard 

Federal capital payment rate’’ for FY 

1998 and beyond. (The designated 

budget neutrality factor constituted a 

17.78 percent reduction.) This statutory 

language indicates that Congress 

considered the payment levels in effect 

during FYs 1992 through 1995, 

established under the budget neutrality 

provision to pay 90 percent of hospitals’ 

inpatient Medicare capital costs in the 

aggregate, appropriate for the capital 

IPPS. The statutory history of the capital 

IPPS thus suggests that the system in the 

aggregate should not provide for 

continuous, large positive margins. 

In analyzing the adequacy of the 

existing capital IPPS rates, we recently 

conducted a comprehensive review of 

hospital experience under the IPPS for 

hospital inpatient capital-related costs, 

with particular attention to the 

relationship between acute care hospital 

capital Medicare costs and payments 

under the capital IPPS. Specifically, we 

examined the relationship between the 

Medicare inpatient capital costs of 

hospitals that are paid under the IPPS 

for hospital inpatient capital-related 

costs and their payments under that 

system over a number of years. We 

derived both cost and revenue data from 

the Medicare cost report. Specifically, 

cost data were derived from Worksheet 

D, Part I, columns 10 and 12 and Part 

II, columns 6 and 8, and revenue data 

from Worksheet E, Part A, Lines 9 and 

10. We began our analysis with FY 

1996, the year in which the statutory 

budget neutrality provision expired. (As 

we have discussed, for FYs 1992 

through 1995, section 1886(g)(1)(A) of 

the Act required that the capital Federal 

rate also be adjusted by a budget 

neutrality factor so that aggregate 

payments for inpatient hospital capital 

costs were projected to equal 90 percent 

of the payments that would have been 

made for capital-related costs on a 

reasonable cost basis during the fiscal 

year. As discussed in section III. of the 

Addendum to this proposed rule, we 

employed an actuarial capital cost 

model (described in Appendix B of the 

FY 2002 IPPS final rule (66 FR 40099)) 

to estimate the aggregate payments that 

would have been made on the basis of 

reasonable cost in order to determine 

the required budget neutrality 

adjustment. As a result of the expiration 

of the budget neutrality provision, the 

standard Federal payment rate for 

capital-related costs increased to 

$461.96 in FY 1996 from $376.83 in FY 

1995.) Our analysis extended through 

FY 2004, the most recent year for which 

we have relatively complete cost report 

information. We examined data across 

all hospitals subject to the capital IPPS 

and across the categories of hospitals 

(for example, urban and rural, and 

teaching and nonteaching) that we 

normally employ in conducting impact 

analyses. Specifically, we looked at the 

difference between aggregate hospital 

revenues from the capital IPPS and 

hospitals’ aggregate Medicare inpatient 

capital costs. We determined the 

inpatient hospital Medicare capital 

margins for each year of the period from 

FY 1996 through FY 2004. (A margin is 

calculated as the difference between 

payments and costs, divided by 

payments.) We similarly calculated the 

aggregate margins for the period (the 

aggregate difference between payments 

and costs over the period, divided by 

total payments over the period). We also 

calculated aggregate margins for the 

period FY 1998 through FY 2004 

(excluding FY 1996 and 1997). As a 

result of the expiration of the statutory 

budget neutrality provision, the capital 

standard Federal rate increased to 

$461.96 in FY 1996 from $376.83 in FY 

1995. The capital standard Federal rate 

was $438.92 in FY 1997, before it was 

reduced to $371.51 in FY 1998 under 

section 4402 of Pub. L. 105–33, which 

required that the unadjusted capital 

standard Federal rate be reduced by 

17.78 percent. The capital standard 

Federal rates for FYs 1996 and 1997 

were thus substantially higher than the 

rates for the periods immediately 

preceding those years, and in the 

subsequent years (FY 1998 and beyond). 

The margins for those years are 

correspondingly higher than the 

margins for the other years in the 

period, and thus it could be argued that 

the margins for FYs 1996 and 1997 are 

unrepresentative. The table below 

summarizes the findings of this 

analysis. 

HOSPITAL INPATIENT MEDICARE CAPITAL MARGINS

1996 1997 1998 1999 2000 2001 2002 2003 2004 1996–2004 1998–2004* 

U.S. .................................................... 17.5 13.4 7.0 6.8 7.3 7.9 8.7 7.7 5.1 9.0 7.2 

URBAN ........................................ 17.6 13.8 7.8 7.4 8.3 8.9 10.3 9.1 6.3 9.9 8.3 

RURAL ........................................ 17.2 11.1 2.0 2.7 1.3 1.5 -1.7 -1.2 -2.9 3.4 0.26 

No DSH Payments ............................. 16.2 11.8 4.4 4.4 5.6 5.6 5.0 4.8 -0.9 6.9 4.2 

Has DSH Payments ........................... 18.3 14.4 8.5 8.1 8.2 8.7 9.9 8.6 6.7 9.9 8.4 

$1–$249,999 ............................... 14.5 12.9 -0.4 3.1 1.6 4.2 2.5 0.6 -3.5 3.3 1.8 

$250,000–$999,999 .................... 15.5 9.3 2.2 1.5 3.0 2.5 -1.2 0.2 -3.8 2.9 0.5 

$1,000,000–$2,999,999 .............. 16.8 12.8 8.5 9.2 8.6 7.2 9.0 4.6 3.0 8.7 7.1 

$3,000,000 or more .................... 20.1 16.6 10.4 9.1 9.7 11.6 13.4 12.5 10.1 12.4 11.1 

TEACHING ......................................... 19.4 15.7 9.8 9.7 11.1 11.7 13.9 13.2 11.3 12.9 11.6 

NON-TEACHING ................................ 15.3 10.5 3.3 2.9 2.2 2.8 1.6 0.2 -3.2 3.9 1.3 

Census Division: 

New England (1) ......................... 26.9 25.8 17.0 15.1 18.2 20.5 21.3 21.2 20.5 20.9 19.3 

Middle Atlantic (2) ....................... 19.1 15.5 11.0 11.5 13.8 16.3 18.4 17.9 15.0 15.5 15.0 

South Atlantic (3) ........................ 17.9 13.9 5.8 3.9 5.9 5.2 6.3 7.5 4.9 7.9 5.7 

East North Central (4) ................. 18.2 12.7 6.2 7.2 8.8 8.6 6.3 8.1 7.1 9.2 7.5 

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HOSPITAL INPATIENT MEDICARE CAPITAL MARGINS—Continued 

% 1996 1997 1998 1999 2000 2001 2002 2003 2004 1996–2004 1998–2004* 

East South Central (5) ................ 14.8 11.1 3.3 4.1 3.4 2.9 3.0 -1.8 -4.2 3.9 1.4 

West North Central (6) ................ 14.2 6.9 0.0 -0.4 -1.6 1.9 2.6 3.3 1.1 3.2 1.1 

West South Central (7) ............... 13.3 8.3 3.4 3.1 0.6 0.1 1.4 -1.2 -4.2 2.5 0.3 

Mountain (8) ................................ 17.3 14.8 8.4 7.6 7.4 6.4 3.2 3.1 0.7 7.2 4.9 

Pacific (9) .................................... 20.5 16.1 12.4 11.3 11.5 12.8 15.5 12.8 9.2 13.5 12.2 

Code 99 ...................................... 24.1 26.1 14.9 16.7 20.0 20.9 20.6 25.2 22.3 21.4 20.3 

Bed Size: 

< 100 beds .................................. 17.7 13.0 4.7 3.5 2.8 2.5 -1.7 -1.3 -5.6 3.5 0.5 

100–249 beds ............................. 15.1 10.6 3.5 4.5 4.7 6.0 6.1 4.5 1.1 6.2 4.4 

250–499 beds ............................. 18.9 14.0 8.7 8.3 10.4 10.5 11.7 11.6 10.6 11.7 10.4 

500–999 beds ............................. 19.7 17.5 11.1 10.3 10.7 10.4 12.5 10.3 6.8 12.0 10.2 

≤= 1000 beds .............................. 8.2 13.8 2.1 0.2 -6.6 -3.5 8.7 6.3 1.4 3.1 1.8 

Notes: 

* Excluding 1996 and 1997. 

Based on Medicare Cost Report hospital data updated as of the 4th quarter of 2006. 

Revenue are from Worksheet E, Part A, Lines 9 and 10. 

Expenses are from Worksheet D, Part I, columns 10 and 12 and Part II, columns 6 and 8. 

We apply the outlier trimming methodology developed by MedPAC. 

As the table shows, hospital inpatient 

Medicare capital margins have been 

very high across all hospitals during the 

period from FY 1996 through FY 2004. 

The margin for the entire period was 9.0 

percent (7.2 percent, excluding FYs 

1996 and 1997). For particular years, 

margins across all hospitals ranged from 

a high of 17.5 percent in FY 1996 to a 

low 5.1 percent in FY 2004. While the 

margins fell after a high in FY 1996 of 

17.5 to 6.8 percent in FY 1999, they rose 

again to 8.7 percent in FY 2002 before 

declining modestly to 5.1 percent in FY 

2004. 

There are similar results among most 

types of hospitals and groupings of 

hospitals by geographic region. For 

example, teaching hospitals have 

realized margins of 12.9 percent (11.6 

percent, excluding FYs 1996 and 1997) 

during the period from FY 1996 through 

FY 2004, with a high margin of 19.4 

percent in FY 1996 and a low margin of 

9.7 percent in FY 1999. Urban hospitals 

realized margins of 9.9 percent during 

the period from FY 1996 through FY 

2004 (8.3 percent, excluding FYs 1996 

and 1997). DSH hospitals realized 

margins of 9.9 percent over the period 

(8.4 percent, excluding FYs 1996 and 

1997), while non-DSH had aggregate 

margins of 6.9 percent (4.2 percent, 

excluding FYs 1996 and 1997). 

During the period from FY 1996 

through FY 2004, every type of hospital 

and geographic grouping of hospitals 

has realized a positive aggregate margin 

from their capital IPPS payments. Of 

course, the aggregate capital margins for 

some types of hospitals have been lower 

than the margins for others. In 

particular, inpatient hospital Medicare 

capital margins for rural hospitals have 

lagged considerably behind the margins 

for urban hospitals. The aggregate 

margin for rural hospitals during the 

period from FY 1996 through FY 2004 

was 3.4 percent (0.2 percent, excluding 

FYs 1996 and 1997), compared to 9.9 

percent for urban hospitals and 9.0 

percent for all hospitals. Rural hospitals 

have even experienced negative margins 

during several years of the period (-1.7 

percent in FY 2002, -1.2 percent in FY 

2003, and -2.9 percent in FY 2004). 

Similarly, nonteaching hospitals have 

experienced lower margins than 

teaching hospitals. Teaching hospitals 

have experienced an aggregate margin of 

12.9 percent during the period from FY 

1996 through FY 2004 (11.6 percent, 

excluding FYs 1996 and 1997). 

However, nonteaching hospitals have 

experienced an aggregate margin of 3.9 

percent during that period (1.3 percent, 

excluding FYs 1996 and 1997). 

There may be various factors reflected 

in these margins. For example, one 

factor in the lower margins experienced 

by rural hospitals may be the transition 

of many rural hospitals to CAHs that are 

paid outside the IPPS. The number of 

rural hospitals in our analysis fell from 

2,243 in FY 1996 to 1,211 in FY 2004, 

as the inpatient Medicare capital 

margins realized by rural hospitals fell 

from 17.2 percent to -2.9 percent. This 

suggests that more rural hospitals with 

relatively higher inpatient Medicare 

capital margins have made the 

transition to CAH status. However, it 

remains to be seen whether this trend in 

inpatient Medicare capital margins will 

continue as the relative numbers of 

CAHs and rural hospitals subject to the 

IPPS stabilize. The low aggregate for 

nonteaching hospitals is largely a 

function of the effect of the low, and for 

some years even negative, margin of the 

rural hospitals, as discussed earlier. 

We believe that there could be a 

number of reasons for the relatively high 

margins that most IPPS hospitals have 

realized under the capital IPPS. One 

possibility is that the updates to the 

capital IPPS rates have been higher than 

the actual increases in Medicare 

inpatient capital costs that hospitals 

have experienced in recent years. As we 

discuss in section III. of the Addendum 

to this proposed rule, we update the 

capital standard Federal rate on the 

basis of an analytical framework that 

takes into account changes in a capital 

input price index (CIPI) and several 

other policy adjustment factors. 

Specifically, we have adjusted the 

projected CIPI rate-of-increase as 

appropriate each year for case-mix 

index-related changes, for intensity, and 

for errors in previous CIPI forecasts. 

Under the framework that we have been 

using, the update factor for FY 2008 

would be 0.8 percent, based on the best 

data available at this time. That update 

factor is derived from a projected 1.2 

percent increase in the CIPI, a 0.0 

percent adjustment for intensity, a 0.0 

percent adjustment for case-mix, a -0.4 

percent adjustment for the FY 2005 DRG 

reclassification and recalibration, and a 

forecast error correction of 0.0 percent. 

We discuss this update framework, and 

the computation of the policy 

adjustment factors, in section III. of the 

Addendum to this proposed rule. 

We believe that the CIPI is the most 

appropriate input price index for capital 

costs to measure capital price changes 

in a given year. We also believe that the 

update framework successfully captures 

several factors that should be taken into 

account in determining appropriate 

updates for hospitals subject to the 

capital IPPS. However, there may be 

factors affecting the rate-of-increase in 

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24822 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

capital costs that are not yet captured in 

our analytical framework. For example, 

hospitals may be experiencing 

productivity gains in their use of capital 

equipment. As productivity increases, 

hospitals would be able to reduce the 

number of inputs required to produce a 

unit of service. MedPAC has taken the 

position that payment ‘‘rate for health 

care providers should be set so that the 

Federal Government benefits from 

providers’ productivity gains, just as 

private purchasers of goods in 

competitive markets benefit from the 

productivity gains of their suppliers.’’ 

MedPAC has, therefore, included a 

productivity improvement target in its 

framework for updating Medicare 

hospital payments on the grounds that 

‘‘as a prudent purchaser, Medicare 

should also require some productivity 

gains each year from its providers.’’ 

(MedPAC, Report to Congress, March 

2006, p. 66) While we have not as yet 

included a specific productivity factor, 

such as MedPAC’s productivity 

improvement target, in our analytical 

frameworks for updating the IPPS 

payment rates, we will continue to 

study the appropriateness of adopting 

such a measure. 

Another possible reason for the 

relatively high margins of most capital 

IPPS hospitals may be that the payment 

adjustments provided under the system 

are too high, or perhaps even 

unnecessary. Specifically, the 

adjustments for teaching hospitals, 

disproportionate share hospitals, and 

large urban hospitals appear to be 

contributing to excessive payment levels 

for these classes of hospitals. Since the 

inception of the capital IPPS in FY 

1992, the system has provided 

adjustments for teaching hospitals (the 

IME adjustment factor, under § 412.322 

of the regulations), disproportionate 

share hospitals (the DHS adjustment 

factor, under § 412.320), and large 

urban hospitals (the large urban location 

adjustment factor, under § 412.316((b)). 

The classes of hospitals eligible for 

these adjustments have been realizing 

much higher margins than other 

hospitals under the system. Specifically, 

teaching hospitals (11.6 percent for FYs 

1998 through 2004), urban hospitals (8.3 

percent), and disproportionate share 

hospitals (8.4 percent) have significant 

positive margins. Other classes of 

hospitals have experienced much lower 

margins, especially rural hospitals (0.2 

percent for FYs 1998 through 2004) and 

nonteaching hospitals (1.3 percent). The 

three groups of hospitals that have been 

realizing especially high margins under 

the capital IPPS are, therefore, classes of 

hospitals that are eligible to receive one 

or more specific payment adjustments 

under the system. We believe that the 

evidence indicates that these 

adjustments have been contributing to 

the significantly large positive margins 

experienced by the classes of hospitals 

eligible for these adjustments. 

We believe that the data on inpatient 

hospital Medicare capital margins, as 

discussed above, provide sufficient 

evidence that some adjustment of the 

updates under the capital IPPS is 

warranted at this time. In light of the 

significant disparities in the margin 

performances of different classes of 

hospitals, we do not believe that an 

adjustment to the updates for FYs 2008 

and 2009 should apply equally to all 

hospitals that are paid under the capital 

IPPS. In particular, an adjustment to the 

updates should take into account the 

much lower margins of rural hospitals 

(0.2 percent for the period from FY 1998 

through FY 2004) compared to urban 

hospitals (8.3 percent during that 

period). We also believe that any initial 

adjustment to the rate should be 

relatively modest. One reason is that 

any adjustment should avoid 

unwarranted disruption to hospital 

finances: because of the nature of capital 

spending, long periods of time can be 

necessary for hospitals to adjust 

adequately to significant changes in 

payment. Therefore, for FYs 2008 and 

2009, we are proposing that the update 

to the capital standard Federal rate for 

urban hospitals will be 0.0 percent, in 

place of the 0.8 percent update that 

would otherwise be provided in FY 

2008 under the update framework that 

we have been employing. (We have not 

yet determined the update that would 

be provided for FY 2009 under the 

framework.) However, in light of the 

margin analysis, we are also proposing 

to give rural hospitals the full 0.8 

percent update determined by the 

update framework in FY 2008. We 

anticipate that we will provide the full 

update to rural hospitals in FY 2009 as 

well, once we have determined what the 

update would be under the update 

framework. We are proposing to revise 

§ 412.308(c)(1) of the regulations 

accordingly. For purposes of the update 

in FYs 2008 and 2009, an urban hospital 

is any hospital located in an area that 

meets the definitions under §

412.64(b)(1)(ii)(A) or (b)(1)(ii)(B), or §

412.64(b)(3). A rural hospital is any 

hospital that does not meet those 

definitions, or that is reclassified as 

rural under § 412.103. For subsequent 

years, we will continue to analyze the 

data concerning the adequacy of 

payments under the capital IPPS, and 

we may propose additional adjustments, 

positive or negative, as they are 

warranted. We will also continue to 

study our update framework and will 

consider whether adoption of additional 

or revised adjustments to account for 

other factors affecting capital cost 

changes may be warranted. 

In addition, we are also proposing to 

eliminate, for FYs 2008 and beyond, one 

of the payment adjustments that has 

been provided under the capital IPPS. 

Specifically, we are proposing to 

discontinue the 3.0 percent additional 

payment that has been provided to 

hospitals located in large urban areas. 

The consistent and significant positive 

margin of hospitals located in urban 

areas is strong evidence that it is not 

necessary to continue this adjustment. 

Therefore, we are proposing to amend §

412.316(b) of the regulations to provide 

that, effective for discharges on or after 

October 1, 2007, there will no longer be 

any additional payment for hospitals 

located in large urban areas, as currently 

provided under that section. When the 

payment adjustments were instituted at 

the inception of the program, the initial 

standard Federal payment rate was 

adjusted in a budget-neutral fashion to 

account for the expenditures that would 

be required by these adjustments. 

However, in light of the strong overall 

positive margins across the system, we 

are proposing not to increase the 

standard capital rate to account for 

expenditures otherwise payable due to 

this adjustment (approximately $147 

million). Rather, in light of the excessive 

capital IPPS payments over the period 

of FYs 1996 through 2004, we believe 

that it is appropriate for the program to 

realize savings from this proposal. 

We will also continue to study the 

adequacy of payments under the capital 

IPPS, and will consider whether it is 

appropriate to make further adjustments 

to the standard Federal capital rate and 

updates of the rate. While we are 

formally proposing an update of 0.0 

percent for urban hospitals, an update of 

0.8 percent for rural hospitals in FY 

2008, and elimination of the large urban 

add-on, we are also soliciting comment 

on additional adjustments to the capital 

payment structure. As we have noted 

above, the margin analysis indicates that 

several classes of hospitals have 

continuous, significant positive 

margins. The analysis indicates that the 

existing payment adjustments for 

teaching hospitals and disproportionate 

share hospitals are contributing to 

excessive payment levels for these 

classes of hospitals. Therefore, it may be 

appropriate to reduce these adjustments 

significantly, or even to eliminate them 

altogether, within the capital IPPS. 

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These payment adjustments, unlike the 

parallel adjustments under the operating 

IPPS, were not mandated by the Act. 

Rather, they were included within the 

original design of the capital IPPS under 

the Secretary’s broad authority under 

sections 1886(g)(1)(A) and (g)(1)(B) of 

the Act to include appropriate 

adjustments and exceptions within a 

capital IPPS. Therefore, we are 

considering whether it may be 

appropriate to develop a proposal to 

reduce or to terminate these payment 

adjustments in the near future. It is 

difficult to justify indefinite 

continuation of these adjustments in the 

light of the continuous, substantial 

positive margins realized by the classes 

of hospitals that qualify for them. When 

the payment adjustments were 

instituted at the inception of the 

program, the initial standard Federal 

payment rate was adjusted in a budgetneutral fashion to account for the 

expenditures that would be required by 

these adjustments. Therefore, if we 

decide to propose to reduce or eliminate 

these adjustments, we will also consider 

whether we should similarly adjust the 

Federal capital payment rate to account 

for all or a portion of these adjustments, 

effectively increasing the base payment 

rate for all hospitals (including rural, 

nonteaching, and non-DSH hospitals 

that do not benefit from these 

adjustments), while removing these 

special adjustments for the hospitals 

that have been eligible to receive them. 

We are also considering whether, in 

light of the substantial positive margins 

experienced by these teaching and DSH 

hospitals, the discontinuation of these 

adjustments should not result in a 

change to the standard capital rate and 

should instead result in savings to the 

program. We welcome comments on 

these potential proposals and on other 

means of appropriately adjusting and 

targeting payments under the capital 

IPPS, as well as on the proposals that 

we are formally making in this proposed 

rule. 

VI. Proposed Changes for Hospitals and 

Hospital Units Excluded From the IPPS 

(If you choose to comment on the 

issues in this section, please include the 

caption ‘‘Excluded Hospitals and 

Hospital Units’’ at the beginning of your 

comment.) 

A. Payments to Existing and New 

Excluded Hospitals and Hospital Units 

Historically, hospitals and hospital 

units excluded from the prospective 

payment system received payment for 

inpatient hospital services they 

furnished on the basis of reasonable 

costs, subject to a rate-of-increase 

ceiling. An annual per discharge limit 

(the target amount as defined in §

413.40(a)) was set for each hospital or 

hospital unit based on the hospital’s 

own cost experience in its base year. 

The target amount was multiplied by 

the Medicare discharges and applied as 

an aggregate upper limit (the ceiling as 

defined in § 413.40(a)) on total 

inpatient operating costs for a hospital’s 

cost reporting period. Prior to October 1, 

1997, these payment provisions applied 

consistently to all categories of excluded 

providers (rehabilitation hospitals and 

units (now referred to as IRFs), 

psychiatric hospitals and units (now 

referred to as IPFs), LTCHs, children’s 

hospitals, and cancer hospitals). 

Payment for children’s hospitals and 

cancer hospitals that are excluded from 

the IPPS continues to be subject to the 

rate-of-increase ceiling based on the 

hospital’s own historical cost 

experience. (We note that, in accordance 

with § 403.752(a) of the regulations, 

RNHCIs are also subject to the rate-ofincrease limits established under §

413.40 of the regulations. IRFs, IPFs, 

and LTCHs were paid previously under 

the reasonable cost methodology. 

However, the statute was amended to 

provide for the implementation of 

prospective payment systems for IRFs, 

IPFs, and LTCHs. In general, the 

prospective payment systems for IRFs, 

IPFs, and LTCHs provide(d) transition 

periods of varying lengths during which 

time a portion of the prospective 

payment is (was) based on cost-based 

reimbursement rules under Part 413 

(certain providers do not receive a 

transition period or may elect to bypass 

the transition as applicable under 

Subparts N, O, and P). We note that the 

various transition periods provided for 

under the IRF PPS, IPF PPS, and LTCH 

PPS have ended or will soon end.) 

For cost reporting periods beginning 

on or after October 1, 2002, all IRFs are 

paid 100 percent of the adjusted Federal 

rate under the IRF PPS. Therefore, for 

cost reporting periods beginning on or 

after October 1, 2002, no portion of an 

IRF PPS payment is subject to Part 413. 

Similarly, for cost reporting periods 

beginning on or after October 1, 2006, 

all LTCHs are paid 100 percent of the 

adjusted Federal rate under the LTCH 

PPS. Therefore, for cost reporting 

periods beginning on or after October 1, 

2006, no portion of the LTCH PPS 

payment is subject to 42 CFR part 413. 

However, except as provided in §

412.426(c), IPFs remain under a blend 

methodology for cost reporting periods 

beginning on or after January 1, 2005, 

and before January 1, 2008. 

For IPFs paid under the blend 

methodology, the portion of the IPF PPS 

payment that is based on reasonable 

cost principles is subject to the rules of 

42 CFR part 413. In order to calculate 

the portion of the PPS payment that is 

based on reasonable cost principles, it is 

necessary to determine whether the IPF 

would be considered ‘‘existing’’ for 

purposes of section 1886(b)(3)(H) of the 

Act or ‘‘new’’ for purposes of section 

1886(b)(7) of the Act. We note that 

readers should not confuse an IPF that 

is considered ‘‘new’’ for purposes of 

section 1886(b)(7) of the Act and §

413.40(f)(2)(ii) of the regulations with an 

IPF that is considered ‘‘new’’ under §

412.426(c) of the reguations. Any IPF 

that, under present or previous 

ownership or both, has its first cost 

reporting period as an IPF beginning on 

or after January 1, 2005, is considered 

‘‘new’’ for purposes of § 412.426(c). An 

IPF that is considered ‘‘new’’ under §

412.426(c) is paid based on 100 percent 

of the Federal per diem payment 

amount. Consequently, only those IPFs 

considered ‘‘new’’ under section 

1886(b)(7) of the Act, but not ‘‘new’’ 

under § 412.426(c) of the regulations 

will be paid under a PPS blended 

payment methodology. An IPF 

considered ‘‘new’’ for purposes of §

413.40(f)(2)(ii) would have its 

‘‘reasonable cost-based’’ portion of its 

prospective payment subject to §

413.40(f)(2)(ii) and § 413.40(c)(4)(v), as 

applicable. An IPF considered ‘‘new’’ 

for purposes of section 1886(b)(7) of the 

Act has the target amount for its third 

cost reporting period determined in 

accordance with sections 

1886(b)(7)(A)(ii) and 1886(b)(3)(A)(ii) of 

the Act. For the fourth and subsequent 

cost reporting periods, the target amount 

is calculated in accordance with section 

1886(b)(3)(A)(ii) of the Act. An IPF that 

would be considered ‘‘existing’’ for 

purposes of section 1886(b)(3)(H) of the 

Act has the target amount for the 

‘‘reasonable cost-based’’ portion of its 

prospective payment determined in 

accordance with section 

1886(b)(3)(A)(ii) of the Act and the 

regulations at § 413.40(c)(4)(ii). 

We are proposing that the applicable 

percentage increase to update the target 

amount for the reasonable cost-based 

portion of the PPS payment of an IPF 

that is considered existing under section 

1886(b)(3)(H) of the Act or new under 

section 1886(b)(7) of the Act, but not 

new under § 412.426(c), is 3.4 percent. 

(However, if more current data become 

available prior to publication of the final 

rule, we will use those data for updating 

the market basket.) 

B. Separate PPS for IRFs 

Section 1886(j) of the Act, as added by 

section 4421(a) of Pub. L. 105–33, 

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24824 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

provided for a phase-in of a case-mix 

adjusted PPS for inpatient hospital 

services furnished by IRFs for cost 

reporting periods beginning on or after 

October 1, 2000, and before October 1, 

2002, with payments based entirely on 

the adjusted Federal prospective 

payment for cost reporting periods 

beginning on or after October 1, 2002. 

Section 1886(j) of the Act was amended 

by section 125 of Pub. L. 106–113 to 

require the Secretary to use a discharge 

as the payment unit under the PPS for 

inpatient hospital services furnished by 

IRFs and to establish classes of patient 

discharges by functional-related groups. 

Section 305 of Pub. L. 106–554 further 

amended section 1886(j) of the Act to 

allow IRFs, subject to the blend 

methodology, to elect to be paid the full 

Federal prospective payment rather than 

the transitional period payments 

specified in the Act. 

On August 7, 2001, we issued a final 

rule in the Federal Register (66 FR 

41316) establishing the PPS for IRFs, 

effective for cost reporting periods 

beginning on or after January 1, 2002. 

There was a transition period for cost 

reporting periods beginning on or after 

January 1, 2002, and ending before 

October 1, 2002. For cost reporting 

periods beginning on or after October 1, 

2002, payments are based entirely on 

the adjusted Federal prospective 

payment rate determined under the IRF 

PPS. 

C. Separate PPS for LTCHs 

On August 30, 2002, we issued a final 

rule in the Federal Register (67 FR 

55954) establishing the PPS for LTCHs, 

effective for cost reporting periods 

beginning on or after October 1, 2002. 

Except for a LTCH that made an election 

under § 412.533(c) or a LTCH that is 

defined as new under § 412.23(e)(4), 

there was a transition period for cost 

reporting periods beginning on or after 

October 1, 2002, and ending before 

October 1, 2007. For cost reporting 

periods beginning on or after October 1, 

2006, total LTCH PPS payments are 

based on 100 percent of the Federal rate. 

D. Separate PPS for IPFs 

In accordance with section 124 of 

Pub. L. 106–113 and section 405(g)(2) of 

Pub. L. 108–173, we established a PPS 

for inpatient hospital services furnished 

in IPFs. On November 15, 2004, we 

issued in the Federal Register a final 

rule (69 FR 66922) that established the 

IPF PPS, effective for IPF cost reporting 

periods beginning on or after January 1, 

2005. Under the final rule, we compute 

a Federal per diem base rate to be paid 

to all IPFs for inpatient psychiatric 

services based on the sum of the average 

routine operating, ancillary, and capital 

costs for each patient day of psychiatric 

care in an IPF, adjusted for budget 

neutrality. The Federal per diem base 

rate is adjusted to reflect certain patient 

characteristics, including age, specified 

DRGs, selected high-cost comorbidities, 

days of the stay, and certain facility 

characteristics, including a wage index 

adjustment, rural location, indirect 

teaching costs, the presence of a fullservice emergency department, and 

COLAs for IPFs located in Alaska and 

Hawaii. We have established a 3-year 

transition period during which IPFs 

whose first cost reporting periods began 

before January 1, 2005, will be paid 

based on a blend of reasonable costbased payment and IPF PPS payments. 

For cost reporting periods beginning on 

or after January 1, 2008, all IPFs will be 

paid 100 percent of the Federal per 

diem payment amount. 

E. Determining Proposed LTCH Cost-toCharge Ratios (CCRs) Under the LTCH 

PPS 

(If you choose to comment on the 

issues in this section, please include the 

caption ‘‘LTCH PPS CCRs and Outlier 

Payments’’ at the beginning of your 

comment.) 

In determining both high-cost outlier 

and short-stay outlier payments under 

the LTCH PPS (at § 412.525(a) and §

412.529, respectively), we calculate the 

estimated cost of the case by 

multiplying the LTCH’s overall CCR by 

the Medicare allowable charges for the 

case. Under the LTCH PPS, a single 

prospective payment per discharge is 

made for both inpatient operating and 

capital-related costs, and, therefore, we 

compute a single ‘‘overall’’ or ‘‘total’’ 

LTCH-specific CCR based on the sum of 

LTCH operating and capital costs (as 

described in Chapter 3, section 150.24, 

of the Medicare Claims Processing 

Manual (CMS Pub. 100–4)) as compared 

to total charges. Specifically, a LTCH’s 

CCR is calculated by dividing a LTCH’s 

total Medicare costs (that is, the sum of 

its operating and capital inpatient 

routine and ancillary costs) by its total 

Medicare charges (that is, the sum of its 

operating and capital inpatient routine 

and ancillary charges) (72 FR 48117). 

In the June 9, 2003 IPPS high-cost 

outlier final rule (68 FR 34498), we 

made revisions to our policies 

concerning the determination of LTCHs’ 

CCRs and the reconciliation of high-cost 

outlier and short-stay outlier payments 

under the LTCH PPS. As we stated in 

that final rule (68 FR 34507), because 

the LTCH PPS high-cost outlier and 

short-stay outlier policies are modeled 

after the IPPS outlier policy, we believe 

they are susceptible to the same 

payment vulnerabilities. 

In the FY 2007 IPPS final rule (71 FR 

48115 through 48122), we amended our 

regulations and, for discharges 

occurring on or after October 1, 2006, 

refined the methodology for 

determining the annual CCR ceiling and 

statewide average CCRs. We also 

codified, with modifications and 

editorial clarifications, our policy for 

the reconciliation of high-cost outlier 

and short-stay outlier payments under 

the LTCH PPS. We indicated that 

because, historically, updates to the 

LTCH PPS CCR ceiling and statewide 

average CCRs have been effective on 

October 1, we would make these 

updates (and include relevant impact 

data) as a part of the IPPS rulemaking 

cycle. 

Specifically, in the FY 2007 IPPS final 

rule (71 FR 48117 through 48121), 

under the broad authority of section 123 

of Pub. L. 106–113 and section 307(b)(1) 

of Pub. L. 106–554, we established 

under the LTCH PPS high-cost outlier 

policy at § 412.525(a)(4)(iv)(C) and the 

LTCH PPS short-stay outlier policy at §

412.529(c)(3)(iv)(C), for discharges 

occurring on or after October 1, 2006, 

that the fiscal intermediary (or currently 

the MAC, if applicable) may use a 

statewide average CCR, which is 

established annually by CMS, if it is 

unable to determine an accurate CCR for 

a LTCH in one of the following three 

circumstances: (1) new LTCHs that have 

not yet submitted their first Medicare 

cost report (for this purpose, a new 

LTCH is defined as an entity that has 

not accepted assignment of an existing 

hospital’s provider agreement in 

accordance with § 489.18); (2) LTCHs 

whose CCR is in excess of the LTCH 

CCR ceiling; and (3) other LTCHs for 

whom data with which to calculate a 

CCR are not available (for example, 

missing or faulty data). (Other sources of 

data that the fiscal intermediary (or, if 

applicable, the MAC) may consider in 

determining a LTCH’s CCR include data 

from a different cost reporting period for 

the LTCH, data from the cost reporting 

period preceding the period in which 

the hospital began to be paid as a LTCH 

(that is, the period of at least 6 months 

that it was paid as a short-term acute 

care hospital), or data from other 

comparable LTCHs, such as LTCHs in 

the same chain or in the same region.) 

As noted above, a LTCH is assigned 

the applicable statewide average CCR if, 

among other things, a LTCH’s CCR is 

found to be in excess of the applicable 

maximum CCR threshold (that is, the 

LTCH CCR ceiling). As we explained in 

the FY 2007 IPPS final rule (71 FR 

48117), CCRs above this threshold are 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24825 

most likely due to faulty data reporting 

or entry, and, therefore, these CCRs 

should not be used to identify and make 

payments for outlier cases. Such data 

are clearly errors and should not be 

relied upon. Thus, under our 

established policy, if a LTCH’s 

calculated CCR is above the applicable 

ceiling, the applicable LTCH PPS 

statewide average CCR is assigned to the 

LTCH instead of the CCR computed 

from its most recent (settled or 

tentatively settled) cost report data. 

We revised our methodology for 

determining the annual CCR ceiling and 

statewide average CCRs under the LTCH 

PPS effective October 1, 2006, as we 

explained in the FY 2007 IPPS final rule 

(71 FR 48117 through 48121), because 

we believe that those changes are 

consistent with the LTCH PPS single 

payment rate for inpatient operating and 

capital costs. Therefore, under the broad 

authority of section 123 of Pub. L. 106– 

113 and section 307(b)(1) of Pub. L. 

106–554, in that same final rule, we 

revised our methodology used to 

determine the LTCH CCR ceiling. For 

discharges occurring on or after October 

1, 2006, we established that the LTCH 

CCR ceiling specified under §

412.525(a)(4)(iv)(C)(2) for high-cost 

outliers and under §

412.529(c)(3)(iv)(C)(2) for short-stay 

outliers is calculated as 3 standard 

deviations above the corresponding 

national geometric mean total CCR 

(established and published annually by 

CMS). (The fiscal intermediary (or, if 

applicable, the MAC) may use a 

statewide average CCR if, among other 

things, a LTCH’s CCR is in excess of the 

LTCH CCR ceiling.) The LTCH total CCR 

ceiling is determined based on IPPS 

CCR data, by first calculating the ‘‘total’’ 

(that is, operating and capital) IPPS CCR 

for each hospital and then determining 

the average ‘‘total’’ IPPS CCR for all 

IPPS hospitals. (Our rationale for using 

IPPS hospital data is discussed in the 

FY 2007 IPPS final rule (71 FR 48117).) 

The LTCH CCR ceiling is then 

established at 3 standard deviations 

from the corresponding national 

geometric mean total CCR. (For further 

detail on our methodology for annually 

determining the LTCH CCR ceiling, we 

refer readers to the FY 2007 IPPS final 

rule (71 FR 48117 through 48119).) 

We also established that the LTCH 

‘‘total’’ CCR ceiling used under the 

LTCH PPS will continue to be published 

annually in the IPPS proposed and final 

rules, and the public should continue to 

consult the annual IPPS proposed and 

final rules for changes to the LTCH total 

CCR ceiling that would be effective for 

discharges occurring on or after October 

1 of each year. Accordingly, in the FY 

2007 IPPS final rule (71 FR 48119), we 

established a FY 2007 LTCH PPS total 

CCR ceiling of 1.321, effective for 

discharges occurring on or after October 

1, 2006. 

In this proposed rule, in accordance 

with § 412.525(a)(4)(iv)(C)(2) for highcost outliers and §

412.529(c)(3)(iv)(C)(2) for short-stay 

outliers, using our established 

methodology for determining the LTCH 

total CCR ceiling (described above), 

based on IPPS total CCR data from the 

December 2006 update to the ProviderSpecific File, we are proposing a total 

CCR ceiling of 1.273 under the LTCH 

PPS that would be effective October 1, 

2007. Furthermore, we are proposing 

that, if more recent data are available, 

we will use such data to determine the 

final total CCR ceiling under the LTCH 

PPS for FY 2008 using our established 

methodology described above. In addition, under the broad authority 

of section 123 of Pub. L. 106–113 and 

section 307(b)(1) of Pub. L. 106–554, in 

the FY 2007 IPPS final rule (71 FR 

48120), we revised our methodology to 

determine the statewide average CCRs 

under § 412.525(a)(4)(iv)(C) for highcost outliers and under §

412.529(c)(3)(iv)(C) for short-stay 

outliers for use under the LTCH PPS in 

a manner similar to the way we 

compute the ‘‘total’’ CCR ceiling using 

IPPS CCR data. Specifically, we first 

calculate the total (that is, operating and 

capital) CCR for each IPPS hospital. We 

then calculate the weighted average 

‘‘total’’ CCR for all IPPS hospitals in the 

rural areas of the State and the weighted 

average ‘‘total’’ CCR for all IPPS 

hospitals in the urban areas of the State. 

(For further detail on our methodology 

for annually determining the LTCH 

urban and rural statewide average CCRs, 

we refer readers to the FY 2007 IPPS 

final rule (71 FR 48119 through 48121).) 

We also established that the applicable 

statewide average ‘‘total’’ (operating and 

capital) CCRs used under the LTCH PPS 

will continue to be published annually 

in the IPPS proposed and final rules, 

and the public should continue to 

consult the annual IPPS proposed and 

final rules for changes to the applicable 

statewide average total CCRs that would 

be effective for discharges occurring on 

or after October 1 each year. 

Accordingly, in the FY 2007 IPPS final 

rule (71 FR 48122), the FY 2007 LTCH 

PPS statewide average total CCRs for 

urban and rural hospitals, effective for 

discharges occurring on or after October 

1, 2006, were presented in Table 8C of 

the Addendum of that final rule (71 FR 

48303). 

In this proposed rule, in accordance 

with § 412.525(a)(4)(iv)(C) for high-cost 

outliers and § 412.529(c)(3)(iv)(C) for 

short-stay outliers, using our established 

methodology for determining the LTCH 

statewide average CCRs (described 

above), based on the most recent 

complete IPPS total CCR data from the 

December 2006 update of the ProviderSpecific File, the proposed LTCH PPS 

statewide average total CCRs for urban 

and rural hospitals that would be 

effective October 1, 2007, are presented 

in Table 8C of the Addendum to this 

proposed rule. Furthermore, we are 

proposing that, if more recent data are 

available, we would use such data to 

determine the final statewide average 

total CCRs for urban and rural hospitals 

under the LTCH PPS for FY 2008 using 

our established methodology described 

above. 

We note that, for this proposed rule, 

as we established when we revised our 

methodology for determining the 

applicable LTCH statewide average 

CCRs in the FY 2007 IPPS final rule (71 

FR 48119 through 48121), and as is the 

case under the IPPS, all areas in the 

District of Columbia, New Jersey, Puerto 

Rico, and Rhode Island are classified as 

urban, and therefore there are no 

proposed rural statewide average total 

CCRs listed for those jurisdictions in 

Table 8C of the Addendum to this 

proposed rule. In addition, as we 

established when we revised our 

methodology for determining the 

applicable LTCH statewide average 

CCRs in that same final rule, and as is 

the case under the IPPS, although 

Massachusetts has areas that are 

designated as rural, there are no shortterm acute care IPPS hospitals or LTCHs 

located in those areas as of December 

2006. Therefore, there is no proposed 

rural statewide average total CCR listed 

for rural Massachusetts in Table 8C of 

the Addendum of this proposed rule. As 

we also established when we revised 

our methodology for determining the 

applicable LTCH statewide average 

CCRs in the FY 2007 IPPS final rule (71 

FR 48120 through 48121), in 

determining the urban and rural 

statewide average total CCRs for 

Maryland LTCHs paid under the LTCH 

PPS, we used, as a proxy, the national 

average total CCR for urban IPPS 

hospitals and the national average total 

CCR for rural IPPS hospitals, 

respectively. We use this proxy because 

we believe that the CCR data on the 

Provider-Specific File for Maryland 

hospitals may not be accurate (as 

discussed in greater detail in that same 

final rule (71 FR 48120)). 

VII. Services Furnished to Beneficiaries 

in Custody of Penal Authorities 

(If you choose to comment on issues 

in this section, please include the 

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24826 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

caption ‘‘Beneficiaries in Custody’’ at 

the beginning of your comment.) 

Section 1862(a)(2) of the Act prohibits 

payment under Medicare Part A or Part 

B for any items or services for which the 

beneficiary has no legal obligation to 

pay, and which no other person or 

organization (such as a prepayment plan 

of which the beneficiary is a member) 

has a legal obligation to provide or pay 

for the service. Our current regulations 

at § 411.4(b) specify the special 

conditions when Medicare payment 

may be made for services furnished to 

individuals in custody of penal 

authorities. These regulatory conditions 

include: (1) State or local law requires 

those individuals or groups of 

individuals to repay the cost of medical 

services they receive while in custody; 

and (2) the State or local government 

entity enforces the requirement to pay 

by billing all such individuals, whether 

or not covered by Medicare or any other 

health insurance, and by pursuing 

collection of the amounts they owe in 

the same way and with the same vigor 

that it pursues the collection of other 

debts. 

However, § 411.4(b) does not define 

‘‘custody’’ and does not clearly state 

that CMS will not defer to a particular 

State or local government’s definition 

(or interpretation) of what constitutes 

‘‘custody.’’ In this proposed rule, we are 

proposing to specify that, for purposes 

of Medicare payment, individuals who 

are in ‘‘custody’’ include, but are not 

limited to, individuals who are under 

arrest, incarcerated, imprisoned, 

escaped from confinement, under 

supervised release, required to reside in 

mental health facilities, required to 

reside in halfway houses, required to 

live under home detention, or confined 

completely or partially in any way 

under a penal statute or rule. We believe 

that this proposed definition of 

‘‘custody’’ is in accordance with how 

custody has been defined by Federal 

courts for purposes of the habeas corpus 

protections of the Constitution. For 

example, the term ‘‘custody’’ is not 

limited solely to physical confinement. 

(Sanders v. Freeman, 221 F.3d 846, 850– 

51 (6th Cir. 2000).) Individuals on 

parole, probation, bail, or supervised 

release may be ‘‘in custody.’’ 

VIII. MedPAC Recommendations 

(If you choose to comment on issues 

in this section, please include the 

caption ‘‘MedPAC Update 

Recommendation’’ at the beginning of 

your comment.) 

We are required by section 

1886(e)(4)(B) of the Act to respond to 

MedPAC’s IPPS recommendations in 

our annual proposed IPPS rule. We have 

reviewed MedPAC’s March 2007 

‘‘Report to the Congress: Medicare 

Payment Policy’’ and have given it 

careful consideration in conjunction 

with the proposed policies set forth in 

this document. MedPAC’s 

Recommendation 2A–1 states that, ‘‘The 

Congress should increase payment rates 

for the acute inpatient and outpatient 

prospective payment systems in 2008 by 

the projected rate of increase in the 

hospital market basket index, 

concurrent with implementation of a 

quality incentive payment program.’’ 

This recommendation is discussed in 

Appendix B to this proposed rule. 

Recommendation 2A–2: MedPAC 

recommended that, ‘‘Concurrent with 

implementation of severity adjustment 

to Medicare’s diagnosis related group 

payments, the Congress should reduce 

the indirect medical education 

adjustment in fiscal year 2008 by 1 

percentage point to 4.5 percent per 10 

percent increment in the resident-to-bed 

ratio. The funds obtained from reducing 

the indirect medical education 

adjustment should be used to fund a 

quality incentive payment system.’’ 

MedPAC further states that the IME 

adjustment is ‘‘set above the empirical 

level which contributes to the large 

differences between teaching and 

nonteaching hospitals in financial 

performance under Medicare.’’ MedPAC 

asserts that since there is no 

accountability for how IME funds are 

used, and teaching hospitals will benefit 

from implementation of the severity 

adjusted DRGs the IME adjustment 

should be reduced in FY 2008. 

Response: We note that, MedPAC 

stated in its March 2007 Report that 

Congress made a conscious decision to 

fund the IME adjustment above the 

empirical level due to the concern for 

how teaching hospitals would fare 

under the PPS. Because the IME 

adjustment is set by Congress, as cited 

in section 1886(d)(5)(B) of the Act, any 

change to the IME adjustment, whether 

it is a 1 percentage point reduction or 

reduction of the IME adjustment to its 

empirical level, would require a 

statutory change. Therefore, absent a 

change to the IME provision in the 

Medicare statute for FY 2008, the IME 

adjustment will remain at the current 

level required by the statute, as 

specified in section IV.D. of this 

preamble. 

Recommendation 2A–3: MedPAC 

recommended that, ‘‘The Secretary 

should improve the form and 

accompanying instructions for 

collecting data on uncompensated care 

in the Medicare cost report and require 

hospitals to report using the revised 

form as soon as possible.’’ MedPAC 

indicated that ‘‘accurate data on 

hospitals’’ charity care and bad debts 

are crucial to any effort to help develop 

a federal payment mechanism to help 

hospitals with their uncompensated 

care.’’ 

Response: MedPAC convened an 

‘‘Expert Panel on Measuring 

Uncompensated Care’’ on May 5, 2005, 

to address concerns raised by 

stakeholders on the usefulness of the S– 

10 Worksheet data. CMS’ 

representatives participated in the 

discussions on this expert panel, and 

listened carefully to the concerns of 

MedPAC and the stakeholders about the 

S–10 Worksheet. MedPAC is 

recommending that we adopt the list of 

recommended changes to the S–10 

Worksheet that resulted from the panel’s 

discussion. CMS is currently 

undertaking a major update of the 

hospital cost report and will be making 

changes to the S–10 Worksheet form 

and accompanying instructions based 

on the panel’s discussions with 

MedPAC. 

In sections II.C. through E. of the 

preamble of this proposed rule, we 

further address the recommendations 

included in Recommendation 1 and 

Recommendation 3 in the March 2005 

Report to Congress on Physician-Owned 

Specialty Hospitals. Recommendation 1 

relates to refining the DRGs used under 

the IPPS to more fully capture 

differences in severity of illness among 

patients; basing the DRG relative 

weights on the estimated cost of 

providing care rather than on charges; 

and basing the weights on the national 

average of hospitals’ relative values in 

each DRG. Recommendation 3 

recommended that the Secretary 

implement MedPAC’s recommended 

policies over a transition period. 

For further information relating 

specifically to the MedPAC reports or to 

obtain a copy of the reports, contact 

MedPAC at (202) 653–7220, or visit 

MedPAC’s website at: http:// 

www.medpac.gov. 

IX. Other Required Information 

A. Requests for Data from the Public 

In order to respond promptly to 

public requests for data related to the 

prospective payment system, we have 

established a process under which 

commenters can gain access to raw data 

on an expedited basis. Generally, the 

data are available in computer tape or 

cartridge format; however, some files are 

available on diskette as well as on the 

Internet at: http://www.cms.hhs.gov/ 

providers/ hipps. Data files and the cost 

for each file, if applicable, are listed 

below. Anyone wishing to purchase 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24827 

data tapes, cartridges, or diskettes 

should submit a written request along 

with a company check or money order 

(payable to CMS-PUF) to cover the cost 

to the following address: Centers for 

Medicare & Medicaid Services, Public 

Use Files, Accounting Division, P.O. 

Box 7520, Baltimore, MD 21207–0520, 

(410) 786–3691. Files on the Internet 

may be downloaded without charge. 

1. CMS Wage Data Public Use File 

This file contains the hospital hours 

and salaries from Worksheet S–3, Parts 

II and Parts III from FY 2004 cost reports 

used to create the proposed FY 2008 

IPPS wage index. The file is typically 

available by the end of February each 

year for the NPRM and will be available 

by the beginning of May for the final 

rule. 

Processing year Wage 

data year 

PPS fiscal year 

2007 .......................... 2004 2008 

2006 .......................... 2003 2007 

2005 .......................... 2002 2006 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2006 through 

2008 IPPS Updates. 

2. CMS Occupational Mix Data Public 

Use File 

This file contains the occupational 

mix survey data to be used to compute 

the occupational mix adjusted wage 

indexes. The file is typically available 

by the end of February each year for the 

NPRM and will be available by the 

beginning of May for the final rule. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 PPS 

Update. 

3. Final AHWs for FY 2007 and 

Proposed AHWs for FY 2008 by CBSA 

Public Use File 

This file includes CBSAs, and the 

AHWs by CBSA for FY 2007 (final data) 

and FY 2008 (proposed data). This file 

is typically available by the end of 

February each year for the NPRM. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Proposed Rule Update. 

4. FY 2008 Occupational Mix Adjusted 

and Unadjusted AHWs by Provider 

This file is available after publication 

of each IPPS NPRM and final rule, and 

includes provider number, CBSA, the 

provider’s unadjusted and occupational 

mix adjusted AHW, and the percent 

difference between the two. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Update. 

5. FY 2008 Occupational Mix Adjusted 

and Unadjusted AHWs and Pre-Reclass 

Wage Indexes by CBSA 

This file is available after publication 

of each IPPS NPRM and final rule, and 

is organized by CBSA, and contains 

total CBSA occupational mix wages, 

total CBSA hours, CBSA occupational 

mix adjusted AHWs, CBSA 

occupational mix adjusted pre-reclass 

wage indexes, total CBS unadjusted 

wages, CBSA unadjusted AHWs, and 

unadjusted pre-reclass wage indexes. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS /WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Update. 

6. FY 2008 Occupational Mix Factor by 

Provider Public Use File 

This file is available after publication 

of each IPPS NPRM and final rule, and 

is organized by provider, and includes 

occupational mix adjusted and 

unadjusted wages, occupational mix 

adjusted and unadjusted AHWs, the 

nurse occupational mix adjustment 

factor, and the CBSA nurse occupational 

mix adjustment factor. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Update. 

7. FY 2008 Average Hourly Wage by 

Provider and CBSA Public Use File 

This file is available after publication 

of each IPPS NPRM and final rule, and 

includes occupational mix adjusted 

wages, hours, occupational mix adjusted 

AHWs, and pre-reclass occupational 

mix adjusted wage indexes, by provider 

and CBSA. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Update. 

8. IPPS SSA/FIPS CBSA State and 

County Crosswalk 

This file contains a crosswalk of State 

and county codes used by the Social 

Security Administration (SSA) and the 

Federal Information Processing 

Standards (FIPS), county name, Core 

Based Statistical Area (CBSA), and the 

historical list of Metropolitan Statistical 

Areas (MSAs). 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ FFD/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Update. 

9. FY 2008 Proposed Rule AHW by 

Provider Area Listing 

This file contains a spreadsheet with 

two tabs: One for providers that are 

geographically located in an area, and 

one for providers that are reclassifying. 

The first tab includes the pre-reclass 

occupational mix adjusted total wages 

and AHWs by provider and CBSA, and 

the second tab lists the providers that 

are reclassifying and their post-reclass 

occupational mix adjusted total wages 

and AHWs by provider and CBSA. This 

file is typically posted after publication 

of the IPPS NPRM each year. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2008 IPPS 

Proposed Rule Update. 

10. PPS–IV to PPS–XII Minimum Data 

Set 

The Minimum Data Set contains cost, 

statistical, financial, and other 

information from Medicare hospital cost 

reports. The data set includes only the 

most current cost report (as submitted, 

final settled, or reopened) submitted for 

a Medicare participating hospital by the 

Medicare fiscal intermediary to CMS. 

This data set is updated at the end of 

each calendar quarter and is available 

on the last day of the following month. 

Media: Compact Disc (CD). 

File Cost: $100.00 per year. 

I 

Periods 

beginning 

on or after 

and before 

PPS–IV ............. 10/01/86 10/01/87 

PPS–V .............. 10/01/87 10/01/88 

PPS–VI ............. 10/01/88 10/01/89 

PPS–VII ............ 10/01/89 10/01/90 

PPS–VIII ........... 10/01/90 10/01/91 

PPS–IX ............. 10/01/91 10/01/92 

PPS–X .............. 10/01/92 10/01/93 

PPS–XI ............. 10/01/93 10/01/94 

PPS–XII ............ 10/01/94 10/01/95 

(Note: The PPS–XIII, PPS–XIV, PPS–XV, 

PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX 

PPS–XX, PPS–XXI, and PPS–XX–II Minimum 

Data Sets are part of the PPS–XIII, PPS–XIV, 

PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, 

PPS–XIX, PPS–XX, PPS–XXI, and PPS–XXII 

Hospital Data Set Files (refer to item 10 

below).) 

11. PPS–XIII to PPS–XXII Hospital Data 

Set 

The file contains cost, statistical, 

financial, and other data from the 

Medicare Hospital Cost Report. The data 

set includes only the most current cost 

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24828 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

report (as submitted, final settled, or 

reopened) submitted for a Medicarecertified hospital by the Medicare fiscal 

intermediary to CMS. The data set is 

updated at the end of each calendar 

quarter and is available on the last day 

of the following month. 

Media: Compact Disc (CD). 

File Cost: $100.00. 

I 

Periods 

beginning 

on or after 

and before 

PPS–XIII ........... 10/01/95 10/01/96 

PPS–XIV ........... 10/01/96 10/01/97 

PPS–XV ............ 10/01/97 10/01/98 

PPS–XVI ........... 10/01/98 10/01/99 

PPS–XVII .......... 10/01/99 10/01/00 

PPS–XVIII ......... 10/01/00 10/01/01 

PPS–XIX ........... 10/01/01 10/01/02 

PPS–XX ............ 10/01/02 10/01/03 

PPS–XXI ........... 10/01/03 10/01/04 

PPS–XXII .......... 10/01/04 10/01/05 

12. Provider-Specific File 

This file is a component of the 

PRICER program used in the fiscal 

intermediary’s system to compute DRG 

payments for individual bills. The file 

contains records for all prospective 

payment system eligible hospitals, 

including hospitals in waiver States, 

and data elements used in the 

prospective payment system 

recalibration processes and related 

activities. Beginning with December 

1988, the individual records were 

enlarged to include pass-through per 

diems and other elements. 

Media: Internet at http://www.cms. 

hhs.gov/ProspMedicareFeeSvcPmt Gen/ 

Downloads/INP—psf0107.zip. 

Periods Available: FY 2008 PPS 

Update. 

13. CMS Medicare Case-Mix Index File 

The Medicare case-mix indexes by 

provider number are published in table 

2 of each year’s update of the Medicare 

hospital inpatient prospective payment 

system. The case-mix index is a measure 

of the costliness of cases treated by a 

hospital relative to the cost of the 

national average of all Medicare hospital 

cases, using DRG weights as a measure 

of relative costliness of cases. Two 

versions of this file are created each 

year. 

They support the following: 

<bullet≤ NPRM published in the 

Federal Register. 

<bullet≤ Final rule published in the 

Federal Register. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ WIFN/ 

list.asp#TopOfPage. 

Periods Available: FY 2006 through 

FY 2008. 

14. DRG Relative Weights (Table 5 DRG) 

This file contains a listing of DRGs, 

DRG narrative descriptions, relative 

weights, and geometric and arithmetic 

mean lengths of stay as published in the 

Federal Register. There are two versions 

of this file as published in the Federal 

Register: <bullet≤ NPRM. 

<bullet≤ Final rule. 

Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ FFD/ 

list.asp#TopOfPage. Periods Available: FY 2006 through 

FY 2008 PPS Update. 

15. PPS Payment Impact File 

This file contains data used to 

estimate payments under Medicare’s 

hospital inpatient prospective payment 

systems for operating and capital-related 

costs. The data are taken from various 

sources, including the Provider-Specific 

File, Minimum Data Sets, and prior 

impact files. The data set is abstracted 

from an internal file used for the impact 

analysis of the changes to the 

prospective payment systems published 

in the Federal Register. Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ FFD/ 

list.asp#TopOfPage and http:// 

www.cms.hhs.gov/ AcuteInpatientPPS/ 

HIF/list.asp#TopOfPage. Periods Available: FY 1994 through 

FY 2008 PPS Update 

16. AOR/BOR Tables 

This file contains data used to 

develop the DRG relative weights. It 

contains mean, maximum, minimum, 

standard deviation, and coefficient of 

variation statistics by DRG for length of 

stay and standardized charges. The BOR 

tables are ‘‘Before Outliers Removed’’ 

and the AOR is ‘‘After Outliers 

Removed.’’ (Outliers refer to statistical 

outliers, not payment outliers.) Two versions of this file are created 

each year. They support the following: <bullet≤ NPRM published in the 

Federal Register. <bullet≤ Final rule published in the 

Federal Register. Media: Internet at http://www.cms. 

hhs.gov/AcuteInpatientPPS/ FFD/ 

list.asp#TopOfPage. Periods Available: FY 2008 PPS 

Update. 

17. Prospective Payment System (PPS) 

Standardizing File 

This file contains information that 

standardizes the charges used to 

calculate relative weights to determine 

payments under the prospective 

payment system. Variables include wage 

index, cost-of-living adjustment (COLA), 

case-mix index, disproportionate share, 

and the Metropolitan Statistical Area 

(MSA). The file supports the following: 

<bullet≤ NPRM published in the 

Federal Register. 

<bullet≤ Final rule published in the 

Federal Register. 

Media: Internet. 

Periods Available: FY 2008 PPS 

Update. 

For further information concerning 

these data tapes, contact the CMS Public 

Use Files Hotline at (410) 786–3691. 

Commenters interested in obtaining or 

discussing any other data used in 

constructing this proposed rule should 

contact Mark Hartstein at (410) 786– 

4548. 

B. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

of 1995 (PRA), we are required to 

provide 60-day notice in the Federal 

Register and solicit public comment 

before a collection of information 

requirement is submitted to the Office of 

Management and Budget (OMB) for 

review and approval. In order to fairly 

evaluate whether an information 

collection should be approved by OMB, 

section 3506(c)(2)(A) of the PRA 

requires that we solicit comment on the 

following issues: 

<bullet≤ The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

<bullet≤ The accuracy of our estimate 

of the information collection burden. 

<bullet≤ The quality, utility, and 

clarity of the information to be 

collected. 

<bullet≤ Recommendations to 

minimize the information collection 

burden on the affected public, including 

automated collection techniques. 

We are soliciting public comment on 

each of these issues for the following 

sections of this document that contain 

information collection requirements. 

Section 412.103 Special Treatment: 

Hospitals Located in Urban Areas and 

That Apply for Reclassifications as 

Rural 

Section 412.103(g)(1) states that (1) for 

a hospital paid on the basis of 

reasonable costs, the hospital may 

cancel its rural reclassification by 

submitting a written request to the CMS 

Regional Office not less than 120 days 

prior to the end of its current cost 

reporting period, and (2) for a hospital 

paid under the hospital inpatient 

prospective payment system, the 

hospital may cancel its rural 

reclassification by submitting a written 

request to the CMS Regional Office not 

less than 120 days prior to the end of 

a Federal fiscal year and after being paid 

as rural for at least one 12-month cost 

reporting period. 

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The burden associated with these 

requirements is the time and effort 

required for a hospital to develop, draft, 

and submit its written request for the 

cancellation of its rural reclassification. 

While these requirements are subject to 

the PRA, we believe the burden is 

exempt under 5 CFR 1320.3(c)(4). We 

believe that the information collection 

requirements in § 412.103(g)(1) and §

421.103(g)(2), respectively, will impact 

less than 10 entities. The notices will be 

submitted by individual hospitals and 

will be reviewed on a case-by-case basis. 

Section 489.20 Basic Commitments 

Proposed § 489.20(u)(1) would 

require physician-owned hospitals, as 

defined in § 489.3, to furnish notice to 

all patients that the hospital is a 

physician-owned hospital. The notice 

must be furnished at the beginning of 

their hospital stay or outpatient visit. 

The burden associated with the 

aforementioned requirements is the time 

and effort associated with a physicianowned hospital developing a generic 

notice and providing notice to the 

patients. Approximately 175 physicianowned hospitals must comply with this 

requirement. We estimate that it will 

require a hospital’s general counsel 4 

hours to develop a standard notice to be 

furnished to all patients upon admission 

as an inpatient or an outpatient. 

In addition, we estimate that it will 

take 30 seconds to provide the notice to 

a patient and it will take another 30 

seconds to maintain a copy of the 

disclosure in the patient’s medical 

record. On average, each hospital will 

be required to make 1,092 disclosures 

per year. The total burden associated 

with the requirements in § 489.20(u)(1) 

is 3,885 annual burden hours. 

Proposed § 489.20(v) would require 

all hospitals, as defined in § 489.24(b), 

to furnish all patients notice, in 

accordance with § 482.13(b)(2), at the 

beginning of their hospital stay or 

outpatient visit if a doctor of medicine 

or a doctor of osteopathy is not present 

in the hospital 24 hours per day, 7 days 

per week. The notice must indicate how 

the hospital will meet the medical needs 

of any inpatient who develops an 

emergency medical condition, as 

defined in § 489.24(b), at a time when 

there is no physician present in the 

hospital. The burden associated with 

this requirement is the time and effort 

necessary for each hospital to develop a 

standard notice to furnish to its patients. 

We believe 2,504 hospitals will be 

required to comply with this 

requirement. Complying with the 

requirement will require a hospital’s 

general counsel 4 hours to develop a 

standard notice. In addition, we 

estimate that it will take 30 seconds to 

provide the notice to a patient, and it 

will take another 30 seconds to maintain 

a copy of the disclosure in the patient’s 

medical record. On average, each 

hospital will be required to make 1,092 

disclosures per year. The total burden 

associated with the requirements in §

489.20(v)(1) is 55,588 annual burden 

hours. 

ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN

Requirements OMB control number Respondents Responses 

Burden 

per response 

(hours) 

Total annual 

burden 

(hours) 

§ 489.20(u)(1) ...................................... 0938–New ............................................ 175 75 4 700 

............................................................... 175 191,100 .016667 3,185 

§ 489.20(v)(1) ....................................... 0938–New ............................................ 2,504 2,504 4 10,016 

............................................................... 2,504 2,734,368 .016667 45,572 

Total ............................................... ............................................................... ........................ ........................ .................... 59,473 

This proposed rule imposes collection 

of information requirements as outlined 

in the regulation text and specified 

above. However, this proposed rule also 

makes reference to several associated 

information collections that are not 

discussed in the regulation text. The 

following is a discussion of these 

collections, which have already 

received the Office of Management and 

Budget’s (OMB) approval. 

Proposed Add-on Payments for New 

Services and Technologies 

Section II.I.1 of the preamble of this 

proposed rule discusses proposed addon payments for new services and 

technologies. Specifically, this section 

states that applicants for add-on 

payments for new medical services or 

technologies for FY 2009 must submit a 

formal request. A formal request 

includes a full description of the 

clinical applications of the medical 

service or technology and the results of 

any clinical evaluations demonstrating 

that the new medical service or 

technology represents a substantial 

clinical improvement. In addition, the 

request must contain a significant 

sample of the data to demonstrate that 

the medical service or technology meets 

the high-cost threshold. 

We also detailed the burden 

associated with this requirement in a 

final rule published in the Federal 

Register on September 7, 2001 (66 FR 

46902). As stated in that final rule, we 

believe the associated burden is exempt 

from the PRA as stipulated under 5 CFR 

1320.3(h)(6). Collection of the 

information for this requirement will be 

conducted on individual case-by-case 

basis. 

Occupational Mix Adjustment to the FY 

2008 Index (Hospital Wage Index 

Occupational Mix Survey) 

Section III. of the preamble of this 

proposed rule details the proposed 

changes to the hospital wage index. 

Specifically, section III.C addresses the 

proposed occupational mix adjustment 

to the proposed FY 2008 index. While 

the preamble does not contain any new 

information collection requirements, it 

is important to note that there is an 

OMB approved collection associated 

with the hospital wage index. 

As stated in section III.C. of the 

preamble of this proposed rule, section 

304(c) of Pub. L. 106–554 amended 

section 1886(d)(3)(E) of the Act to 

require CMS to collect data at least once 

every 3 years on the occupational mix 

of employees for each short-term, acute 

care hospital participating in the 

Medicare program, in order to construct 

an occupational mix adjustment to the 

wage index. We collect the data via the 

occupational mix survey. 

The burden associated with this 

information collection request is the 

time and effort required to collect and 

submit the data in the Hospital Wage 

Index Occupational Mix Survey to CMS. 

While this burden is subject to the PRA, 

it is already approved under OMB 

control number 0938–0907, with an 

expiration date of May 31, 2009. 

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24830 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

Revisions to the Wage Index Based on 

Hospital Redesignations (Medicare 

Geographic Classification Review 

Board) 

As noted in section III.I of the 

preamble of this proposed rule, section 

1886(d)(10) of the Act established the 

MGCRB, an entity that has the authority 

to accept IPPS hospital applications 

requesting geographic reclassification 

for wage index or standardized payment 

amounts and to issue decisions on these 

requests. It is important for CMS to 

ensure the accuracy of the MGCRB 

decisions and remain apprised of 

potential payment impacts. Our 

regulations at § 412.256 require a 

hospital to submit a copy of its MGCRB 

application to CMS. 

The burden associated with this 

requirement is the time and effort 

associated with a hospital compiling 

and submitting a copy of its MGCRB 

application to CMS. While this 

requirement is subject to the PRA, the 

burden is approved under OMB control 

number 0938–0573, with an expiration 

date of November 30, 2008. 

Reporting of Hospital Quality Data for 

Annual Hospital Payment Update 

As noted in section IV.A.1 of the 

preamble of this proposed rule, section 

5001(a) of the DRA sets out new 

requirements for the RHQDAPU 

program. The RHQDAPU program was 

established to implement section 501(b) 

of Pub. L. 108–173, thereby expanding 

our Hospital Quality Initiative. The 

RHQDAPU program originally consisted 

of a ‘‘starter set’’ of 10 quality measures. 

Hospitals participating in the hospital 

quality initiative submit their quality 

data on the 10 measures to receive an 

increase in their Medicare Annual 

Payment Update. The Office of 

Management and Budget approved the 

collection of data associated with the 

original starter set of quality measures 

under OMB control number 0938–0918, 

with an expiration date of January 31, 

2010. 

However, we recently submitted a 

new information collection request 

containing additional quality measures 

to OMB for approval. The new measures 

collect data for the Surgical Care 

Improvement Project (SCIP) and 

mortality measures. We announced and 

sought public comment on the 

information collection request in both 

60-day and 30-day Federal Register 

notices that published on October 13, 

2006 (71 FR 60532), and December 22, 

2006 (71 FR 77026), respectively. The 

revised information collection request is 

currently under review at OMB. 

Section IV.A.1 of the preamble of this 

proposed rule also discusses the use of 

the HCAHPS survey to capture quality 

data. The survey is designed to produce 

comparable data on the patient’s 

perspective on care that allows objective 

and meaningful comparisons between 

hospitals on domains that are important 

to consumers. The HCAHPS survey is 

currently approved under OMB control 

number 0938–0981, with an expiration 

date of December 31, 2007. 

Section IV.A.2.h of the preamble of 

this proposed rule addresses the 

reconsideration and appeal procedures 

for a hospital that we believe did not 

meet the RHQDAPU program 

requirements. If a hospital disagrees 

with our determination, it may submit 

a written request to us requesting that 

we reconsider our decision. The 

hospital’s letter must explain the 

reasons it believes it did meet the 

RHQDAPU program requirements. 

While this is a reporting requirement, 

the burden associated with it is not 

subject to the PRA under 5 CFR 

1320.4(a)(2). The burden associated 

with information collection 

requirements imposed subsequent to an 

administrative action is not subject to 

the PRA. 

If you comment on these information 

collection and recordkeeping 

requirements, please mail copies 

directly to the following: 

Centers for Medicare & Medicaid 

Services, Office of Strategic 

Operations and Regulatory Affairs, 

Regulations Development Group, 

Attn: William N. Parham, III, CMS– 

1533–P, Room C4–26–05, 7500 

Security Boulevard, Baltimore, MD 

21244–1850; and 

Office of Information and Regulatory 

Affairs, Office of Management and 

Budget, Room 10235, New Executive 

Office Building, Washington, DC 

20503, Attn: Carolyn Lovett, CMS 

Desk Officer, CMS–1533–P, carolyn— 

lovett@omb.eop.gov. Fax (202) 395– 

6974. 

C. Response to Comments 

Because of the large number of 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

List of Subjects 

42 CFR Part 411 

Kidney diseases, Medicare, Physician 

referral, Reporting and recordkeeping 

requirements. 

42 CFR Part 412 

Administrative practice and 

procedure, Health facilities, Medicare, 

Puerto Rico, Reporting and 

recordkeeping requirements. 

42 CFR Part 413 

Health facilities, Kidney diseases, 

Medicare, Puerto Rico, Reporting and 

recordkeeping requirements. 

42 CFR Part 489 

Health facilities, Medicare, Reporting 

and recordkeeping requirements. 

For the reasons stated in the preamble 

of this proposed rule, the Centers for 

Medicare & Medicaid Services is 

proposing to amend 42 CFR Chapter IV 

as follows: 

PART 411—EXCLUSIONS FROM 

MEDICARE AND LIMITATIONS ON 

MEDICARE PAYMENT 

1. The authority citation for Part 411 

continues to read as follows: 

Authority: Secs. 1102, 1860D–4(e)(6), 1871, 

and 1877(b)(4) and (5) of the Social Security 

Act (42 U.S.C. 1302, 1395w–10(e)(6), 1395hh, 

and 1395nn(b)(4) and (5). 

2. Section 411.4 is amended by 

revising the introductory text of 

paragraph (b) to read as follows: 

§ 411.4 Services for which neither the 

beneficiary nor any other person is legally 

obligated to pay. 

* * * * * 

(b) Special conditions for services 

furnished to individuals in custody of 

penal authorities. Individuals who are 

in custody include, but are not limited 

to, individuals who are under arrest, 

incarcerated, imprisoned, escaped from 

confinement, under supervised release, 

required to reside in mental health 

facilities, required to reside in halfway 

houses, required to live under home 

detention, or confined completely or 

partially in any way under a penal 

statute or rule. Payment may be made 

for services furnished to individuals or 

groups of individuals who are in the 

custody of police or other penal 

authorities or in the custody of a 

government agency under a penal 

statute only if the following conditions 

are met. 

* * * * * 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24831 

PART 412—PROSPECTIVE PAYMENT 

SYSTEMS FOR INPATIENT HOSPITAL 

SERVICES 

3. The authority citation for Part 412 

is revised to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh), and sec. 124 of Pub. L. 106–113 

(113 Stat. 1501A–332). 

4. Section 412.2 is amended by 

adding a new paragraph (g) to read as 

follows: 

§ 412.2 Basis for payment. 

* * * * * 

(g) Payment adjustment for certain 

replaced devices. CMS makes a payment 

adjustment for certain replaced devices, 

as provided under § 412.89. 

5. Section 412.4 is amended by— 

a. Revising paragraphs (d)(3)(ii)(B) 

and (d)(3)(ii)(C). 

b. Adding a new paragraph 

(d)(3)(ii)(D). 

c. Revising paragraph (f)(3). 

d. Revising the introductory text of 

paragraph (f)(5). 

e. Revising paragraph (f)(5)(i). 

f. Revising paragraph (f)(5)(iv). 

g. Adding a new paragraph (f)(6). 

The revisions and additions read as 

follows: 

§ 412.4 Discharges and transfers. 

* * * * * 

(d) * * * 

(3) * * * 

* * * * * 

(ii) * * * 

(B) The proportion of short-stay 

discharges to postacute care to total 

discharges in the DRG exceeds the 55th 

percentile for all DRGs; 

(C) The DRG is paired with a DRG 

based on the presence or absence of a 

comorbidity or a complication or major 

cardiovascular condition that meets the 

criteria specified under paragraphs 

(d)(3)(ii)(A) and (d)(3)(ii)(B) of this 

section; and 

(D) In the case of MS–DRGs that share 

the same base MS–DRG, if one MS–DRG 

meets the criteria specified under 

paragraph (d)(3)(ii)(B) of this section, 

every MS–DRG that shares the same 

base MS–DRG is a qualifying DRG. 

* * * * * 

(f) * * * 

(3) Transfer assigned to DRG for 

newborns that die or are transferred to 

another hospital. If a transfer is 

classified into CMS DRG 385 (Neonates, 

Died or Transferred) prior to October 1, 

2007, or into MS–DRG 789 (Neonates, 

Died or Transferred to Another Acute 

Care Facility) on or after October 1, 

2007, the transferring hospital is paid in 

accordance with § 412.2(b). 

* * * * * 

(5) Special rule for DRGs meeting 

specific criteria. For discharges 

occurring on or after October 1, 2005, 

and prior to October 1, 2007, a hospital 

that transfers an inpatient under the 

circumstances described in paragraph 

(c) of this section is paid using the 

provisions of paragraphs (f)(2)(i) and 

(f)(2)(ii) of this section if the transfer 

case is assigned to one of the DRGs 

meeting the following criteria: 

(i) The DRG meets the criteria 

specified in paragraph (d)(3)(i) or 

(d)(3)(ii) of this section. 

* * * * * 

(iv) If a DRG is paired with a DRG 

based on the presence or absence of a 

comorbidity or complication or a major 

cardiovascular complication that meets 

the criteria specified in paragraphs 

(f)(5)(i) through (f)(5)(iii) of this section, 

that DRG will also be paid under the 

provisions of paragraphs (f)(2)(i) and 

(f)(2)(ii) of this section. 

(6) Special rule for DRGs meeting 

specific criteria. For discharges 

occurring on or after October 1, 2007, a 

hospital that transfers an inpatient 

under the circumstances described in 

paragraph (c) of this section is paid 

using the provisions of paragraphs 

(f)(2)(i) and (f)(2)(ii) of this section if the 

transfer case is assigned to one of the 

DRGs meeting the following criteria: 

(i) The DRG meets the criteria 

specified in paragraph (d)(3)(i) or 

(d)(3)(ii) of this section; 

(ii) The average charges of the 1-day 

discharge cases in the DRG must be at 

least 50 percent of the average charges 

for all cases in the DRG; and 

(iii) The geometric mean length of 

stay for the DRG is greater than 4 days. 

(iv) If a DRG is part of an MS–DRG 

group that meets the criteria specified in 

paragraphs (f)(6)(i) through (f)(6)(iii) of 

this section, that DRG will also be paid 

under the provisions of paragraphs 

(f)(2)(i) and (f)(2)(ii) of this section. 

6. Section 412.64 is amended by— 

a. Revising paragraph (b)(1)(ii)(B). 

b. In paragraph (b)(3), designating the 

existing text as (b)(3)(i) and adding a 

new paragraph (b)(3)(ii). 

c. Adding a new paragraph (e)(3). 

d. Revising paragraph (i)(2). 

The revisions read as follows: 

§ 412.64 Federal rates for inpatient 

operating costs for Federal fiscal year 2005 

and subsequent fiscal years. 

* * * * * 

(b) * * * 

(1) * * * 

(ii) * * * 

(B) For discharges occurring on or 

after October 1, 1983, and before 

October 1, 2007, the following New 

England counties, which are deemed to 

be parts of urban areas under section 

601(g) of the Social Security 

Amendments of 1983 (Public Law 98– 

21, 42 U.S.C. 1395ww (note); Litchfield 

County, Connecticut; York County, 

Maine; Sagadahoc County, Maine; 

Merrimack County, New Hampshire; 

and Newport County, Rhode Island. 

* * * * * 

(3)(i) * * * 

(ii) For discharges occurring on or 

after October 1, 2007, hospitals in the 

following New England counties, if not 

already located in an urban area, are 

deemed to be located in urban areas 

under section 601(g) of the Social 

Security Amendments of 1983 (Public 

Law 98–21, 42 U.S.C. 1395ww (note)): 

Litchfield County, Connecticut; York 

County, Maine; Sagadahoc County, 

Maine; Merrimack County, New 

Hampshire; and Newport County, 

Rhode Island. 

* * * * * 

(e) * * * 

(3) To the extent CMS determines that 

changes to the DRG classification and 

recalibrations of the DRG relative 

weights for a previous year (or estimates 

that such adjustments for a future fiscal 

year) did (or are likely to) result in a 

change in aggregate payments under this 

subsection during the fiscal year that are 

a result of changes in coding or 

classification of discharges that do not 

reflect real changes in case mix, CMS 

may adjust the standardized amount for 

subsequent fiscal years so as to 

eliminate the effect of such coding and 

classification changes. 

(i) * * * 

(2) Amount of adjustment. A hospital 

located in a county that meets the 

criteria under paragraphs (i)(1)(i) 

through (i)(1)(iii) of this section will 

receive an increase in its wage index 

that is equal to a weighted average of the 

difference between the postreclassified 

wage index of the MSA (or MSAs) with 

the higher wage index (or wage indices) 

and the postreclassified wage index of 

the MSA or rural statewide area in 

which the qualifying county is located, 

weighted by the overall percentage of 

the hospital employees residing in the 

qualifying county who are employed in 

any MSA with a higher wage index. 

* * * * * 

7. The heading of Subpart F is revised 

to read as follows: 

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24832 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

Subpart F—Payments for Outlier 

Cases, Special Treatment Payment for 

New Technology, and Payment 

Adjustment for Certain Replaced 

Devices 

8. Section 412.88 is amended by 

revising the introductory text of 

paragraph (a)(2) to read as follows: 

§ 412.88 Additional payment for new 

medical service or technology. 

(a) * * * 

(2) If the costs of the discharge 

(determined by applying the operating 

cost-to-charge ratios as described in §

412.84(h)) exceed the full DRG payment, 

an additional amount equal to the lesser 

of— 

* * * * * 

9. A new undesignated center heading 

and a new § 412.89 are added under 

Subpart F following § 412.88 to read as 

follows: 

Payment Adjustment for Certain 

Replaced Devices 

§ 412.89 Payment adjustment for certain 

replaced devices. 

(a) General rule. For discharges 

occurring on or after October 1, 2007, 

the amount of payment for a discharge 

described in paragraph (b) of this 

section is reduced when— 

(1) A device is replaced without cost 

to the hospital; 

(2) The provider received full credit 

for the cost of a device; or 

(3) The provider receives a credit 

equal to 20 percent or more of the cost 

of the device. 

(b) Discharges subject to payment 

adjustment. (1) Payment is reduced in 

accordance with paragraph (a) of this 

section only if the implantation of the 

device determines the DRG assignment. 

(2) CMS lists the DRGs that qualify 

under paragraph (b)(1) of this section in 

the annual final rule for the hospital 

inpatient prospective payment system. 

(c) Amount of reduction. (1) For a 

device provided to the hospital without 

cost, the cost of the device is subtracted 

from the DRG payment. 

(2) For a device for which the hospital 

received a full or partial credit, the 

amount credited is subtracted from the 

DRG payment. 

10. Section 412.103 is amended by 

revising paragraph (g) to read as follows: 

§ 412.103 Special treatment: Hospitals 

located in urban areas and that apply for 

reclassifications as rural. 

* * * * * 

(g) Cancellation of classification—(1) 

Hospitals paid on basis of reasonable 

costs. For a hospital paid on the basis 

of reasonable costs— 

(i) A hospital may cancel its rural 

reclassification by submitting a written 

request to the CMS Regional Office not 

less than 120 days prior to the end of 

its current cost reporting period. 

(ii) The hospital’s cancellation of the 

classification is effective beginning with 

the next full cost reporting period. 

(2) Hospitals paid under the hospital 

inpatient prospective payment system. 

For a hospital paid under the hospital 

inpatient prospective payment system— 

(i) A hospital may cancel its rural 

reclassification by submitting a written 

request to the CMS Regional Office not 

less than 120 days prior to the end of 

a Federal fiscal year and after being paid 

as rural for at least one 12-month cost 

reporting period. 

(ii) The hospital’s cancellation of the 

classification is not effective until it has 

been paid as rural for at least one 12- 

month cost reporting period, and not 

until the beginning of the Federal fiscal 

year following such 12-month cost 

reporting period. 

11. Section 412.105 is amended by 

adding a sentence at the end of 

paragraph (f)(1)(iii)(A) to read as 

follows: 

§ 412.105 Special treatment: Hospitals 

that incur indirect costs for graduate 

medical education programs. 

* * * * * 

(f) * * * 

(1) * * * 

(iii) * * * 

(A) * * * Effective for cost reporting 

periods beginning on or after October 1, 

2007, vacation leave and sick leave (that 

do not prolong the total time a resident 

is participating in the approved program 

beyond the normal duration of the 

program) are not included in the 

determination of full-time equivalency. 

* * * * * 

12. Section 412.308 is amended by— 

a. Revising paragraph (c)(1)(ii). 

b. Adding new paragraphs (c)(1)(iii) 

and (c)(1)(iv). 

The revision and addition read as 

follows: 

§ 412.308 Determining and updating the 

Federal rate. 

* * * * * 

(c) * * * 

(1) * * * 

(ii) Effective FY 1996. Except as 

specified in paragraph (c)(1)(iii) of this 

section, effective FY 1996, the standard 

Federal rate is updated based on an 

analytical framework. The framework 

includes a capital input price index, 

which measures the annual change in 

the prices associated with capitalrelated costs during the year. CMS 

adjusts the capital input price index rate 

of change to take into account forecast 

errors, changes to the case-mix index, 

the effect of changes to DRG 

classification and relative weights, and 

allowable changes in the intensity of 

hospital services. 

(iii) Effective FY 2008. Effective FY 

2008, the update to the standard Federal 

rate for urban hospitals equals 0 and the 

update for rural hospitals is determined 

based on an analytical framework as 

described in paragraph (c)(1)(ii) of this 

section. 

(iv) Definition of urban and rural 

hospital. For purposes of paragraph 

(c)(1)(iii) of this section, an urban 

hospital is a hospital located in an area 

that meets the definition under §

412.64(b)(1)(ii)(A) or §

412.64(b)(1)(ii)(B) or that is deemed to 

be located in an urban area under §

412.64(b)(3). A rural hospital includes a 

hospital reclassified under § 412.103. 

* * * * * 

13. Section 412.316 is amended by— 

a. Revising the introductory text of 

paragraph (b). 

b. Revising paragraph (b)(2). 

c. Revising paragraph (b)(3). 

The revisions read as follows: 

§ 412.316 Geographic adjustment factor. 

* * * * * 

(b) Large urban location. For 

discharges occurring on or before 

September 30, 2007, CMS provides an 

additional payment to a hospital located 

in a large urban area equal to 3.0 percent 

of what would otherwise be payable to 

the hospital based on the Federal rate. 

* * * * * 

(2) For discharges occurring on or 

after October 1, 2004, and before 

October 1, 2007, the definition of large 

urban areas under § 412.63(c)(6) 

continues to be in effect for purposes of 

the payment adjustment under this 

section, based on the geographic 

classification under § 412.64, except as 

provided for in paragraph (b)(3) of this 

section. 

(3) For purposes of this section, the 

geographic classifications specified 

under § 412.64 apply, except that, 

effective for discharges occurring on or 

after October 1, 2006, and before 

October 1, 2007, for an urban hospital 

that is reclassified as rural as set forth 

in § 412.103, the geographic 

classification is rural. 

* * * * * 

14. Section 412.517 is amended by— 

a. Redesignating the introductory text 

and paragraphs (a), (b), (c), and (d) as 

paragraphs (a) introductory text, (a)(1), 

(a)(2), (a)(3), and (a)(4), respectively. 

b. Reserving paragraph (b). 

c. Adding a new paragraph (c). 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24833 

The additions read as follows: 

§ 412.517 Revision of LTC–DRG group 

classifications and weighting factors. 

* * * * * 

(b) [Reserved] 

(c) To the extent CMS determines that 

changes to the DRG classifications and 

recalibrations of the DRG relative 

weights for a previous year (or estimates 

that such adjustments for a future fiscal 

year) did (or are likely to) result in a 

change in aggregate payments under this 

subpart during the fiscal year that are a 

result of changes in coding or 

classification of discharges that do not 

reflect real changes in case mix, CMS 

may adjust the DRG relative weights for 

subsequent fiscal years so as to 

eliminate the effect of such coding and 

classification changes. 

PART 413—PRINCIPLES OF 

REASONABLE COST 

REIMBURSEMENT; PAYMENT FOR 

END-STAGE RENAL DISEASE 

SERVICES; PROSPECTIVELY 

DETERMINED PAYMENT RATES FOR 

SKILLED NURSING FACILITIES 

15. The authority citation for Part 413 

is revised to read as follows: 

Authority: Secs. 1102, 1812(d), 1814(b), 

1815, 1833(a), (i), and (n), 1861(v), 1871, 

1881, 1883, and 1886 of the Social Security 

Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 

1395g, 1395l(a), (i), and (n), 1395x(v), 

1395hh, 1395rr, 1395tt, and 1395ww); and 

sec. 124 of Pub. L. 106–133 (113 Stat. 1501A– 

332). 

16. Section 413.75(b) is amended by— 

a. Adding in alphabetical order a 

definition of ‘‘orientation activities’’. 

b. Revising the definition of ‘‘patient 

care activities’’. 

The addition and revision read as 

follows: 

§ 413.75 Direct GME payments: General 

requirements. 

* * * * * 

(b) * * * 

Orientation activities means activities 

that are principally designed to prepare 

an individual for employment as a 

resident in a particular setting, or for 

participation in a particular specialty 

program and patient care activities 

associated with that particular specialty 

program. 

Patient care activities means the care 

and treatment of particular patients, 

including services for which a physician 

or other practitioner may bill, and 

orientation activities as defined in this 

section. 

* * * * * 

17. Section 413.78 is amended by 

adding a sentence at the end of 

paragraph (b) to read as follows: 

§ 413.78 Direct GME payments: 

Determination of the total number of FTE 

residents. 

* * * * * 

(b) * * * Effective for cost reporting 

periods beginning on or after October 1, 

2007, vacation leave and sick leave (that 

do not prolong the total time a resident 

is participating in the approved program 

beyond the normal duration of the 

program) are not included in the 

determination of full-time equivalency. 

* * * * * 

PART 489—PROVIDER AGREEMENTS 

AND SUPPLIER APPROVAL 

18. The authority citation for part 489 

is amended to read as follows: 

Authority: Secs. 1102, 1819, 1820(e), 1861, 

1864(m), 1866, 1869, and 1871 of the Social 

Security Act (41 U.S.C. 1302, 1395i–3, 1395x, 

1395aa(m), 1395cc, 1395ff, and 1395hh) 

19. Section 489.3 is amended by 

adding a definition of ‘‘physicianowned hospital’’ in alphabetical order to 

read as follows: 

§ 489.3 Definitions. 

* * * * * 

Physician-owned hospital means any 

participating hospital (as defined in §

489.24) in which a physician or 

physicians have an ownership or 

investment interest. The ownership or 

investment interest may be through 

equity, debt, or other means, and 

includes an interest in an entity that 

holds an ownership or investment 

interest in the hospital. 

20. Section 489.12 is amended by— 

a. Revising paragraph (a)(2). 

b. Redesignating paragraph (a)(3) as 

paragraph (a)(4). 

c. Adding a new paragraph (a)(3). 

The revision and addition read as 

follows: 

§ 489.12 Decision to deny an agreement. 

(a) * * * 

(2) The prospective provider has 

failed to disclose ownership and control 

interests in accordance with § 420.206 

of this chapter; 

(3) The prospective provider is a 

physician-owned hospital as defined in 

§ 489.3 and does not have procedures 

in place for making physician 

ownership disclosures to patients in 

accordance with § 489.20(u) of this 

chapter; or 

* * * * * 

21. Section 489.20 is amended by 

adding new paragraphs (u) and (v) to 

read as follows: 

§ 489.20 Basic commitments. 

* * * * * 

(u) In the case of a physician-owned 

hospital as defined in § 489.3— 

(1) To furnish all patients notice, in 

accordance with § 482.13(b)(2), at the 

beginning of their hospital stay or 

outpatient visit that the hospital is a 

physician-owned hospital. The notice 

should disclose, in a manner reasonably 

designed to be understood by all 

patients, the fact that the hospital meets 

the Federal definition of a physicianowned hospital specified in § 489.3 and 

that the list of the hospital’s physician 

owners or investors is available upon 

request. For the purposes of this 

paragraph, the hospital stay or 

outpatient visit begins with the 

provision of a package of information 

regarding scheduled preadmission 

testing and registration for a planned 

hospital admission for inpatient care or 

outpatient service. 

(2) To require all physician owners 

who also are members of the hospital’s 

medical staff to agree, as a condition of 

continued medical staff membership, to 

disclose in writing their ownership 

interest in the hospital to all patients 

they refer to the hospital. Disclosure 

shall be required at the time the referral 

is made. 

(v) In the case of a hospital as defined 

in § 489.24(b), to furnish all patients 

written notice, in accordance with §

482.13(b)(2), at the beginning of their 

hospital stay or outpatient visit if a 

doctor of medicine or a doctor of 

osteopathy is not present in the hospital 

24 hours per day, seven days per week. 

The notice must indicate how the 

hospital will meet the medical needs of 

any inpatient who develops an 

emergency medical condition, as 

defined in § 489.24(b), at a time when 

there is no physician present in the 

hospital. For purposes of this paragraph, 

the hospital stay or outpatient visit 

begins with the provision of a package 

of information regarding scheduled 

preadmission testing and registration for 

a planned hospital admission for 

inpatient care or the provision of a 

package of information regarding an 

outpatient service. 

22. Section 489.24 is amended by 

revising paragraph (a)(2) to read as 

follows: 

§ 489.24 Special responsibilities of 

Medicare hospitals in emergency cases. 

(a) * * * 

(2) Nonapplicability of provisions of 

this section. Sanctions under this 

section for an inappropriate transfer 

during a national emergency or for the 

direction or relocation of an individual 

to receive medical screening at an 

alternate location do not apply to a 

hospital with a dedicated emergency 

department located in an emergency 

area, as specified in section 1135(g)(1) of 

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24834 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

the Act. A waiver of these sanctions is 

limited to a 72-hour period beginning 

upon the implementation of a hospital 

disaster protocol, except that, if a public 

health emergency involves a pandemic 

infectious disease (such as pandemic 

influenza), the waiver will continue in 

effect until the termination of the 

applicable declaration of a public health 

emergency, as provided for by section 

1135(e)(1)(B) of the Act. 

* * * * * 

23. Section 489.53 is amended by— 

a. Redesignating paragraph (c) and (d) 

as paragraphs (d) as (e), respectively. b. Adding a new paragraph (c). 

c. In newly redesignated paragraph (d) 

introductory text, removing the crossreference ‘‘paragraph (c)(2) of this 

section’’ and adding the reference 

‘‘paragraph (d)(2) of this section’’ in its 

place. The revisions and additions read as 

follows: 

§ 489.53 Termination by CMS. 

* * * * * 

(c) Termination of agreements with 

physician-owned hospitals. In the case 

of a physician-owned hospital, as 

defined at § 489.3, CMS may terminate 

the provider agreement if the hospital 

failed to comply with the requirements 

of § 489.20(u). 

* * * * * 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: April 13, 2007. 

Leslie Norwalk, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: April 13, 2007. 

Michael O. Leavitt, 

Secretary. 

Editorial Note: The following Addendum 

and appendices will not appear in the Code 

of Federal Regulations. 

Addendum—Proposed Schedule of 

Standardized Amounts, Update Factors, and 

Rate-of-Increase Percentages Effective With 

Cost Reporting Periods Beginning On or 

After October 1, 2007 

I. Summary and Background 

In this Addendum, we are setting forth the 

proposed methods and data we are using to 

determine the proposed prospective payment 

rates for Medicare hospital inpatient 

operating costs and Medicare hospital 

inpatient capital-related costs. We are also 

setting forth the proposed rate-of-increase 

percentages for updating the target amounts 

for certain hospitals and hospital units 

excluded from the IPPS. In general, except 

for SCHs, MDHs, and hospitals located in 

Puerto Rico, each hospital’s payment per 

discharge under the IPPS is based on 100 

percent of the Federal national rate, also 

known as the national adjusted standardized 

amount. This amount reflects the national 

average hospital cost per case from a base 

year, updated for inflation. 

SCHs are paid based on whichever of the 

following rates yields the greatest aggregate 

payment: the Federal national rate; the 

updated hospital-specific rate based on FY 

1982 costs per discharge; the updated 

hospital-specific rate based on FY 1987 costs 

per discharge; or the updated hospitalspecific rate based on FY 1996 costs per 

discharge. 

Under section 1886(d)(5)(G) of the Act, 

MDHs historically have been paid based on 

the Federal national rate or, if higher, the 

Federal national rate plus 50 percent of the 

difference between the Federal national rate 

and the updated hospital-specific rate based 

on FY 1982 or FY 1987 costs per discharge, 

whichever is higher. (MDHs did not have the 

option to use their FY 1996 hospital-specific 

rate.) Section 5003(a)(1) of Pub. L. 109–171 

extended and modified the MDH special 

payment provision which was previously set 

to expire on October 1, 2006, to discharges 

occurring on or after October 1, 2006, but 

before October 1, 2011. Under section 

5003(b) of Pub. L. 109–171, if the change 

results in an increase to its target amount, an 

MDH must rebase its hospital-specific rates 

to its FY 2002 cost report. In addition, under 

section 5003(c) of Pub. L. 109–171, MDHs are 

now paid based on the Federal national rate 

or, if higher, the Federal national rate plus 75 

percent of the difference between the Federal 

national rate and the updated hospitalspecific rate. Further, based upon section 

5003(d) of Pub. L. 109–171, MDHs are no 

longer subject to the 12-percent cap on their 

DSH payment adjustment factor. 

For hospitals in Puerto Rico, the payment 

per discharge is based on the sum of 25 

percent of a Puerto Rico rate that reflects base 

year average costs per case of Puerto Rico 

hospitals and 75 percent of the Federal 

national rate. (See section II.D.3. of this 

Addendum for a complete description.) 

As discussed below in section II. of this 

Addendum, we are proposing to make 

changes in the determination of the 

prospective payment rates for Medicare 

inpatient operating costs for FY 2008. In 

section III. of this Addendum, we discuss our 

proposed changes for determining the 

prospective payment rates for Medicare 

inpatient capital-related costs for FY 2008. 

Section IV. of this Addendum sets forth our 

proposed changes for determining the rate-ofincrease limits for certain hospitals excluded 

from the IPPS for FY 2008. The tables to 

which we refer in the preamble of this 

proposed rule are presented in section VI. of 

this Addendum of this proposed rule. 

II. Proposed Changes to Prospective Payment 

Rates for Hospital Inpatient Operating Costs 

The basic methodology for determining 

prospective payment rates for hospital 

inpatient operating costs for FY 2005 and 

subsequent fiscal years is set forth at §

412.64. The basic methodology for 

determining the prospective payment rates 

for hospital inpatient operating costs for 

hospitals located in Puerto Rico for FY 2005 

and subsequent fiscal years is set forth at § §

412.211 and 412.212. Below we discuss the 

factors used for determining the prospective 

payment rates. 

In summary, the proposed standardized 

amounts set forth in Tables 1A, 1B, 1C, and 

1D of section VI. of this Addendum reflect— 

<bullet≤ Equalization of the standardized 

amounts for urban and other areas at the 

level computed for large urban hospitals 

during FY 2004 and onward, as provided for 

under section 1886(d)(3)(A)(iv) of the Act, 

updated by the applicable percentage 

increase required under sections 

1886(b)(3)(B)(i)(XX) and 1886(b)(3)(B)(viii) of 

the Act. 

<bullet≤ The labor-related share that is 

applied to the standardized amounts and 

Puerto Rico-specific standardized amounts to 

give the hospital the highest payment, as 

provided for under sections 1886(d)(3)(E), 

and 1886(d)(9)(C)(iv) of the Act. 

<bullet≤ Proposed updates of 3.3 percent 

for all areas (that is, the estimated full market 

basket percentage increase of 3.3 percent), as 

required by section 1886(b)(3)(B)(i)(XX) of 

the Act, as amended by section 5001(a)(1) of 

Pub. L. 109–171, and reflecting the 

requirements of section 1886(b)(3)(B)(viii) of 

the Act, as added by section 5001(a)(3) of 

Pub. L. 109–171, to reduce the applicable 

percentage increase by 2.0 percentage points 

for a hospital that fails to submit data, in a 

form and manner specified by the Secretary, 

relating to the quality of inpatient care 

furnished by the hospital. 

<bullet≤ An adjustment to the standardized 

amount to ensure budget neutrality for DRG 

recalibration and reclassification, as provided 

for under section 1886(d)(4)(C)(iii) of the Act. 

<bullet≤ An adjustment to ensure the wage 

index update and changes are budget neutral, 

as provided for under section 1886(d)(3)(E) of 

the Act. 

<bullet≤ An adjustment to ensure the 

effects of geographic reclassification are 

budget neutral, as provided for in section 

1886(d)(8)(D) of the Act, by removing the FY 

2007 budget neutrality factor and applying a 

revised factor. 

<bullet≤ An adjustment to remove the FY 

2007 outlier offset and apply an offset for FY 

2008. 

<bullet≤ An adjustment to ensure the 

effects of the rural community hospital 

demonstration required under section 410A 

of Pub. L. 108–173 are budget neutral, as 

required under section 410A(c)(2) of Pub. L. 

108–173. 

<bullet≤ An adjustment to eliminate the 

effect of coding or classification changes that 

do not reflect real changes in case-mix using 

the Secretary’s authority under section 

1886(d)(3)(A)(vi) of the Act (as discussed in 

section II.D.6. of the preamble to this 

proposed rule). 

We note that two budget neutrality 

provisions will no longer be applied to the 

standardized amounts beginning with FY 

2008. First, in the FY 2005 IPPS final rule (69 

FR 49032 through 49034), we allowed urban 

hospitals that became rural under the new 

labor market area definitions to maintain 

their assignment to the MSA where they were 

previously located for the 3-year period of FY 

2005, FY 2006, and FY 2007. In these years, 

we provided for a budget neutrality 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24835 

adjustment to the standardized amount to 

ensure that this policy did not increase 

Medicare expenditures for hospital inpatient 

services. For FY 2008, this budget neutrality 

adjustment to the IPPS standardized amounts 

will no longer be necessary because the 

provision has expired. Second, in this 

proposed rule, we are proposing a 

prospective change to how budget neutrality 

is applied to implement the rural floor for FY 

2008 and subsequent years. As discussed in 

section III.G.4. of the preamble of this 

proposed rule, we are proposing to apply the 

budget neutrality adjustment to hospital 

wage indices rather than the standardized 

amount. 

A. Calculation of the Proposed Adjusted 

Standardized Amount 

1. Standardization of Base-Year Costs or 

Target Amounts 

In general, the national standardized 

amount is based on per discharge averages of 

adjusted hospital costs from a base period 

(section 1886(d)(2)(A) of the Act) or, for 

Puerto Rico, adjusted target amounts from a 

base period (section 1886(d)(9)(B)(i) of the 

Act), updated and otherwise adjusted in 

accordance with the provisions of section 

1886(d) of the Act. The September 1, 1983 

interim final rule (48 FR 39763) contained a 

detailed explanation of how base-year cost 

data (from cost reporting periods ending 

during FY 1981) were established in the 

initial development of standardized amounts 

for the IPPS. The September 1, 1987 final 

rule (52 FR 33043 and 33066) contains a 

detailed explanation of how the target 

amounts were determined, and how they are 

used in computing the Puerto Rico rates. 

Sections 1886(d)(2)(B) and (d)(2)(C) of the 

Act require us to update base-year per 

discharge costs for FY 1984 and then 

standardize the cost data in order to remove 

the effects of certain sources of cost 

variations among hospitals. These effects 

include case-mix, differences in area wage 

levels, cost-of-living adjustments for Alaska 

and Hawaii, indirect medical education 

costs, and costs to hospitals serving a 

disproportionate share of low-income 

patients. 

In accordance with section 1886(d)(3)(E) of 

the Act, the Secretary estimates, from timeto-time, the proportion of hospitals’ costs that 

are attributable to wages and wage-related 

costs. In general, the standardized amount is 

divided into labor-related and nonlaborrelated amounts; only the proportion 

considered the labor-related amount is 

adjusted by the wage index. Section 

1886(d)(3)(E) of the Act requires that 62 

percent of the standardized amount be 

adjusted by the wage index, unless doing so 

would result in lower payments to a hospital 

than would otherwise be made. (Section 

1886(d)(9)(C)(iv)(II) of the Act extends this 

provision to the labor-related share for 

hospitals located in Puerto Rico.) 

For FY 2008, we are not proposing to 

change the national and Puerto Rico-specific 

labor-related and nonlabor-related shares 

from the percentages established for FY 2007. 

Therefore, the labor-related share would 

continue to be 69.7 percent for the national 

standardized amounts and 58.7 percent for 

the Puerto Rico specific standardized 

amount. Consistent with section 

1886(d)(3)(E) of the Act, we will apply the 

wage index to a labor-related share of 62 

percent for all non-Puerto Rico hospitals 

whose wage indexes are less than or equal to 

1.0000. For all non-Puerto Rico hospitals 

whose wage indices are greater than 1.0000, 

we will apply the wage index to a labor share 

of 69.7 percent of the national standardized 

amount. For a Puerto Rico hospital, we will 

apply a labor share of 58.7 percent if its 

Puerto Rico-specific wage index is less than 

or equal to 1.0000. For Puerto Rico hospitals 

whose Puerto Rico-specific wage index 

values are greater than 1.0000, we will apply 

a labor share of 62 percent. 

The standardized amounts for operating 

costs appear in Table 1A, 1B, and 1C of the 

Addendum to this proposed rule. 

2. Computing the Average Standardized 

Amount 

Section 1886(d)(3)(A)(iv) of the Act 

requires that, beginning with FY 2004 and 

thereafter, an equal standardized amount is 

to be computed for all hospitals at the level 

computed for large urban hospitals during FY 

2003, updated by the applicable percentage 

update. Section 1886(d)(9)(A) of the Act 

equalizes the Puerto Rico-specific urban and 

rural area rates. Accordingly, we are 

calculating FY 2008 national and Puerto Rico 

standardized amounts, irrespective of 

whether a hospital is located in an urban or 

rural location. 

3. Updating the Average Standardized 

Amount 

In accordance with section 

1886(d)(3)(A)(iv)(II) of the Act, we are 

updating the equalized standardized amount 

for FY 2008 by the full estimated market 

basket percentage increase for hospitals in all 

areas, as specified in section 

1886(b)(3)(B)(i)(XX) of the Act, as amended 

by section 5001(a)(1) of Pub. L. 109–171. The 

percentage change in the market basket 

reflects the average change in the price of 

goods and services purchased by hospitals to 

furnish inpatient care. The most recent 

forecast of the hospital market basket 

increase for FY 2008 is 3.3 percent. Thus, for 

FY 2008, the proposed update to the average 

standardized amount is 3.3 percent for 

hospitals in all areas. The estimated market 

basket increase of 3.3 percent is based on the 

2007 first quarter forecast of the hospital 

market basket increase by the Office of the 

Actuary (as discussed in Appendix B of this 

proposed rule). 

Section 1886(b)(3)(B) of the Act specifies 

the mechanism used to update the 

standardized amount for payment for 

inpatient hospital operating costs. Section 

1886(b)(3)(B)(viii) of the Act, as added by 

section 5001(a)(3) of Pub. L. 109–171, 

provides for a reduction of 2.0 percentage 

points to the update percentage increase (also 

known as the market basket update) for FY 

2007 and each subsequent fiscal year for any 

‘‘subsection (d) hospital’’ that does not 

submit quality data as discussed in section 

IV.A. of the preamble of this proposed rule. 

The standardized amounts in Tables 1A 

through 1C of section VI. of the Addendum 

to this proposed rule reflect these differential 

amounts. 

Although the update factors for FY 2008 

are set by law, we are required by section 

1886(e)(4) of the Act to recommend, taking 

into account MedPAC’s recommendations, 

appropriate update factors for FY 2008 for 

both IPPS hospitals and hospitals and 

hospital units excluded from the IPPS. Our 

recommendation on the update factors 

(which is required by sections 1886(e)(4)(A) 

and (e)(5)(A) of the Act) is set forth in 

Appendix B of this proposed rule. 

4. Other Adjustments to the Average 

Standardized Amount 

As in the past, we are adjusting the FY 

2008 standardized amount to remove the 

effects of the FY 2007 geographic 

reclassifications and outlier payments before 

applying the FY 2008 updates. We then 

apply budget neutrality offsets for outliers 

and geographic reclassifications to the 

standardized amount based on FY 2008 

payment policies. 

We do not remove the prior year’s budget 

neutrality adjustments for reclassification 

and recalibration of the DRG weights and for 

updated wage data because, in accordance 

with sections 1886(d)(4)(C)(iii) and 

1886(d)(3)(E) of the Act, estimated aggregate 

payments after the changes in the DRG 

relative weights and wage index should equal 

estimated aggregate payments prior to the 

changes. If we removed the prior year 

adjustment, we would not satisfy these 

conditions. 

Budget neutrality is determined by 

comparing aggregate IPPS payments before 

and after making the changes that are 

required to be budget neutral (for example, 

changes to DRG classifications, recalibration 

of the DRG relative weights, updates to the 

wage index, and different geographic 

reclassifications). We include outlier 

payments in the simulations because they 

may be affected by changes in these 

parameters. 

We are also proposing to adjust the 

standardized amount this year by an 

estimated amount to ensure that aggregate 

IPPS payments do not exceed the amount of 

payments that would have been made in the 

absence of the rural community hospital 

demonstration required under section 410A 

of Pub. L. 108–173. This demonstration is 

required to be budget neutral under section 

410A(c)(2) of Pub. L. 108–173. For FY 2008 

and FY 2009, we are also proposing an 

adjustment to eliminate the effect of coding 

or classification changes that do not reflect 

real changes in case-mix using the Secretary’s 

authority under section 1886(d)(3)(A)(vi) of 

the Act. 

a. Proposed Recalibration of DRG Weights 

and Updated Wage Index—Budget Neutrality 

Adjustment 

Section 1886(d)(4)(C)(iii) of the Act 

specifies that, beginning in FY 1991, the 

annual DRG reclassification and recalibration 

of the relative weights must be made in a 

manner that ensures that aggregate payments 

to hospitals are not affected. As discussed in 

section II. of the preamble of this proposed 

rule, we normalized the recalibrated DRG 

weights by an adjustment factor, so that the 

average case weight after recalibration is 

equal to the average case weight prior to 

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24836 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

recalibration. However, equating the average 

case weight after recalibration to the average 

case weight before recalibration does not 

necessarily achieve budget neutrality with 

respect to aggregate payments to hospitals 

because payments to hospitals are affected by 

factors other than average case weight. 

Therefore, as we have done in past years, we 

are proposing to make a budget neutrality 

adjustment to ensure that the requirement of 

section 1886(d)(4)(C)(iii) of the Act is met. 

Section 1886(d)(3)(E) of the Act requires us 

to update the hospital wage index on an 

annual basis beginning October 1, 1993. This 

provision also requires us to make any 

updates or adjustments to the wage index in 

a manner that ensures that aggregate 

payments to hospitals are not affected by the 

change in the wage index. Consistent with 

current policy, for FY 2008, we are adjusting 

100 percent of the wage index factor for 

occupational mix. We describe the 

occupational mix adjustment in section III.C. 

of the preamble to this proposed rule. 

To comply with the requirement that DRG 

reclassification and recalibration of the 

relative weights and the updated wage index 

be budget neutral, we are using FY 2006 

discharge data to simulate payments and 

compare aggregate payments using the FY 

2007 relative weights and wage indexes to 

aggregate payments using the proposed FY 

2008 relative weights and wage indexes. The 

same methodology was used for the FY 2007 

budget neutrality adjustment. Based on this 

comparison, we computed a budget 

neutrality adjustment factor equal to 

0.999317 to be applied to the national 

standardized amount. We also are adjusting 

the Puerto Rico-specific standardized amount 

for the effect of DRG reclassification and 

recalibration. We computed a budget 

neutrality adjustment factor of 0.998557 to be 

applied to the Puerto Rico-specific 

standardized amount. These budget 

neutrality adjustment factors are applied to 

the standardized amounts for FY 2007 

without removing prior year budget 

neutrality adjustments. In addition, as 

discussed in section IV. of this addendum, 

we are applying the same DRG 

reclassification and recalibration budget 

neutrality factor of 0.998557 to the hospitalspecific rates that are to be effective for cost 

reporting periods beginning on or after 

October 1, 2007. 

b. Reclassified Hospitals—Budget Neutrality 

Adjustment 

Section 1886(d)(8)(B) of the Act provides 

that, effective with discharges occurring on 

or after October 1, 1988, certain rural 

hospitals are deemed urban. In addition, 

section 1886(d)(10) of the Act provides for 

the reclassification of hospitals based on 

determinations by the MGCRB. Under section 

1886(d)(10) of the Act, a hospital may be 

reclassified for purposes of the wage index. 

Under section 1886(d)(8)(D) of the Act, the 

Secretary is required to adjust the 

standardized amount to ensure that aggregate 

payments under the IPPS after 

implementation of the provisions of sections 

1886(d)(8)(B) and (C) and 1886(d)(10) of the 

Act are equal to the aggregate prospective 

payments that would have been made absent 

these provisions. We note that the wage 

index adjustments provided under section 

1886(d)(13) of the Act are not budget neutral. 

Section 1886(d)(13)(H) of the Act provides 

that any increase in a wage index under 

section 1886(d)(13) shall not be taken into 

account ‘‘in applying any budget neutrality 

adjustment with respect to such index’’ 

under section 1886(d)(8)(D) of the Act. To 

calculate the budget neutrality factor, we 

used FY 2006 discharge data to simulate 

payments, and compared total IPPS 

payments prior to any reclassifications under 

sections 1886(d)(8)(B) and (C) and 

1886(d)(10) of the Act to total IPPS payments 

after such reclassifications. Based on these 

simulations, we calculated an adjustment 

factor of 0.991938 to ensure that the effects 

of this reclassification are budget neutral, 

consistent with the statute. 

The proposed adjustment factor is applied 

to the standardized amount after removing 

the effects of the FY 2007 budget neutrality 

adjustment factor. We note that the FY 2008 

adjustment reflects FY 2008 wage index 

reclassifications approved by the MGCRB or 

the Administrator. (Section 1886(d)(10)(D)(v) 

of the Act makes wage index reclassifications 

effective for 3 years. Therefore, the FY 2008 

geographic reclassification could either be 

the continuation of a 3-year reclassification 

that began in FY 2006 or FY 2007 or a new 

one beginning in FY 2008.) 

c. Case-Mix Budget Neutrality Adjustment 

The proposed MS–DRGs will increase the 

total number of DRGs from 538 to 745. Such 

a significant expansion in the number of 

DRGs could lead hospitals to improve coding 

and documentation in order to have a case 

assigned to a DRG with a higher payment. As 

explained above, we make an adjustment to 

ensure that the DRG relative weights remain 

budget neutral assuming constant utilization. 

However, without an adjustment to the IPPS 

rates to account for expected case mix growth 

due to improved coding rather than to 

underlying changes in patient status, the 

change to severity DRGs will not be budget 

neutral. Section 1886(d)(3)(A)(vi) of the Act 

provides the Secretary with explicit authority 

to adjust the standardized amounts to 

account for case mix growth due to improved 

documentation and coding. Further, the 

Secretary may subsequently revisit this 

adjustment if actual data is different than the 

projection. 

Based on the Actuary’s analysis, using the 

Secretary’s authority under section 

1886(d)(3)(A)(vi) of the Act to adjust the 

standardized amount to eliminate the effect 

of changes in coding or classification of 

discharges that do not reflect real changes in 

case-mix, we are proposing to reduce the 

IPPS standardized amounts by 2.4 percent 

each year for FY 2008 and FY 2009. Section 

1886(d)(3)(A)(vi) further gives the Secretary 

authority to revisit adjustments to the 

standardized amounts for changes in coding 

or classification of discharges that were based 

on estimates in a future year. Consistent with 

the statute, we will compare the actual 

increase in case-mix due to documentation 

and coding to our projection once we have 

actual data for FY 2008 and FY 2009 for the 

FY 2010 and FY 2011 IPPS rules. As that 

time, if necessary, we may make a further 

adjustment to the standardized amounts to 

account for the difference between our 

projection and actual data. 

d. Outliers 

Section 1886(d)(5)(A) of the Act provides 

for payments in addition to the basic 

prospective payments for ‘‘outlier’’ cases 

involving extraordinarily high costs. To 

qualify for outlier payments, a case must 

have costs greater than the sum of the 

prospective payment rate for the DRG, any 

IME and DSH payments, any new technology 

add-on payments, and the ‘‘outlier 

threshold’’ or ‘‘fixed loss’’ amount (a dollar 

amount by which the costs of a case must 

exceed payments in order to qualify for an 

outlier payment). We refer to the sum of the 

prospective payment rate for the DRG, any 

IME and DSH payments, any new technology 

add-on payments, and the outlier threshold 

as the outlier ‘‘fixed-loss cost threshold.’’ To 

determine whether the costs of a case exceed 

the fixed-loss cost threshold, a hospital’s CCR 

is applied to the total covered charges for the 

case to convert the charges to estimated costs. 

Payments for eligible cases are then made 

based on a marginal cost factor, which is a 

percentage of the estimated costs above the 

fixed-loss cost threshold. The marginal cost 

factor for FY 2008 is 80 percent, the same 

marginal cost factor we have used since FY 

1995 (59 FR 45367). 

In accordance with section 

1886(d)(5)(A)(iv) of the Act, outlier payments 

for any year are projected to be not less than 

5 percent nor more than 6 percent of total 

operating DRG payments plus outlier 

payments. Section 1886(d)(3)(B) of the Act 

requires the Secretary to reduce the average 

standardized amount by a factor to account 

for the estimated proportion of total DRG 

payments made to outlier cases. Similarly, 

section 1886(d)(9)(B)(iv) of the Act requires 

the Secretary to reduce the average 

standardized amount applicable to hospitals 

in Puerto Rico to account for the estimated 

proportion of total DRG payments made to 

outlier cases. More information on outlier 

payments may be found on the CMS Web site 

at http://www.cms.hhs.gov/Acute 

InpatientPPS/04—outlier.asp#TopOfPage. 

(1) Proposed FY 2008 Outlier Fixed-Loss Cost 

Threshold 

For FY 2008, we are proposing to use the 

same methodology used for FY 2007 (71 FR 

48148 through 484151) to calculate the 

outlier threshold. Similar to the methodology 

used in the FY 2007 final rule, for FY 2008, 

we are applying an adjustment factor to the 

CCRs to account for cost and charge inflation 

(as explained below). As we have done in the 

past, to calculate the proposed FY 2008 

outlier threshold, we simulated payments by 

applying FY 2008 rates and policies using 

cases from the FY 2006 MedPAR files. 

Therefore, in order to determine the 

proposed FY 2008 outlier threshold, we 

inflate the charges on the MedPAR claims by 

2 years, from FY 2006 to FY 2008. 

We are proposing to continue using a 

refined methodology that takes into account 

the lower inflation in hospital charges that is 

occurring as a result of the outlier final rule 

(68 FR 34494), which changed our 

methodology for determining outlier 

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payments by implementing the use of more 

current CCRs. Our refined methodology uses 

more recent data that reflect the rate-ofchange in hospital charges under the new 

outlier policy. 

Using the most recent data available, we 

calculated the 1-year average annualized rateof-change in charges-per-case from the last 

quarter of FY 2005 in combination with the 

first quarter of FY 2006 (July 1, 2005 through 

December 31, 2005) to the last quarter of FY 

2006 in combination with the first quarter of 

FY 2007 (July 1, 2006 through December 31, 

2006). This rate of change was 7.26 percent 

(1.0726) or 15.04 percent (1.1504) over 2 

years. 

As we have done in the past, we are 

proposing to establish the proposed FY 2008 

outlier threshold using hospital CCRs from 

the December 2006 update to the ProviderSpecific File—the most recent available at 

the time of this proposed rule. This file 

includes CCRs that reflect implementation of 

the changes to the policy for determining the 

applicable CCRs that became effective August 

8, 2003 (68 FR 34494). 

As discussed in the FY 2007 final rule (71 

FR 48150), we worked with the Actuary to 

derive the methodology described below to 

develop the CCR adjustment factor. For FY 

2008, we are proposing to use the same 

methodology by using the operating cost per 

discharge increase in combination with the 

final updated market basket increase 

determined by Global Insight, Inc., as well as 

the charge inflation factor described above to 

estimate the adjustment to the CCRs. By 

using the market basket rate-of-increase and 

the increase in the average cost per discharge 

from hospital cost reports, we are using two 

different measures of cost inflation. For FY 

2008, we determined the adjustment by 

taking the percentage increase in the 

operating costs per discharge from FY 2004 

to FY 2005 (1.0529) from the cost report and 

dividing it by the final market basket increase 

from FY 2005 (1.043) We repeated this 

calculation for 2 prior years to determine the 

3-year average of the rate of adjusted change 

in costs between the market basket rate-ofincrease and the increase in cost per case 

from the cost report (FY 2002 to FY 2003 

percentage increase of operating costs per 

discharge of 1.0721 divided by FY 2003 final 

market basket increase of 1.041, FY 2003 to 

FY 2004 percentage increase of operating 

costs per discharge of 1.0624 divided by FY 

2004 final market basket increase of 1.04). 

For FY 2008, we averaged the differentials 

calculated for FY 2003, FY 2004, and FY 

2005 which resulted in a mean ratio of 

1.0203. We multiplied the 3-year average of 

1.0203 by the 2006 market basket percentage 

increase of 1.0420, which resulted in an 

operating cost inflation factor of 6.32 percent 

or 1.0632. We then divided the operating cost 

inflation factor by the 1-year average change 

in charges (1.0726) and applied an 

adjustment factor of 0.9912 to the operating 

CCRs from the Provider-Specific File. 

As stated in the FY 2007 final rule, we 

continue to believe it is appropriate to apply 

only a one year adjustment factor to the 

CCRs. On average, it takes approximately 9 

months for fiscal intermediaries (or, if 

applicable, the MAC) to tentatively settle a 

cost report from the fiscal year end of a 

hospital’s cost reporting period. The average 

‘‘age’’ of hospitals’’ CCRs from the time the 

fiscal intermediary or the MAC inserts the 

CCR in the PSF until the beginning of FY 

2007 is approximately 1 year. Therefore, as 

stated above, we believe a one year 

adjustment to the CCRs is appropriate. 

We used the same methodology for the 

capital CCRs and applied an adjustment 

factor of 0.964 (cost inflation factor of 1.0340 

divided by a charge inflation factor of 1.0726) 

to the capital CCRs. We are using the same 

charge inflation factor for the capital CCRs 

that was used for the operating CCRs. The 

charge inflation factor is based on the overall 

billed charges. Therefore, we believe it is 

appropriate to apply the charge factor to both 

the operating and capital CCRs. 

Using this methodology, we are proposing 

an outlier fixed-loss cost threshold for FY 

2008 equal to the prospective payment rate 

for the DRG, plus any IME and DSH 

payments, and any add-on payments for new 

technology, plus $23,015. With this 

threshold, we are projecting that outlier 

payments will equal 5.1 percent of total IPPS 

payments. 

As we did in establishing the FY 2007 

outlier threshold (71 FR 48149), in our 

projection of FY 2008 outlier payments, we 

are not making any adjustments for the 

possibility that hospitals’ CCRs and outlier 

payments may be reconciled upon cost report 

settlement. We continue to believe that, due 

to the policy implemented in the outlier final 

rule (68 FR 34494, June 9, 2003), CCRs will 

no longer fluctuate significantly and, 

therefore, few hospitals will actually have 

these ratios reconciled upon cost report 

settlement. In addition, it is difficult to 

predict the specific hospitals that will have 

CCRs and outlier payments reconciled in any 

given year. We also noted that reconciliation 

occurs because hospitals’ actual CCRs for the 

cost reporting period are different than the 

interim CCRs used to calculate outlier 

payments when a bill is processed. Our 

simulations assume that CCRs accurately 

measure hospital costs based on information 

available to us at the time we set the outlier 

threshold. For these reasons, we are not 

making any assumptions about the effects of 

reconciliation on the outlier threshold 

calculation. 

We also note that there are several factors 

that contributed to a lower fixed loss outlier 

threshold for FY 2008 compared to FY 2007. 

First, the case-weighted national average 

operating CCR declined by approximately an 

additional 1.3 percentage points from the 

March 2006 (used to calculate the FY 2007 

outlier threshold) to the December 2006 

update of the Provider-Specific File. Second, 

we further reduced the CCRs by applying an 

adjustment to reflect the differential increase 

between costs and charges. As noted above, 

using lower CCRs from the December 2006 

Provider-Specific File, in combination with 

the FY 2006 MedPAR claims and inflated 

charges, contributes to a lower outlier 

threshold for FY 2008 in this proposed rule 

compared to an outlier threshold of $24,485 

in FY 2007. Finally, as discussed in section 

II.D. of the preamble of this proposed rule, 

we are proposing to adopt the use of MS– 

DRGs under the IPPS for FY 2008. The 

proposed MS–DRG system would increase 

the number of DRGs from 538 to 745 and 

better recognize severity of illness than the 

CMS DRGs. Better recognition of severity of 

illness with the MS–DRGs means that 

nonoutlier payments will compensate 

hospitals for the higher costs of some cases 

that previously received outlier payments. As 

cases are paid more accurately, in order to 

meet the 5.1 percent target, we would need 

to decrease the fixed-loss outlier threshold so 

that more cases qualify for outlier payments. 

Therefore, we believe that all of the above 

factors cumulatively contributed to a lower 

proposed fixed-loss outlier threshold in FY 

2008 compared to FY 2007. 

(2) Other Proposed Changes Concerning 

Outliers 

As stated in the FY 1994 IPPS final rule (58 

FR 46348, September 1, 1993), we establish 

outlier thresholds that are applicable to both 

hospital inpatient operating costs and 

hospital inpatient capital-related costs. When 

we modeled the combined operating and 

capital outlier payments, we found that using 

a common set of thresholds resulted in a 

lower percentage of outlier payments for 

capital-related costs than for operating costs. 

We are project that the proposed thresholds 

for FY 2008 would result in outlier payments 

equal to 5.1 percent of operating DRG 

payments and 4.87 percent of capital 

payments based on the Federal rate. 

In accordance with section 1886(d)(3)(B) of 

the Act, we are reducing the FY 2008 

standardized amount by the same percentage 

to account for the projected proportion of 

payments paid to outliers. 

The outlier adjustment factors that would 

be applied to the standardized amount for the 

proposed FY 2008 outlier threshold are as 

follows: 

I 

Operating 

standardized 

amounts 

Capital 

federal 

rate 

National ..... 0.948989 0.948377 

Puerto Rico 0.965244 0.954922 

Consistent with current policy, we are 

applying the outlier adjustment factors to FY 

2008 rates after removing the effects of the 

FY 2007 outlier adjustment factors on the 

standardized amount. 

To determine whether a case qualifies for 

outlier payments, we apply hospital-specific 

CCRs to the total covered charges for the 

case. Estimated operating and capital costs 

for the case are calculated separately by 

applying separate operating and capital 

CCRs. These costs are then combined and 

compared with the outlier fixed-loss cost 

threshold. 

The outlier final rule (68 FR 34494) 

eliminated the application of the statewide 

average CCRs for hospitals with CCRs that 

fall below 3 standard deviations from the 

national mean CCR. However, for those 

hospitals for which the fiscal intermediary or 

MAC computes operating CCRs greater than 

1.221 or capital CCRs greater than 0.150, or 

hospitals for whom the fiscal intermediary or 

MAC is unable to calculate a CCR (as 

described at § 412.84(i)(3) of our 

regulations), 

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24838 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

18 These figures represent 3.0 standard deviations 

from the mean of the log distribution of CCRs for 

all hospitals. 

we are still using statewide average CCRs to 

determine whether a hospital qualifies for 

outlier payments.18 Table 8A in section VI. 

of this Addendum contains the statewide 

average operating CCRs for urban hospitals 

and for rural hospitals for which the fiscal 

intermediary or MAC is unable to compute 

a hospital-specific CCR within the above 

range. Effective for discharges occurring on 

or after October 1, 2007, these statewide 

average ratios would replace the ratios 

published in the IPPS final rule for FY 2007 

(71 FR 48303). Table 8B in section VI. of this 

Addendum contains the comparable 

statewide average capital CCRs. Again, the 

CCRs in Tables 8A and 8B would be used 

during FY 2008 when hospital-specific CCRs 

based on the latest settled cost report are 

either not available or are outside the range 

noted above. For an explanation of Table 8C, 

please see section VI. of this Addendum. 

We finally note that we published a 

manual update (Change Request 3966) to 

outliers on October 12, 2005 which updated 

Chapter 3, Section 20.1.2 of the Medicare 

Claims Processing Manual. The manual 

update covered an array of topics, including 

CCRs, reconciliation, and the time value of 

money. We encourage hospitals that are 

assigned the statewide average operating 

and/or capital CCRs to work with their fiscal 

intermediaries or MAC on a possible 

alternative operating and/or capital CCR as 

explained in Change Request 3966. Use of an 

alternative CCR developed by the hospital in 

conjunction with the fiscal intermediary or 

MAC can avoid possible overpayments or 

underpayments at cost report settlement thus 

ensuring better accuracy when making 

outlier payments and negating the need for 

outlier reconciliation. We also note a hospital 

may request an alternative operating or 

capital CCR ratio at any time as long as the 

guidelines of Change Request 3966 are 

followed. To download and view the manual 

instructions on outlier and cost-to-charge 

ratios, please visit the Web site: http:// 

www.cms.hhs.gov/ manuals/downloads/ 

clm104c03.pdf. 

(3) FY 2006 and FY 2007 Outlier Payments 

In the FY 2007 IPPS final rule (70 FR 

47496), we stated that, based on available 

data, we estimated that actual FY 2006 

outlier payments would be approximately 

4.62 percent of actual total DRG payments. 

This estimate was computed based on 

simulations using the FY 2005 MedPAR file 

(discharge data for FY 2005 bills). That is, the 

estimate of actual outlier payments did not 

reflect actual FY 2006 bills, but instead 

reflected the application of FY 2006 rates and 

policies to available FY 2005 bills. 

Our current estimate, using available FY 

2006 bills, is that actual outlier payments for 

FY 2006 were approximately 4.50 percent of 

actual total DRG payments. Thus, the data 

indicate that, for FY 2006, the percentage of 

actual outlier payments relative to actual 

total payments is lower than we projected 

before FY 2006. Consistent with the policy 

and statutory interpretation we have 

maintained since the inception of the IPPS, 

we do not plan to make retroactive 

adjustments to outlier payments to ensure 

that total outlier payments for FY 2006 are 

equal to 5.1 percent of total DRG payments. 

We currently estimate that actual outlier 

payments for FY 2007 will be approximately 

4.9 percent of actual total DRG payments, 0.2 

percentage points lower than the 5.1 percent 

we projected in setting the outlier policies for 

FY 2007. This estimate is based on 

simulations using the FY 2006 MedPAR file 

(discharge data for FY 2006 bills). We used 

these data to calculate an estimate of the 

actual outlier percentage for FY 2007 by 

applying FY 2007 rates and policies, 

including an outlier threshold of $24,485 to 

available FY 2006 bills. We believe the 0.2 

percentage point difference between the 

projected estimate of outlier payments for FY 

2007 and our current estimate of actual 

outlier payments in this proposed rule 

provides preliminary evidence that 

incorporating an adjustment factor to the 

CCRs for FY 2007 in response to public 

comments has improved our estimating 

methodology. 

e. Proposed Rural Community Hospital 

Demonstration Program Adjustment (Section 

410A of Pub. L. 108–173) 

Section 410A of Pub. L. 108–173 requires 

the Secretary to establish a demonstration 

that will modify reimbursement for inpatient 

services for up to 15 small rural hospitals. 

Section 410A(c)(2) of Pub. L. 108–173 

requires that ‘‘in conducting the 

demonstration program under this section, 

the Secretary shall ensure that the aggregate 

payments made by the Secretary do not 

exceed the amount which the Secretary 

would have paid if the demonstration 

program under this section was not 

implemented.’’ As discussed in section IV.G. 

of the preamble to this proposed rule, we 

have satisfied this requirement by adjusting 

national IPPS rates by a factor that is 

sufficient to account for the added costs of 

this demonstration. We estimate that the 

average additional annual payment that will 

be made to each participating hospital under 

the demonstration will be approximately 

$1,075,765. We based this estimate on the 

recent historical experience of the difference 

between inpatient cost and payment for 

hospitals that are participating in the 

demonstration. For 9 participating hospitals, 

the total annual impact of the demonstration 

program is estimated to be $9,681,893. The 

required adjustment to the Federal rate used 

in calculating Medicare inpatient prospective 

payments as a result of the demonstration is 

0.999899. 

In order to achieve budget neutrality, we 

are adjusting the national IPPS rates by an 

amount sufficient to account for the added 

costs of this demonstration. In other words, 

we are applying budget neutrality across the 

payment system as a whole rather than 

merely across the participants of this 

demonstration, consistent with past practice. 

We believe that the language of the statutory 

budget neutrality requirement permits the 

agency to implement the budget neutrality 

provision in this manner. The statutory 

language requires that ‘‘aggregate payments 

made by the Secretary do not exceed the 

amount which the Secretary would have paid 

if the demonstration * * * was not 

implemented,’’ but does not identify the 

range across which aggregate payments must 

be held equal. 

5. Proposed FY 2008 Standardized Amount 

The proposed adjusted standardized 

amount is divided into labor-related and 

nonlabor-related portions. Tables 1A and 1B 

in section VI. of this Addendum contain the 

national standardized amount that we are 

proposing to apply to all hospitals, except 

hospitals in Puerto Rico. The proposed 

Puerto Rico-specific amounts are shown in 

Table 1C. The proposed amounts shown in 

Tables 1A and 1B differ only in that the 

labor-related share applied to the 

standardized amounts in Table 1A is 69.7 

percent, and Table 1B is 62 percent. In 

accordance with sections 1886(d)(3)(E) and 

1886(d)(9)(C)(iv) of the Act, we are applying 

a labor-related share of 62 percent, unless the 

application of that percentage would result in 

lower payments to a hospital than would 

otherwise be made. In effect, the statutory 

provision means that we will apply a laborrelated share of 62 percent for all hospitals 

(other than those in Puerto Rico) whose wage 

indexes are less than or equal to 1.0000. 

In addition, Tables 1A and 1B include 

proposed standardized amounts reflecting 

the proposed full 3.3 percent update for FY 

2008, and proposed standardized amounts 

reflecting the 2.0 percentage point reduction 

to the update (a 1.3 percent update) 

applicable for hospitals that fail to submit 

quality data consistent with section 

1886(b)(3)(B)(viii) of the Act. 

Under section 1886(d)(9)(A)(ii) of the Act, 

the Federal portion of the Puerto Rico 

payment rate is based on the dischargeweighted average of the national large urban 

standardized amount (this proposed amount 

is set forth in Table 1A). The proposed laborrelated and nonlabor-related portions of the 

national average standardized amounts for 

Puerto Rico hospitals for FY 2008 are set 

forth in Table 1C of section VI. of this 

Addendum. This table also includes the 

proposed Puerto Rico standardized amounts. 

The labor-related share applied to the 

proposed Puerto Rico specific standardized 

amount is 58.7 percent, or 62 percent, 

depending on which provides higher 

payments to the hospital. (Section 

1886(d)(9)(C)(iv) of the Act, as amended by 

section 403(b) of Pub. L. 108–173, provides 

that the labor-related share for hospitals in 

Puerto Rico will be 62 percent, unless the 

application of that percentage would result in 

lower payments to the hospital.) 

The following table illustrates the 

proposed changes from the FY 2007 national 

average standardized amount. The second 

column shows the proposed changes from 

the FY 2007 standardized amounts for 

hospitals that satisfy the quality data 

submission requirement for receiving the full 

update (3.3 percent). The third column 

shows the proposed changes for hospitals 

receiving the reduced update (1.3 percent). 

The first row of the table shows the proposed 

updated (through FY 2007) average 

standardized amount after restoring the FY 

2007 offsets for outlier payments, 

demonstration budget neutrality, the wage 

index transition budget neutrality, and the 

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geographic reclassification budget neutrality. 

The DRG reclassification and recalibration 

and wage index budget neutrality factor is 

cumulative. Therefore, the FY 2007 factor is 

not removed from this table. We have added 

two additional rows: One for the 

documentation and coding adjustment and 

the other for the rural floor adjustment. (For 

a complete discussion on the documentation 

and coding adjustment and the rural floor 

adjustment, see sections II.D.1.c and III.G.4 of 

the Addendum to this proposed rule). We 

have also added separate rows to this table 

to reflect the different labor related shares 

that apply to hospitals. 

COMPARISON OF FY 2007 STANDARDIZED AMOUNTS TO PROPOSED FY 2008 SINGLE STANDARDIZED AMOUNT WITH FULL

UPDATE AND REDUCED UPDATE

Full update 

(3.3 percent) 

Reduced update 

(1.3 percent) 

FY 2007 Base Rate, after removing reclassification budget neutrality, demonstration budget neutrality, wage index transition budget neutrality factors 

and outlier offset (based on the labor and market share percentage for FY 

2008).

Labor: $3,609.23 ....................

Nonlabor: $1,569.01 ..............

Labor: $3,609.23 

Nonlabor: $1,569.01 

FY 2008 Update Factor .......................................................................................... 1.033 ...................................... 1.013 

FY 2008 DRG Recalibrations and Wage Index Budget Neutrality Factor ............. 0.999317 ................................ 0.999317

FY 2008 Reclassification Budget Neutrality Factor ............................................... 0.991938 ................................ 0.991938 

Adjusted for Blend of FY 2007 DRG Recalibration and Wage Index Budget 

Neutrality Factors.

Labor: $3,695.75 ....................

Nonlabor: $1,606.62 ..............

Labor: $3,624.20 

Nonlabor: $1,575.51 

FY 2008 Outlier Factor ........................................................................................... 0.948989 ................................ 0.948989 

Rural Demonstration Budget Neutrality Factor ...................................................... 0.999899 ................................ 0.999899 

Proposed FY 2008 Documentation and Coding Adjustment ................................. 0.976 ...................................... 0.976 

Rural Floor Adjustment ........................................................................................... 1.002214 ................................ 1.002214 

Proposed Rate for FY 2008 (after multiplying FY 2007 base rate by above factors) where the wage index is less than or equal to 1.0000.Labor: $3,051.33 ....................

Nonlabor: $1,870.17 ..............

Labor: $2,992.26 

Nonlabor: $1,833.96 

Proposed Rate for FY 2008 (after multiplying FY 2007 base rate by above factors) where the wage index is greater than 1.0000.Labor: $3,430.29 ....................

Nonlabor: $1,491.21 ..............

Labor: $3,363.88 

Nonlabor: $1,462.34 

Under section 1886(d)(9)(A)(ii) of the Act, 

the Federal portion of the Puerto Rico 

payment rate is based on the dischargeweighted average of the national large urban 

standardized amount (as set forth in Table 

1A). The labor-related and nonlabor-related 

portions of the national average standardized 

amounts for Puerto Rico hospitals are set 

forth in Table 1C of section VI. of this 

Addendum. This table also includes the 

Puerto Rico standardized amounts. The 

labor-related share applied to the Puerto Rico 

standardized amount is 58.7 percent, or 62 

percent, depending on which results in 

higher payments to the hospital. (Section 

1886(d)(9)(C)(iv) of the Act, as amended by 

section 403(b) of Pub. L. 108–173, provides 

that the labor-related share for hospitals in 

Puerto Rico will be 62 percent, unless the 

application of that percentage would result in 

lower payments to the hospital.) 

B. Proposed Adjustments for Area Wage 

Levels and Cost-of-Living 

Tables 1A through 1C, as set forth in 

section VI. of this Addendum, contain the 

proposed labor-related and nonlabor-related 

shares that we are using to calculate the 

proposed prospective payment rates for 

hospitals located in the 50 States, the District 

of Columbia, and Puerto Rico for FY 2008. 

This section addresses two types of 

adjustments to the standardized amounts that 

are made in determining the proposed 

prospective payment rates as described in 

this Addendum. 

1. Proposed Adjustment for Area Wage 

Levels 

Sections 1886(d)(3)(E) and 

1886(d)(9)(C)(iv) of the Act require that we 

make an adjustment to the labor-related 

portion of the national and Puerto Rico 

prospective payment rates, respectively, to 

account for area differences in hospital wage 

levels. This adjustment is made by 

multiplying the labor-related portion of the 

adjusted standardized amounts by the 

appropriate wage index for the area in which 

the hospital is located. In section III. of the 

preamble to this proposed rule, we discuss 

the data and methodology for the proposed 

FY 2008 wage index. 

2. Proposed Adjustment for Cost-of-Living in 

Alaska and Hawaii 

Section 1886(d)(5)(H) of the Act authorizes 

an adjustment to take into account the 

unique circumstances of hospitals in Alaska 

and Hawaii. Higher labor-related costs for 

these two States are taken into account in the 

adjustment for area wages described above. 

For FY 2008, we are proposing to adjust the 

payments for hospitals in Alaska and Hawaii 

by multiplying the nonlabor-related portion 

of the standardized amount by the applicable 

adjustment factor contained in the table 

below. 

TABLE OF COST-OF-LIVING ADJUSTMENT FACTORS: ALASKA AND HAWAII HOSPITALS

Area Cost of living adjustment factor 

Alaska: 

City of Anchorage and 80-kilometer (50-mile) radius by road ............................................................................................. 1.24 

City of Fairbanks and 80-kilometer (50-mile) radius by road ............................................................................................... 1.24 

City of Juneau and 80-kilometer (50-mile) radius by road ................................................................................................... 1.24 

Alaska-All areas .................................................................................................................................................................... 1.25 

Hawaii: 

City and County of Honolulu ................................................................................................................................................ 1.25 

County of Hawaii .................................................................................................................................................................. 1.17 

County of Kauai .................................................................................................................................................................... 1.25 

County of Maui and County of Kalawao .............................................................................................................................. 1.25 

(The above factors are based on data obtained from the U.S. Office of Personnel Management.) 

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24840 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

C. Proposed DRG Relative Weights 

As discussed in section II. of the preamble 

of this proposed rule, we are proposing to 

adopt a revised classification system for all 

hospital discharges, assigning them into 

proposed MS–DRGs, and have developed 

proposed relative weights for each MS–DRG 

that reflect the resource utilization of cases 

in each proposed MS–DRG relative to 

Medicare cases in other proposed MS–DRGs. 

Table 5 of section VI. of this Addendum 

contains the proposed relative weights that 

we would use for discharges occurring in FY 

2008. These factors have been recalibrated as 

explained in section II. of the preamble of 

this proposed rule. 

D. Calculation of the Proposed Prospective 

Payment Rates 

General Formula for Calculation of the 

Proposed Prospective Payment Rates for FY 

2008 

In general, the operating prospective 

payment rate for all hospitals paid under the 

IPPS located outside of Puerto Rico, except 

SCHs and MDHs, for FY 2008 equals the 

Federal rate. 

The prospective payment rate for SCHs for 

FY 2008 equals the higher of the applicable 

Federal rate or the hospital-specific rate as 

described below. The prospective payment 

rate for MDHs for FY 2008 equals the higher 

of the Federal rate, or the Federal rate plus 

75 percent of the difference between the 

Federal rate and the hospital-specific rate as 

described below. The prospective payment 

rate for Puerto Rico for FY 2008 equals 25 

percent of the Puerto Rico rate plus 75 

percent of the applicable national rate. 

1. Federal Rate 

The Federal rate is determined as follows: 

Step 1—Select the applicable average 

standardized amount depending on whether 

the hospital has submitted qualifying quality 

data (full update for qualifying hospitals, 

update minus 2.0 percentage points for 

nonqualifying hospitals). 

Step 2—Multiply the labor-related portion 

of the standardized amount by the applicable 

wage index for the geographic area in which 

the hospital is located or the area to which 

the hospital is reclassified. 

Step 3—For hospitals in Alaska and 

Hawaii, multiply the non-labor-related 

portion of the standardized amount by the 

applicable cost-of-living adjustment factor. 

Step 4—Add the amount from Step 2 and 

the non-labor-related portion of the 

standardized amount (adjusted, if applicable, 

under Step 3). 

Step 5—Multiply the final amount from 

Step 4 by the relative weight corresponding 

to the applicable MS–DRG (see Table 5 of 

section VI. of this Addendum). 

The Federal rate as determined in Step 5 

may then be further adjusted if the hospital 

qualifies for either the IME or DSH 

adjustment. In addition, for hospitals that 

qualify for a low-volume payment adjustment 

under section 1886(d)(12) of the Act, the 

payment in Step 5 would be increased by 25 

percent. 

2. Hospital-Specific Rate (Applicable Only to 

SCHs and MDHs) 

a. Calculation of Hospital-Specific Rate 

Section 1886(b)(3)(C) of the Act provides 

that SCHs are paid based on whichever of the 

following rates yields the greatest aggregate 

payment: the Federal rate; the updated 

hospital-specific rate based on FY 1982 costs 

per discharge; the updated hospital-specific 

rate based on FY 1987 costs per discharge; or 

the updated hospital-specific rate based on 

FY 1996 costs per discharge. 

As discussed previously, MDHs are 

required to rebase their hospital-specific rates 

to their FY 2002 cost reports if doing so 

results in higher payments. In addition, 

effective for discharges occurring on or after 

October 1, 2006, MDHs are to be paid based 

on the Federal national rate or, if higher, the 

Federal national rate plus 75 percent 

(changed from 50 percent) of the difference 

between the Federal national rate and the 

greater of the updated hospital-specific rates 

based on either FY 1982, FY 1987 or FY 2002 

costs per discharge. Further, MDHs will no 

longer be subject to the 12-percent cap on 

their DSH payment adjustment factor. 

Hospital-specific rates have been 

determined for each of these hospitals based 

on the FY 1982 costs per discharge, the FY 

1987 costs per discharge, or, for SCHs, the FY 

1996 costs per discharge and for MDHs, the 

FY 2002 cost per discharge. For a more 

detailed discussion of the calculation of the 

hospital-specific rates, we refer the reader to 

the FY 1984 IPPS interim final rule (48 FR 

39772); the April 20, 1990 final rule with 

comment (55 FR 15150); the FY 1991 IPPS 

final rule (55 FR 35994); and the FY 2001 

IPPS final rule (65 FR 47082). In addition, for 

both SCHs and MDHs, the hospital-specific 

rate is adjusted by the budget neutrality 

adjustment factor as discussed in section 

IV.C. of the preamble to this proposed rule. 

The resulting rate will be used in 

determining the payment rate an SCH or 

MDH will receive for its discharges beginning 

on or after October 1, 2007. 

b. Updating the FY 1982, FY 1987, FY 1996, 

and FY 2002 Hospital-Specific Rates for FY 

2008 

We are proposing to increase the hospitalspecific rates by 3.3 percent (the proposed 

estimated hospital market basket percentage 

increase) for SCHs and MDHs for FY 2008. 

Section 1886(b)(3)(C)(iv) of the Act provides 

that the update factor applicable to the 

hospital-specific rates for SCHs is equal to 

the update factor provided under section 

1886(b)(3)(B)(iv) of the Act, which, for SCHs 

in FY 2007, is the market basket rate-ofincrease. Section 1886(b)(3)(D) of the Act 

provides that the update factor applicable to 

the hospital-specific rates for MDHs also 

equals the update factor provided under 

section 1886(b)(3)(B)(iv) of the Act, which, 

for FY 2007, is the market basket rate-ofincrease. 

3. General Formula for Calculation of 

Proposed Prospective Payment Rates for 

Hospitals Located in Puerto Rico Beginning 

On or After October 1, 2007, and Before 

October 1, 2008 

Section 1886(d)(9)(E)(iv) of the Act 

provides that, effective for discharges 

occurring on or after October 1, 2004, 

hospitals located in Puerto Rico are paid 

based on a blend of 75 percent of the national 

prospective payment rate and 25 percent of 

the Puerto Rico-specific rate. 

a. Puerto Rico Rate 

The Puerto Rico prospective payment rate 

is determined as follows: 

Step 1—Select the applicable average 

standardized amount considering the 

applicable wage index (see Table 1C). 

Step 2—Multiply the labor-related portion 

of the standardized amount by the applicable 

Puerto Rico-specific wage index. 

Step 3—Add the amount from Step 2 and 

the nonlabor-related portion of the 

standardized amount. 

Step 4—Multiply the amount from Step 3 

by the applicable MS–DRG relative weight 

(see Table 5 of section IV. of the Addendum). 

Step 5—Multiply the result in Step 4 by 25 

percent. 

b. National Rate 

The national prospective payment rate is 

determined as follows: 

Step 1—Select the applicable average 

standardized amount. 

Step 2—Multiply the labor-related portion 

of the standardized amount by the applicable 

wage index for the geographic area in which 

the hospital is located or the area to which 

the hospital is reclassified. 

Step 3—Add the amount from Step 2 and 

the nonlabor-related portion of the national 

average standardized amount. 

Step 4—Multiply the amount from Step 3 

by the applicable MS–DRG relative weight 

(see Table 5 of section VI. of the Addendum). 

Step 5—Multiply the result in Step 4 by 75 

percent. 

The sum of the Puerto Rico rate and the 

national rate computed above equals the 

prospective payment for a given discharge for 

a hospital located in Puerto Rico. This rate 

may then be further adjusted if the hospital 

qualifies for either the IME or DSH 

adjustment. 

III. Proposed Changes to Payment Rates for 

Acute Care Hospital Inpatient CapitalRelated Costs for FY 2008 

(If you choose to comment on issues in this 

section, please include the caption ‘‘Capital 

Payment Rate’’ at the beginning of your 

comment.) 

The PPS for acute care hospital inpatient 

capital-related costs was implemented for 

cost reporting periods beginning on or after 

October 1, 1991. Effective with that cost 

reporting period, hospitals were paid during 

a 10-year transition period (which extended 

through FY 2001) to change the payment 

methodology for Medicare acute care hospital 

inpatient capital-related costs from a 

reasonable cost-based methodology to a 

prospective methodology (based fully on the 

Federal rate). 

The basic methodology for determining 

Federal capital prospective rates is set forth 

in regulations at § § 412.308 through 

412.352. Below we discuss the factors that 

we are proposing to use to determine the 

capital Federal rate for FY 2008, which will 

be effective for discharges occurring on or 

after October 1, 2007. 

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The 10-year transition period ended with 

hospital cost reporting periods beginning on 

or after October 1, 2001 (FY 2002). Therefore, 

for cost reporting periods beginning in FY 

2002, all hospitals (except ‘‘new’’ hospitals 

under § 412.304(c)(2)) are paid based on 100 

percent of the capital Federal rate. For FY 

1992, we computed the standard Federal 

payment rate for capital-related costs under 

the IPPS by updating the FY 1989 Medicare 

inpatient capital cost per case by an actuarial 

estimate of the increase in Medicare inpatient 

capital costs per case. Each year after FY 

1992, we update the capital standard Federal 

rate, as provided at § 412.308(c)(1), to 

account for capital input price increases and 

other factors. The regulations at §

412.308(c)(2) provide that the capital Federal 

rate is adjusted annually by a factor equal to 

the estimated proportion of outlier payments 

under the capital Federal rate to total capital 

payments under the capital Federal rate. In 

addition, § 412.308(c)(3) requires that the 

capital Federal rate be reduced by an 

adjustment factor equal to the estimated 

proportion of payments for (regular and 

special) exceptions under § 412.348. Section 

412.308(c)(4)(ii) requires that the capital 

standard Federal rate be adjusted so that the 

effects of the annual DRG reclassification and 

the recalibration of DRG weights and changes 

in the geographic adjustment factor are 

budget neutral. 

For FYs 1992 through 1995, § 412.352 

required that the capital Federal rate also be 

adjusted by a budget neutrality factor so that 

aggregate payments for inpatient hospital 

capital costs were projected to equal 90 

percent of the payments that would have 

been made for capital-related costs on a 

reasonable cost basis during the fiscal year. 

That provision expired in FY 1996. Section 

412.308(b)(2) describes the 7.4 percent 

reduction to the capital rate that was made 

in FY 1994, and § 412.308(b)(3) describes the 

0.28 percent reduction to the capital rate 

made in FY 1996 as a result of the revised 

policy of paying for transfers. In FY 1998, we 

implemented section 4402 of Pub. L. 105–33, 

which required that, for discharges occurring 

on or after October 1, 1997, the budget 

neutrality adjustment factor in effect on 

September 30, 1995, be applied to the 

unadjusted capital standard Federal rate and 

the unadjusted hospital-specific rate. That 

factor was 0.8432, which was equivalent to 

a 15.68 percent reduction to the unadjusted 

capital payment rates. An additional 2.1 

percent reduction to the rates was effective 

from October 1, 1997 through September 30, 

2002, making the total reduction 17.78 

percent. As we discussed in the FY 2003 

IPPS final rule (67 FR 50102) and 

implemented in § 412.308(b)(6), the 2.1 

percent reduction was restored effective 

October 1, 2002. 

To determine the appropriate budget 

neutrality adjustment factor and the regular 

exceptions payment adjustment during the 

10-year transition period, we developed a 

dynamic model of Medicare inpatient 

capital-related costs; that is, a model that 

projected changes in Medicare inpatient 

capital-related costs over time. With the 

expiration of the budget neutrality provision, 

the capital cost model was only used to 

estimate the regular exceptions payment 

adjustment and other factors during the 

transition period. As we explained in the FY 

2002 IPPS final rule (66 FR 39911), beginning 

in FY 2002, an adjustment for regular 

exception payments is no longer necessary 

because regular exception payments were 

only made for cost reporting periods 

beginning on or after October 1, 1991, and 

before October 1, 2001 (see § 412.348(b)). 

Because payments are no longer being made 

under the regular exception policy effective 

with cost reporting periods beginning in FY 

2002, we no longer use the capital cost 

model. The capital cost model and its 

application during the transition period are 

described in Appendix B of the FY 2002 IPPS 

final rule (66 FR 40099). 

Section 412.374 provides for the use of a 

blended payment system for payments to 

Puerto Rico hospitals under the IPPS for 

acute care hospital inpatient capital-related 

costs. Accordingly, under the capital PPS, we 

compute a separate payment rate specific to 

Puerto Rico hospitals using the same 

methodology used to compute the national 

Federal rate for capital-related costs. In 

accordance with section 1886(d)(9)(A) of the 

Act, under the IPPS for acute care hospital 

operating costs, hospitals located in Puerto 

Rico are paid for operating costs under a 

special payment formula. Prior to FY 1998, 

hospitals in Puerto Rico were paid a blended 

operating rate that consisted of 75 percent of 

the applicable standardized amount specific 

to Puerto Rico hospitals and 25 percent of the 

applicable national average standardized 

amount. Similarly, prior to FY 1998, 

hospitals in Puerto Rico were paid a blended 

capital rate that consisted of 75 percent of the 

applicable capital Puerto Rico-specific rate 

and 25 percent of the applicable capital 

Federal rate. However, effective October 1, 

1997, in accordance with section 4406 of 

Pub. L. 105–33, operating payments to 

hospitals in Puerto Rico were revised to be 

based on a blend of 50 percent of the 

applicable standardized amount specific to 

Puerto Rico hospitals and 50 percent of the 

applicable national average standardized 

amount. In conjunction with this change to 

the operating blend percentage, effective with 

discharges occurring on or after October 1, 

1997, we also revised the methodology for 

computing capital payments to hospitals in 

Puerto Rico to be based on a blend of 50 

percent of the Puerto Rico capital rate and 50 

percent of the capital Federal rate. 

As we discussed in the FY 2005 IPPS final 

rule (69 FR 49185), section 504 of Pub. L. 

108–173 increased the national portion of the 

operating IPPS payments for Puerto Rico 

hospitals from 50 percent to 62.5 percent and 

decreased the Puerto Rico portion of the 

operating IPPS payments from 50 percent to 

37.5 percent for discharges occurring on or 

after April 1, 2004 through September 30, 

2004 (see the March 26, 2004 One-Time 

Notification (Change Request 3158)). In 

addition, section 504 of Pub. L. 108–173 

provided that the national portion of 

operating IPPS payments for Puerto Rico 

hospitals is equal to 75 percent and the 

Puerto Rico portion of operating IPPS 

payments is equal to 25 percent for 

discharges occurring on or after October 1, 

2004. Consistent with that change in 

operating IPPS payments to hospitals in 

Puerto Rico, for FY 2005 (as we discussed in 

the FY 2005 IPPS final rule), we revised the 

methodology for computing capital payments 

to hospitals located in Puerto Rico to be 

based on a blend of 25 percent of the Puerto 

Rico capital rate and 75 percent of the capital 

Federal rate for discharges occurring on or 

after October 1, 2004. 

A. Determination of Proposed Federal 

Hospital Inpatient Capital-Related 

Prospective Payment Rate Update 

In the FY 2007 IPPS final rule (71 FR 

48161), we established a tentative capital 

Federal rate of $427.38 for FY 2007. In the 

Federal Register notice establishing the 

occupational mix adjusted payment rates for 

FY 2007 (71 FR 59891), we established the 

final FY 2007 Federal rate of $427.03 for FY 

2007. In the discussion that follows, we 

explain the factors that we are proposing to 

use to determine the proposed FY 2008 

capital Federal rate. However, as discussed in 

section V. of the preamble of this proposed 

rule, we are proposing two separate capital 

Federal rates for FY 2008: a capital Federal 

rate for rural hospitals and a capital Federal 

rate for urban hospitals. In particular, we 

explain why the proposed FY 2008 capital 

Federal rate for rural hospitals would 

decrease approximately 2.3 percent, 

compared to the FY 2007 capital Federal rate, 

and why the proposed FY 2008 capital 

Federal rate for urban hospitals would 

decrease approximately 3.1 percent, 

compared to the FY 2007 capital Federal rate. 

Consequently, despite an estimated increase 

in Medicare fee-for-service discharges in FY 

2008 as compared to FY 2007, we estimate 

aggregate capital payments would decrease 

by 0.13 percent during this same period. 

Total payments to hospitals under the IPPS 

are relatively unaffected by changes in the 

capital prospective payments. Since capital 

payments constitute about 10 percent of 

hospital payments, a 1-percent change in the 

capital Federal rate yields only about 0.1 

percent change in actual payments to 

hospitals. As noted above, aggregate 

payments under the capital IPPS are 

estimated to decrease in FY 2008 compared 

to FY 2007. 

1. Projected Capital Standard Federal Rate 

Update 

a. Description of the Update Framework 

Under § 412.308(c)(1), the capital standard 

Federal rate is updated on the basis of an 

analytical framework that takes into account 

changes in a capital input price index (CIPI) 

and several other policy adjustment factors. 

Specifically, we have adjusted the projected 

CIPI rate-of-increase as appropriate each year 

for case-mix index-related changes, for 

intensity, and for errors in previous CIPI 

forecasts. The proposed update factor for FY 

2008 under that framework is 0.8 percent 

based on the best data available at this time. 

The proposed update factor under that 

framework is based on a projected 1.2 

percent increase in the CIPI, a 0.0 percent 

adjustment for intensity, a 0.0 percent 

adjustment for case-mix, a -0.4 percent 

adjustment for the FY 2006 DRG 

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reclassification and recalibration, and a 

forecast error correction of 0.0 percent. As 

discussed below in section III.C. of this 

Addendum, we believe that the CIPI is the 

most appropriate input price index for 

capital costs to measure capital price changes 

in a given year. We also explain the basis for 

the FY 2008 CIPI projection in that same 

section of this Addendum. (However, as 

discussed in greater detail in section V. of the 

preamble of this proposed rule, we are 

proposing a zero percent update factor for 

urban hospitals instead of the 0.8 percent 

proposed update factor that we are proposing 

for rural hospitals. In addition, as also note 

below, the proposed capital rates would be 

further adjusted to account for upcoding 

under the proposed MS–DRGs discussed in 

section II.D. of the preamble of this proposed 

rule.) Below we describe the policy 

adjustments that have been applied in the 

update framework for FY 2008. 

The case-mix index is the measure of the 

average DRG weight for cases paid under the 

IPPS. Because the DRG weight determines 

the prospective payment for each case, any 

percentage increase in the case-mix index 

corresponds to an equal percentage increase 

in hospital payments. 

The case-mix index can change for any of 

several reasons: 

<bullet≤ The average resource use of 

Medicare patients changes (‘‘real’’ case-mix 

change); 

<bullet≤ Changes in hospital coding of 

patient records result in higher weight DRG 

assignments (‘‘coding effects’’); and 

<bullet≤ The annual DRG reclassification 

and recalibration changes may not be budget 

neutral (‘‘reclassification effect’’). 

We define real case-mix change as actual 

changes in the mix (and resource 

requirements) of Medicare patients as 

opposed to changes in coding behavior that 

result in assignment of cases to higher 

weighted DRGs but do not reflect higher 

resource requirements. The capital update 

framework includes the same case-mix index 

adjustment used in the former operating IPPS 

update framework (as discussed in the May 

18, 2004 IPPS proposed rule for FY 2005 (69 

FR 28816)). (We are no longer using an 

update framework in making a 

recommendation for updating the operating 

IPPS standardized amounts as discussed in 

section II. of Appendix B in the FY 2006 IPPS 

final rule (70 FR 47707).) 

Absent the proposed change to the MS– 

DRGs, for FY 2008, we are projecting a 1.0 

percent total increase in the case-mix index. 

We estimate that the real case-mix increase 

will also equal 1.0 percent in FY 2008. The 

net adjustment for change in case-mix is the 

difference between the projected real 

increase in case-mix and the projected total 

increase in case-mix. Therefore, the net 

adjustment for case-mix change in FY 2008 

is 0.0 percentage points. 

The capital update framework also 

contains an adjustment for the effects of DRG 

reclassification and recalibration. This 

adjustment is intended to remove the effect 

on total payments of prior year changes to the 

DRG classifications and relative weights, in 

order to retain budget neutrality for all casemix index-related changes other than those 

due to patient severity. Due to the lag time 

in the availability of data, there is a 2-year 

lag in data used to determine the adjustment 

for the effects of DRG reclassification and 

recalibration. For example, we are adjusting 

for the effects of the FY 2006 DRG 

reclassification and recalibration as part of 

our proposed update for FY 2008. We 

estimate that FY 2006 DRG reclassification 

and recalibration resulted in a 0.4 percent 

change in the case-mix when compared with 

the case-mix index that would have resulted 

if we had not made the reclassification and 

recalibration changes to the DRGs. Therefore, 

we are proposing to make a -0.4 percent 

adjustment for DRG reclassification in the 

proposed update for FY 2008 to maintain 

budget neutrality. 

The capital update framework also 

contains an adjustment for forecast error. The 

input price index forecast is based on 

historical trends and relationships 

ascertainable at the time the update factor is 

established for the upcoming year. In any 

given year, there may be unanticipated price 

fluctuations that may result in differences 

between the actual increase in prices and the 

forecast used in calculating the update 

factors. In setting a prospective payment rate 

under the framework, we make an 

adjustment for forecast error only if our 

estimate of the change in the capital input 

price index for any year is off by 0.25 

percentage points or more. There is a 2-year 

lag between the forecast and the 

measurement of the forecast error. A forecast 

error of 0.10 percentage point was calculated 

for the FY 2006 update. That is, current 

historical data indicate that the forecasted FY 

2006 CIPI (0.80 percent) used in calculating 

the FY 2006 update factor slightly 

understated the actual realized price 

increases (0.90 percent) by 0.10 percentage 

point. This slight underprediction was 

mostly due to the incorporation of newly 

available source data for fixed asset prices 

into the market basket. However, because this 

estimation of the change in the CIPI is less 

than 0.25 percentage points, it is not reflected 

in the update recommended under this 

framework. Therefore, we are proposing to 

make a 0.0 percent adjustment for forecast 

error in the update for FY 2008. 

Under the capital IPPS update framework, 

we also make an adjustment for changes in 

intensity. We calculate this adjustment using 

the same methodology and data that were 

used in the past under the framework for 

operating IPPS. The intensity factor for the 

operating update framework reflects how 

hospital services are utilized to produce the 

final product, that is, the discharge. This 

component accounts for changes in the use 

of quality-enhancing services, for changes in 

within-DRG severity, and for expected 

modification of practice patterns to remove 

noncost-effective services. 

We calculate case-mix constant intensity as 

the change in total charges per admission, 

adjusted for price level changes (the CPI for 

hospital and related services) and changes in 

real case-mix. The use of total charges in the 

calculation of the intensity factor makes it a 

total intensity factor; that is, charges for 

capital services are already built into the 

calculation of the factor. Therefore, we have 

incorporated the intensity adjustment from 

the operating update framework into the 

capital update framework. Without reliable 

estimates of the proportions of the overall 

annual intensity increases that are due, 

respectively, to ineffective practice patterns 

and to the combination of quality-enhancing 

new technologies and within-DRG 

complexity, we assume, as in the operating 

update framework, that one-half of the 

annual increase is due to each of these 

factors. The capital update framework thus 

provides an add-on to the input price index 

rate of increase of one-half of the estimated 

annual increase in intensity, to allow for 

within-DRG severity increases and the 

adoption of quality-enhancing technology. 

We have developed a Medicare-specific 

intensity measure based on a 5-year average. 

Past studies of case-mix change by the RAND 

Corporation (‘‘Has DRG Creep Crept Up? 

Decomposing the Case Mix Index Change 

Between 1987 and 1988’’ by G.M. Carter, J. 

P. Newhouse, and D.A. Relles, R–4098– 

HCFA/ProPAC (1991)) suggest that real casemix change was not dependent on total 

change, but was usually a fairly steady 1.0 to 

1.5 percent per year. However, we use 1.4 

percent as the upper bound because the 

RAND study did not take into account that 

hospitals may have induced doctors to 

document medical records more completely 

in order to improve payment. 

We calculate case-mix constant intensity as 

the change in total charges per admission, 

adjusted for price level changes (the CPI for 

hospital and related services), and changes in 

real case-mix. As we noted above, in 

accordance with § 412.308(c)(1)(ii), we began 

updating the capital standard Federal rate in 

FY 1996 using an update framework that 

takes into account, among other things, 

allowable changes in the intensity of hospital 

services. For FYs 1996 through 2001, we 

found that case-mix constant intensity was 

declining and we established a 0.0 percent 

adjustment for intensity in each of those 

years. For FYs 2002 and 2003, we found that 

case-mix constant intensity was increasing 

and we established a 0.3 percent adjustment 

and 1.0 percent adjustment for intensity, 

respectively. For FYs 2004 and 2005, we 

found that the charge data appeared to be 

skewed (as discussed in greater detail below) 

and we established a 0.0 percent adjustment 

in each of those years. Furthermore, we 

stated that we would continue to apply a 0.0 

percent adjustment for intensity until any 

increase in charges can be tied to intensity 

rather than attempts to maximize outlier 

payments. 

As noted above, our intensity measure is 

based on a 5-year average, and therefore, the 

intensity adjustment for FY 2008 is based on 

data from the 5-year period FY 2002 through 

FY 2006. We found a dramatic increase in 

hospital charges for each of those 5 years 

without a corresponding increase in the 

hospital case-mix index. These findings are 

similar to the considerable increase in 

hospitals’ charges, which we found when we 

were determining the intensity factor in the 

FY 2004, FY 2005 and FY 2006 update 

recommendations as discussed in the FY 

2004 IPPS final rule (68 FR 45482), the FY 

2005 IPPS final rule (69 FR 49285) the FY 

2006 IPPS final rule (70 FR 47500), and the 

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FY 2007 IPPS final rule (72 FR 47500), 

respectively. If hospitals were treating new or 

different types of cases, which would result 

in an appropriate increase in charges per 

discharge, then we would expect hospitals’ 

case-mix to increase proportionally. 

As we discussed in the FY 2006 IPPS final 

rule (70 FR 47500) and the FY 2007 IPPS 

final rule (71 FR 48157), because our 

intensity calculation relies heavily upon 

charge data and we believe that these charge 

data may be inappropriately skewed, we 

established a 0.0 percent adjustment for 

intensity for FY 2006 and FY 2007, 

respectively. 

On June 9, 2003, we published revisions to 

our outlier policy for determining the 

additional payment for extraordinarily highcost cases (68 FR 34494 through 34515). 

These revised policies were effective on 

August 8, 2003, and October 1, 2003. While 

it does appear that a response to these policy 

changes is beginning to occur, that is, the 

change in charges for FYs 2004 and 2005 are 

somewhat less than the previous 4 years, and 

the change in charges for FY 2006 is slightly 

less than FY 2005, they still show a 

significant annual increase in charges 

without a corresponding increase in hospital 

case-mix. The increase in charges in FY 2004, 

for example, is approximately 12 percent, 

which, while less than the increase in the 

previous 3 years, is still much higher than 

increases in years prior to FY 2001. In 

addition, this approximate 12-percent 

increase in charges for FY 2004 significantly 

exceeds the case-mix increase for the same 

period. Based on the approximate 12-percent 

increase in charges for FY 2004, we believe 

residual effects of hospitals’ charge practices 

prior to the implementation of the outlier 

policy revisions established in the June 9, 

2003 final rule continue to appear in the data 

because hospitals may not have had enough 

time to adopt changes in their behavior in 

response to the new outlier policy. Thus, we 

believe that the FY 2004, FY 2005, and FY 

2006 charge data may still be skewed. 

Because the intensity adjustment is based on 

a 5-year average, and although the new 

outlier policy was generally effective in FY 

2004, we believe the effects of hospitals 

attempting to maximize outlier payments, 

while lessening, continue to skew the charge 

data. 

Therefore, we are proposing to make a 0.0 

percent adjustment for intensity for FY 2008. 

In the past (FYs 1996 through 2001) when we 

found intensity to be declining, we believed 

a zero (rather than negative) intensity 

adjustment was appropriate. Similarly, we 

believe that it is appropriate to apply a zero 

intensity adjustment for FY 2008 until any 

increase in charges can be tied to intensity 

rather than to attempts to maximize outlier 

payments. 

Above, we described the basis of the 

components used to develop the proposed 

0.8 percent capital update factor under the 

capital update framework for FY 2008 as 

shown in the table below. However, as 

discussed in section V. of the preamble of 

this proposed rule, we are proposing that the 

proposed 0.8 percent capital update be 

applied to rural hospitals only. We are 

proposing a 0.0 percent update for urban 

hospitals for reasons also discussed in 

section V. of the preamble of this proposed 

rule. 

CMS PROPOSED FY 2008 UPDATE

FACTOR TO THE CAPITAL FEDERAL

RATE FOR RURAL HOSPITALS

Capital Input Price Index .................... 1.2 

Intensity: 0.0 

Case-Mix Adjustment Factors: 

Real Across DRG Change .......... 1.0 

Projected Case-Mix Change ....... -1.0 

Subtotal ........................................... 0.0 

Effect of FY 2005 Reclassification 

and Recalibration ............................ -0.4 

Forecast Error Correction ................... 0.0 

Total Update for Rural Hospitals .... 0.8 

b. Comparison of CMS and MedPAC Update 

Recommendation 

In the past, MedPAC has included update 

recommendations for capital PPS in a Report 

to Congress. In its March 2007 Report to 

Congress, MedPAC did not make an update 

recommendation for capital IPPS payments 

for FY 2008. However, in that same report, 

MedPAC made an update recommendation 

for hospital inpatient and outpatient services 

(page 67). MedPAC reviews inpatient and 

outpatient services together because they are 

so closely interrelated. For FY 2008, MedPAC 

recommended an increase in the payment 

rate for the operating IPPS by the projected 

increase in the hospital market basket index 

concurrent with implementation of a quality 

incentive payment policy. (MedPAC’s Report 

to the Congress: Medicare Payment Policy, 

March 2007, Section 2A.) 

2. Proposed Outlier Payment Adjustment 

Factor 

Section 412.312(c) establishes a unified 

outlier methodology for inpatient operating 

and inpatient capital-related costs. A single 

set of thresholds is used to identify outlier 

cases for both inpatient operating and 

inpatient capital-related payments. Section 

412.308(c)(2) provides that the standard 

Federal rate for inpatient capital-related costs 

be reduced by an adjustment factor equal to 

the estimated proportion of capital-related 

outlier payments to total inpatient capitalrelated PPS payments. The outlier thresholds 

are set so that operating outlier payments are 

projected to be 5.1 percent of total operating 

DRG payments. 

In the Federal Register notice establishing 

the final occupational mix adjusted payment 

rates for FY 2007 (71 FR 59890), we 

estimated that outlier payments for capital 

would equal 4.32 percent of inpatient capitalrelated payments based on the capital 

Federal rate in FY 2007. Based on the 

proposed thresholds as set forth in section 

II.A.4.c. of this Addendum, we estimate that 

proposed outlier payments for capital-related 

costs would equal 5.16 percent for inpatient 

capital-related payments based on the 

proposed Federal rate in FY 2008. Therefore, 

we are proposing to apply an outlier 

adjustment factor of 0.9484 to the capital 

Federal rate. Thus, we estimate that the 

percentage of capital outlier payments to 

total capital standard payments for FY 2008 

will be slightly higher than the percentages 

for FY 2007. 

The outlier reduction factors are not built 

permanently into the capital rates; that is, 

they are not applied cumulatively in 

determining the capital Federal rate. The 

proposed FY 2008 outlier adjustment of 

0.9484 is a -0.88 percent change from the FY 

2007 outlier adjustment of 0.9568. Therefore, 

the net change in the proposed outlier 

adjustment to the proposed capital Federal 

rate for FY 2008 is 0.9912 (0.9484/0.9568). 

Thus, the proposed outlier adjustment 

decreases the proposed FY 2008 capital 

Federal rate by 0.88 percent compared with 

the FY 2007 outlier adjustment. 

3. Proposed Budget Neutrality Adjustment 

Factor for Changes in DRG Classifications 

and Weights and the GAF 

Section 412.308(c)(4)(ii) requires that the 

capital Federal rate be adjusted so that 

aggregate payments for the fiscal year based 

on the capital Federal rate after any changes 

resulting from the annual DRG 

reclassification and recalibration and changes 

in the GAF are projected to equal aggregate 

payments that would have been made on the 

basis of the capital Federal rate without such 

changes. Because we implemented a separate 

GAF for Puerto Rico, we apply separate 

budget neutrality adjustments for the 

national GAF and the Puerto Rico GAF. We 

apply the same budget neutrality factor for 

DRG reclassifications and recalibration 

nationally and for Puerto Rico. Separate 

adjustments were unnecessary for FY 1998 

and earlier because the GAF for Puerto Rico 

was implemented in FY 1998. 

In the past, we used the actuarial capital 

cost model (described in Appendix B of the 

FY 2002 IPPS final rule (66 FR 40099)) to 

estimate the aggregate payments that would 

have been made on the basis of the capital 

Federal rate with and without changes in the 

DRG classifications and weights and in the 

GAF to compute the adjustment required to 

maintain budget neutrality for changes in 

DRG weights and in the GAF. During the 

transition period, the capital cost model was 

also used to estimate the regular exception 

payment adjustment factor. As we explain in 

section III.A.4. of this Addendum, beginning 

in FY 2002, an adjustment for regular 

exception payments is no longer necessary. 

Therefore, we are no longer using the capital 

cost model. Instead, we are using historical 

data based on hospitals’ actual cost 

experiences to determine the exceptions 

payment adjustment factor for special 

exceptions payments. 

To determine the proposed factors for FY 

2008, we compared (separately for the 

national capital rate and the Puerto Rico 

capital rate) estimated aggregate capital 

Federal rate payments based on the FY 2007 

DRG relative weights and the FY 2007 GAF 

to estimated aggregate capital Federal rate 

payments based on the proposed FY 2008 

relative weights and the proposed FY 2008 

GAF. As we established in the final FY 2007 

occupational mix adjusted payment rates 

notice (71 FR 59890), the budget neutrality 

factors were 0.9906 for the national capital 

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24844 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

rate and 0.9968 for the Puerto Rico capital 

rate. In making the comparison, we set the 

exceptions reduction factor to 1.00. To 

achieve budget neutrality for the changes in 

the national GAF, based on calculations 

using updated data, we propose to apply an 

incremental budget neutrality adjustment of 

1.0026 for FY 2008 to the previous 

cumulative FY 2007 adjustments of 0.9906, 

yielding a proposed adjustment of 0.9932, 

through FY 2008 (calculations done on 

unrounded numbers). For the Puerto Rico 

GAF, we are proposing to apply a proposed 

incremental budget neutrality adjustment of 

1.0009 for FY 2008 to the previous 

cumulative FY 2007 adjustment of 0.9968, 

yielding a proposed cumulative adjustment 

of 0.9978 through FY 2008 (calculations done 

on unrounded numbers). 

We then compared estimated aggregate 

capital Federal rate payments based on the 

FY 2007 DRG relative weights and the FY 

2007 GAF to estimated aggregate capital 

Federal rate payments based on the proposed 

FY 2008 DRG relative weights and the 

proposed FY 2008 GAF. The proposed 

incremental adjustment for DRG 

classifications and changes in relative 

weights is 0.9992 both nationally and for 

Puerto Rico. The proposed cumulative 

adjustments for DRG classifications and 

changes in relative weights and for changes 

in the GAF through FY 2008 are 0.9924 

nationally and 0.9970 for Puerto Rico. The 

following table summarizes the adjustment 

factors for each fiscal year: 

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BUDGET

NEUTRALITY

ADJUSTMENT FOR DRG RECLASSIFICATIONS AND

RECALIBRATION AND THE

GEOGRAPHIC

ADJUSTMENT

FACTORS

Fiscal year 

National Puerto Rico 

Incremental adjustment 

Cumulative 

Incremental adjustment 

Cumulative Geographic 

adjustment 

factor 

DRG reclassifications and 

recalibration 

Combined 

Geographic 

adjustment 

factor 

DRG reclassifications and 

recalibration 

Combined 

1992 ......................................................................... ........................ ........................ ........................ 1.00000 ........................ ........................ ........................ ........................1993 ......................................................................... ........................ ........................ 0.99800 0.99800 ........................ ........................ ........................ ........................1994 ......................................................................... ........................ ........................ 1.00531 1.00330 ........................ ........................ ........................ ........................1995 ......................................................................... ........................ ........................ 0.99980 1.00310 ........................ ........................ ........................ ........................1996 ......................................................................... ........................ ........................ 0.99940 1.00250 ........................ ........................ ........................ ........................1997 ......................................................................... ........................ ........................ 0.99873 1.00123 ........................ ........................ ........................ ........................1998 ......................................................................... ........................ ........................ 0.99892 1.00015 ........................ ........................ ........................ 1.00000 1999 ......................................................................... 0.99944 1.00335 1.00279 1.00294 0.99898 1.00335 1.00233 1.00233 2000 ......................................................................... 0.99857 0.99991 0.99848 1.00142 0.99910 0.99991 0.99901 1.00134 2001 1 ...................................................................... 0.99782 1.00009 0.99791 0.99933 1.00365 1.00009 1.00374 1.00508 2001 2 ...................................................................... 3 0.99771 3 1.00009 3 0.99780 0.99922 3 1.00365 3 1.00009 3 1.00374 1.00508 2002 ......................................................................... 4 0.99666 4 0.99668 4 0.99335 0.99268 4 0.98991 4 0.99668 4 0.99662 0.99164 2003 5 ...................................................................... 0.99915 0.99662 0.99577 0.98848 1.00809 0.99662 1.00468 0.99628 2003 6 ...................................................................... 7 0.99896 7 0.99662 7 0.99558 0.98830 1.00809 0.99662 1.00468 0.99628 2004 8 ...................................................................... 9 1.00175 9 1.00081 9 1.00256 0.99083 1.00028 1.00081 1.00109 0.99736 2004 10 .................................................................... 9 1.00164 9 1.00081 9 1.00245 0.99072 1.00028 1.00081 1.00109 0.99736 2005 11 .................................................................... 12 0.99967 1.00094 12 1.00061 0.99137 0.99115 1.00094 0.99208 0.98946 2005 13 .................................................................... 12 0.99946 1.00094 12 1.00040 0.99117 0.99115 1.00094 0.99208 0.98946 2006 ......................................................................... 14 1.00185 0.99892 14 1.00076 0.99198 1.00762 0.99892 1.00653 0.99592 2007 ......................................................................... 1.00000 0.99858 0.99858 0.99057 1.00234 0.99858 1.00092 0.99683 2008 ......................................................................... 15 1.00261 0.99921 15 1.00182 15 0.99237 15 1.00093 0.99921 15 1.00014 15 0.99697 

1 Factors effective for the first half of FY 2001 (October 2000 through March 2001). 2 Factors effective for the second half of FY 2001 (April 2001 through September 2001). 3 Incremental factors are applied to FY 2000 cumulative factors. 4 Incremental factors are applied to the cumulative factors for the first half of FY 2001. 5 Factors effective for the first half of FY 2003 (October 2002 through March 2003). 6 Factors effective for the second half of FY 2003 (April 2003 through September 2003). 7 Incremental factors are applied to FY 2002 cumulative factors. 8 Factors effective for the first half of FY 2004 (October 2003 through March 2004). 9 Incremental factors are applied to the cumulative factors for the second half of FY 2003. 10 Factors effective for the second half of FY 2004 (April 2004 through September 2004). 11 Factors effective for the first quarter of FY 2005 (September 2004 through December 2004). 12 Incremental factors are applied to average of the cumulative factors for the first half (October 1, 2003 through March 31, 2004) and second half (April 1, 2004 through September 30, 

2004) of FY 2004. 

13 Factors effective for the last three quarters of FY 2005 (January 2005 through September 2005). 14 Incremental factors are applied to average of the cumulative factors for 2005. 15 Proposed factors for FY 2008, as discussed above in section III. of this Addendum. 

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The methodology used to determine the 

recalibration and geographic (DRG/GAF) 

budget neutrality adjustment factor is similar 

to that used in establishing budget neutrality 

adjustments under the PPS for operating 

costs. One difference is that, under the 

operating PPS, the budget neutrality 

adjustments for the effect of geographic 

reclassifications are determined separately 

from the effects of other changes in the 

hospital wage index and the DRG relative 

weights. Under the capital PPS, there is a 

single DRG/GAF budget neutrality 

adjustment factor (the national capital rate 

and the Puerto Rico capital rate are 

determined separately) for changes in the 

GAF (including geographic reclassification) 

and the DRG relative weights. In addition, 

there is no adjustment for the effects that 

geographic reclassification has on the other 

payment parameters, such as the payments 

for serving low-income patients, indirect 

medical education payments, or the large 

urban add-on payments. 

In the Federal Register notice establishing 

the final FY 2007 occupational mix adjusted 

payment rates (71 FR 59890), we calculated 

a GAF/DRG budget neutrality factor of 0.9986 

for FY 2007. For FY 2008, we are proposing 

to establish a proposed GAF/DRG budget 

neutrality factor of 1.0018. The GAF/DRG 

budget neutrality factors are built 

permanently into the capital rates; that is, 

they are applied cumulatively in determining 

the capital Federal rate. This follows from the 

requirement that estimated aggregate 

payments each year be no more or less than 

they would have been in the absence of the 

annual DRG reclassification and recalibration 

and changes in the GAF. The incremental 

change in the proposed adjustment from FY 

2007 to FY 2008 is 1.0018. The cumulative 

change in the proposed capital Federal rate 

due to this proposed adjustment is 0.9924 

(the product of the incremental factors for 

FYs 1994 through 2007 and the proposed 

incremental factor of 1.0018 for FY 2008). 

(We note that averages of the incremental 

factors that were in effect during FYs 2004 

and 2005, respectively, were used in the 

calculation of the proposed cumulative 

adjustment of 0.9924 for FY 2008.) 

This proposed factor accounts for DRG 

reclassifications and recalibration and for 

changes in the GAF. It also incorporates the 

effects on the proposed GAF of FY 2008 

geographic reclassification decisions made by 

the MGCRB compared to FY 2007 decisions. 

However, it does not account for changes in 

payments due to changes in the DSH and 

IME adjustment factors or in the large urban 

add-on. 

4. Exceptions Payment Adjustment Factor 

Section 412.308(c)(3) requires that the 

capital standard Federal rate be reduced by 

an adjustment factor equal to the estimated 

proportion of additional payments for both 

regular exceptions and special exceptions 

under § 412.348 relative to total capital PPS 

payments. In estimating the proportion of 

regular exception payments to total capital 

PPS payments during the transition period, 

we used the actuarial capital cost model 

originally developed for determining budget 

neutrality (described in Appendix B of the 

FY 2002 IPPS final rule (66 FR 40099)) to 

determine the exceptions payment 

adjustment factor, which was applied to both 

the Federal and hospital-specific capital 

rates. 

An adjustment for regular exception 

payments is no longer necessary in 

determining the FY 2008 capital Federal rate 

because, in accordance with § 412.348(b), 

regular exception payments were only made 

for cost reporting periods beginning on or 

after October 1, 1991 and before October 1, 

2001. Accordingly, as we explained in the FY 

2002 IPPS final rule (66 FR 39949), in FY 

2002 and subsequent fiscal years, no 

payments will be made under the regular 

exceptions provision. However, in 

accordance with § 412.308(c), we still need 

to compute a budget neutrality adjustment 

for special exception payments under §

412.348(g). We describe our methodology for 

determining the exceptions adjustment used 

in calculating the FY 2007 capital Federal 

rate below. 

Under the special exceptions provision 

specified at § 412.348(g)(1), eligible hospitals 

include SCHs, urban hospitals with at least 

100 beds that have a disproportionate share 

percentage of at least 20.2 percent or qualify 

for DSH payments under § 412.106(c)(2), and 

hospitals with a combined Medicare and 

Medicaid inpatient utilization of at least 70 

percent. An eligible hospital may receive 

special exceptions payments if it meets: (1) 

a project need requirement as described at §

412.348(g)(2), which, in the case of certain 

urban hospitals, includes an excess capacity 

test as described at § 412.348(g)(4); (2) an age 

of assets test as described at § 412.348(g)(3); 

and (3) a project size requirement as 

described at § 412.348(g)(5). 

Based on information compiled from our 

fiscal intermediaries, six hospitals have 

qualified for special exceptions payments 

under § 412.348(g). Because we have cost 

reports ending in FY 2006 for all of these 

hospitals, we calculated the adjustment 

based on actual cost experience. Using data 

from cost reports ending in FY 2006 from the 

December 2006 update of the HCRIS data, we 

divided the capital special exceptions 

payment amounts for the six hospitals that 

qualified for special exceptions by the total 

capital PPS payment amounts (including 

special exception payments) for all hospitals. 

Based on the data from cost reports ending 

in FY 2006, this ratio is rounded to 0.0003. 

Because we have not received all cost reports 

ending in FY 2006, we also divided the FY 

2005 special exceptions payments by the 

total capital PPS payment amounts for all 

hospitals with cost reports ending in FY 

2005. This ratio also rounds to 0.0003. 

Because special exceptions are budget 

neutral, we are offsetting the proposed 

capital Federal rate by 0.03 percent for 

special exceptions payments for FY 2008. 

Therefore, the exceptions adjustment factor is 

equal to 0.9997 (1 - 0.0003) to account for 

special exceptions payments in FY 2008. 

In the FY 2007 IPPS final rule (71 FR 

48161) we estimated that total (special) 

exceptions payments for FY 2007 would 

equal 0.03 percent of aggregate payments 

based on the capital Federal rate. Therefore, 

we applied an exceptions adjustment factor 

of 0.9997 (1 - 0.0003) in determining the FY 

2007 capital Federal rate. As we stated above, 

we estimate that exceptions payments in FY 

2008 will equal 0.03 percent of aggregate 

payments based on the proposed FY 2008 

capital Federal rate. Therefore, we are 

proposing to apply an exceptions payment 

adjustment factor of 0.9997 to the capital 

Federal rate for FY 2008. The proposed 

exceptions adjustment factor for FY 2008 is 

the same as the factor used in determining 

the FY 2007 capital Federal rate in the FY 

2007 IPPS final rule (71 FR 48161) and is the 

same factor used for the occupational mix 

adjusted payment rates since the adjustments 

made to the wage index had no effect on 

capital exceptions payments (71 FR 59890). 

The exceptions reduction factors are not built 

permanently into the capital rates; that is, the 

factors are not applied cumulatively in 

determining the capital Federal rate. 

Therefore, the net change in the proposed 

exceptions adjustment factor used in 

determining the proposed FY 2008 capital 

Federal rate is 1.0000(0.9997/0.9997). 

5. Proposed Capital Standard Federal Rate for 

FY 2008 

In the Federal Register notice that 

established the occupational mix adjusted 

payment rates for FY 2007 (71 FR 59891), we 

established a capital Federal rate of $427.03 

for FY 2007. As discussed above and in 

section V. of the preamble of this proposed 

rule, we are proposing two separate capital 

Federal rates for FY 2008: a rural capital 

Federal rate based on an update of 0.8 

percent and an urban capital Federal rate 

based on a 0.0 percent update. However, 

under the statutory authority at section 

1886(d)(3)(A)(vi) of the Act, we are proposing 

an additional 2.4 percent reduction to the 

proposed standardized amounts for both 

capital and operating Federal payment rates. 

The proposed 2.4 percent reduction is based 

on our actuary’s analysis to eliminate the 

effect of changes in coding or classification 

of discharges that do not reflect real changes 

in case-mix in light of the proposed MS– 

DRGs. Although the proposed 2.4 percent 

reduction is outside the established process 

for developing the proposed capital Federal 

payment rate, it nevertheless is a factor in the 

final prospective payment rate to hospitals 

for capital-related costs. For that reason, the 

capital Federal payment rates proposed in 

this proposed rule were determined by 

applying the proposed 2.4 percent reduction. 

As a result of the proposed 0.8 percent 

update for rural hospitals, the proposed 0.0 

percent update for urban hospitals, the 

proposed 2.4 percent reduction to account for 

upcoding (for all hospitals), and the other 

factors as discussed above, we are proposing 

to establish a capital Federal rate for rural 

hospitals of $417.26 for FY 2008, and we are 

proposing to establish a capital Federal rate 

for urban hospitals of $413.87 for FY 2008. 

The proposed capital Federal rates for FY 

2008 were calculated as follows: 

<bullet≤ The proposed FY 2008 update 

factor for rural hospitals is 1.0080, that is, the 

update is 0.8 percent; and the proposed FY 

2008 update factor for urban hospitals is 

1.0000, that is, the update is 0.0 percent. 

<bullet≤ The proposed FY 2008 budget 

neutrality adjustment factor that is applied to 

the capital standard Federal payment rate for 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24847 

changes in the DRG relative weights and in 

the GAF (for all hospitals) is 1.0018. 

<bullet≤ The proposed FY 2008 outlier 

adjustment factor is 0.9484. 

<bullet≤ The proposed FY 2008 (special) 

exceptions payment adjustment factor is 

0.9997. 

<bullet≤ The proposed FY 2008 reduction 

for upcoding under the proposed MS-DRGs is 

-2.40 percent. 

Because the proposed capital Federal rate 

has already been adjusted for differences in 

case-mix, wages, cost-of-living, indirect 

medical education costs, and payments to 

hospitals serving a disproportionate share of 

low-income patients, we are not making 

additional adjustments in the capital 

standard Federal rate for these factors, other 

than the proposed budget neutrality factor for 

changes in the DRG relative weights and the 

GAF. 

We are providing the following charts that 

show how each of the proposed factors and 

adjustments for FY 2008 affected the 

computation of the proposed FY 2008 capital 

Federal rate for urban hospitals and the 

proposed FY 2008 capital Federal rate for 

rural hospitals in comparison to the FY 2007 

capital Federal rate. The proposed FY 2008 

update factor for urban hospitals of zero 

percent would have a 0.0 percent net effect 

on the proposed FY 2008 capital Federal 

compared to the FY 2007 capital Federal rate. 

The proposed FY 2008 update factor for rural 

hospitals has the effect of increasing the 

proposed capital Federal rate by 0.80 percent 

compared to the FY 2007 capital Federal rate. 

The proposed GAF/DRG budget neutrality 

factor has the effect of increasing the 

proposed capital Federal rate by 0.18 percent 

for both urban and rural hospitals. The 

proposed FY 2008 outlier adjustment factor 

has the effect of decreasing the proposed 

capital Federal rate by 0.89 percent compared 

to the FY 2007 capital Federal rate for both 

urban and rural hospitals. The proposed FY 

2008 exceptions payment adjustment factor 

remains unchanged from the FY 2007 

exceptions payment adjustment factor, and 

therefore, has a 0.0 percent net effect on the 

proposed FY 2008 capital Federal rate for 

both urban and rural hospitals. In addition to 

the factors historically used to determine the 

capital Federal rate, for FY 2008, we are 

proposing an adjustment factor to account for 

upcoding expected to result if the proposed 

MS–DRGs are adopted, as discussed above in 

section III. of this Addendum, in determining 

the capital Federal rate for FY 2008. The 

combined effect of all the changes is to 

decrease the proposed capital Federal rate by 

3.09 percent compared to the FY 2007 capital 

Federal rate for urban hospitals and to 

decrease the proposed capital Federal rate by 

2.29 percent compared to the FY 2007 capital 

Federal rate for rural hospitals. 

COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2007 CAPITAL FEDERAL RATE AND PROPOSED FY 2008 CAPITAL

FEDERAL RATE FOR URBAN HOSPITALS

FY 2007 Proposed FY 

20084 Change Percent 

change5

Update Factor1 ................................................................................................. 1.0110 1.0000 0.0000 0.00 

GAF/DRG Adjustment Factor1 ......................................................................... 0.9986 1.0018 1.0018 0.18 

Outlier Adjustment Factor 2 ............................................................................. 0.9568 0.9484 0.9912 -0.88 

Exceptions Adjustment Factor 2 ...................................................................... 0.9997 0.9997 1.0000 0.00 

MS–DRG Upcoding Adjustment Factor 3 ........................................................ ........................ 0.9760 0.9760 -2.40 

Capital Federal Rate ........................................................................................ $427.03 $413.87 0.9692 -3.10 

1 The proposed update factor for rural hospitals and the proposed GAF/DRG budget neutrality factors are built permanently into the capital 

rates. Thus, for example, the incremental change from FY 2007 to FY 2008 resulting from the application of the proposed 1.0018 GAF/DRG 

budget neutrality factor for FY 2008 is 1.0018. 2 The proposed outlier reduction factor and the proposed exceptions adjustment factor are not built permanently into the capital rates; that is, 

these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the 

proposed FY 2008 outlier adjustment factor would be 0.9484/0.9568, or 0.9912. 3 Proposed adjustment to FY 2008 IPPS rates to account for upcoding expected to result if the proposed MS-DRGs are adopted, as discussed 

above in section III. of this Addendum. 4 Proposed factors for FY 2008, as discussed above in section III. of this Addendum. 5 Percent change of individual proposed factors may not sum due to rounding. 

COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2007 CAPITAL FEDERAL RATE AND PROPOSED FY 2008 CAPITAL

FEDERAL RATE FOR RURAL HOSPITALS

FY 2007 Proposed FY 

20084 Change Percent 

change5

Update Factor 1 ............................................................................................... 1.0110 1.0080 1.0080 0.80 

GAF/DRG Adjustment Factor 1 ....................................................................... 0.9986 1.0018 1.0018 0.18 

Outlier Adjustment Factor 2 ............................................................................. 0.9568 0.9484 0.9912 -0.88 

Exceptions Adjustment Factor 2 ...................................................................... 0.9997 0.9997 1.0000 0.00 

MS–DRG Upcoding Adjustment Factor 3 ........................................................ ........................ 0.9760 0.9760 -2.40 

Capital Federal Rate ........................................................................................ $427.03 $417.26 0.9771 -2.29 

1 The proposed update factor for rural hospitals and the proposed GAF/DRG budget neutrality factors are built permanently into the capital 

rates. Thus, for example, the incremental change from FY 2007 to FY 2008 resulting from the application of the proposed 1.0018 GAF/DRG 

budget neutrality factor for FY 2008 is 1.0018. 2 The proposed outlier reduction factor and the proposed exceptions adjustment factor are not built permanently into the capital rates; that is, 

these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the 

proposed FY 2008 outlier adjustment factor would be 0.9484/0.9568, or 0.9912. 3 Proposed adjustment to FY 2008 IPPS rates to account for upcoding expected to result if the proposed MS–DRGs are adopted, as discussed above in section III. of this Addendum. 4 Proposed factors for FY 2008, as discussed above in section III. of this Addendum. 5 Percent change of individual proposed factors may not sum due to rounding. 

6. Proposed Special Capital Rate for Puerto 

Rico Hospitals 

Section 412.374 provides for the use of a 

blended payment system for payments to 

Puerto Rico hospitals under the PPS for acute 

care hospital inpatient capital-related costs. 

Accordingly, under the capital PPS, we 

compute a separate payment rate specific to 

Puerto Rico hospitals using the same 

methodology used to compute the national 

Federal rate for capital-related costs. Under 

the broad authority of section 1886(g) of the 

Act, as discussed in section V. of the 

preamble of this proposed rule, beginning 

with discharges occurring on or after October 

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24848 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

1, 2004, capital payments to hospitals in 

Puerto Rico are based on a blend of 25 

percent of the Puerto Rico capital rate and 75 

percent of the capital Federal rate. The 

Puerto Rico capital rate is derived from the 

costs of Puerto Rico hospitals only, while the 

capital Federal rate is derived from the costs 

of all acute care hospitals participating in the 

IPPS (including Puerto Rico). 

To adjust hospitals’ capital payments for 

geographic variations in capital costs, we 

apply a GAF to both portions of the blended 

capital rate. The GAF is calculated using the 

operating IPPS wage index and varies, 

depending on the labor market area or rural 

area in which the hospital is located. We use 

the Puerto Rico wage index to determine the 

GAF for the Puerto Rico part of the capitalblended rate and the national wage index to 

determine the GAF for the national part of 

the blended capital rate. 

Because we implemented a separate GAF 

for Puerto Rico in FY 1998, we also apply 

separate budget neutrality adjustments for 

the national GAF and for the Puerto Rico 

GAF. However, we apply the same budget 

neutrality factor for DRG reclassifications and 

recalibration nationally and for Puerto Rico. 

As we stated above in section III.A.4. of this 

Addendum, for Puerto Rico, the proposed 

GAF budget neutrality factor is 1.0009, while 

the DRG adjustment is 0.9992, for a 

combined proposed cumulative adjustment 

of 1.0001. 

In computing the payment for a particular 

Puerto Rico hospital, the Puerto Rico portion 

of the capital rate (25 percent) is multiplied 

by the Puerto Rico-specific GAF for the labor 

market area in which the hospital is located, 

and the national portion of the capital rate 

(75 percent) is multiplied by the national 

GAF for the labor market area in which the 

hospital is located (which is computed from 

national data for all hospitals in the United 

States and Puerto Rico). In FY 1998, we 

implemented a 17.78 percent reduction to the 

Puerto Rico capital rate as a result of Pub. L. 

105–33. In FY 2003, a small part of that 

reduction was restored. 

For FY 2007, before application of the 

GAF, the special capital rate for Puerto Rico 

hospitals was $203.06 for discharges 

occurring on or after October 1, 2006 through 

September 30, 2007. With the changes we are 

making to the factors used to determine the 

capital rate, in addition to the proposed zero 

percent update for urban hospitals, the 

proposed FY 2008 special capital rate for 

rural hospitals in Puerto Rico is $197.21 For 

urban hospitals in Puerto Rico, the proposed 

FY 2008 special capital rate is $195.60. 

B. Calculation of the Proposed Inpatient 

Capital-Related Prospective Payments for FY 

2008 

Because the 10-year capital PPS transition 

period ended in FY 2001, all hospitals 

(except ‘‘new’’ hospitals under § 412.324(b) 

and under § 412.304(c)(2)) are paid based on 

100 percent of the capital Federal rate in FY 

2007. The applicable capital Federal rate was 

determined by making adjustments as 

follows: 

<bullet≤ For outliers, by dividing the 

capital standard Federal rate by the outlier 

reduction factor for that fiscal year; and 

<bullet≤ For the payment adjustments 

applicable to the hospital, by multiplying the 

hospital’s GAF, disproportionate share 

adjustment factor, and IME adjustment factor, 

when appropriate. 

For purposes of calculating payments for 

each discharge during FY 2008, the capital 

standard Federal rate would be adjusted as 

follows: (Standard Federal Rate) x (DRG 

weight) x (GAF) x (COLA for hospitals 

located in Alaska and Hawaii) x (1 + 

Disproportionate Share Adjustment Factor + 

IME Adjustment Factor, if applicable). The 

result is the adjusted capital Federal rate. (As 

discussed above and in section V. of the 

preamble of this proposed rule, we are 

proposing to eliminate the large urban addon adjustment in existing regulations at §

412.316, beginning in FY 2008.) 

Hospitals also may receive outlier 

payments for those cases that qualify under 

the thresholds established for each fiscal 

year. Section 412.312(c) provides for a single 

set of thresholds to identify outlier cases for 

both inpatient operating and inpatient 

capital-related payments. The proposed 

outlier thresholds for FY 2008 are in section 

II.A.4.c. of this Addendum. For FY 2008, a 

case qualifies as a cost outlier if the cost for 

the case plus the IME and DSH payments is 

greater than the prospective payment rate for 

the DRG plus the proposed fixed-loss amount 

of $23,015. 

An eligible hospital may also qualify for a 

special exceptions payment under §

412.348(g) for up through the 10th year 

beyond the end of the capital transition 

period if it meets: (1) a project need 

requirement described at § 412.348(g)(2), 

which in the case of certain urban hospitals 

includes an excess capacity test as described 

at § 412.348(g)(4); and (2) a project size 

requirement as described at § 412.348(g)(5). 

Eligible hospitals include SCHs, urban 

hospitals with at least 100 beds that have a 

DSH patient percentage of at least 20.2 

percent or qualify for DSH payments under 

§ 412.106(c)(2), and hospitals that have a 

combined Medicare and Medicaid inpatient 

utilization of at least 70 percent. Under §

412.348(g)(8), the amount of a special 

exceptions payment is determined by 

comparing the cumulative payments made to 

the hospital under the capital PPS to the 

cumulative minimum payment level. This 

amount is offset by: (1) any amount by which 

a hospital’s cumulative capital payments 

exceed its cumulative minimum payment 

levels applicable under the regular 

exceptions process for cost reporting periods 

beginning during which the hospital has 

been subject to the capital PPS; and (2) any 

amount by which a hospital’s current year 

operating and capital payments (excluding 75 

percent of operating DSH payments) exceed 

its operating and capital costs. Under §

412.348(g)(6), the minimum payment level is 

70 percent for all eligible hospitals. 

During the transition period, new hospitals 

(as defined under § 412.300) were exempt 

from the capital IPPS for their first 2 years 

of operation and were paid 85 percent of 

their reasonable costs during that period. 

Effective with the third year of operation 

through the remainder of the transition 

period, under § 412.324(b), we paid the 

hospitals under the appropriate transition 

methodology (if the hold-harmless 

methodology were applicable, the holdharmless payment for assets in use during the 

base period would extend for 8 years, even 

if the hold-harmless payments extend beyond 

the normal transition period). 

Under § 412.304(c)(2), for cost reporting 

periods beginning on or after October 1, 

2002, we pay a new hospital 85 percent of 

its reasonable costs during the first 2 years 

of operation unless it elects to receive 

payment based on 100 percent of the capital 

Federal rate. Effective with the third year of 

operation, we pay the hospital based on 100 

percent of the capital Federal rate (that is, the 

same methodology used to pay all other 

hospitals subject to the capital PPS). 

C. Capital Input Price Index 

1. Background 

Like the operating input price index, the 

capital input price index (CIPI) is a fixedweight price index that measures the price 

changes associated with capital costs during 

a given year. The CIPI differs from the 

operating input price index in one important 

aspect—the CIPI reflects the vintage nature of 

capital, which is the acquisition and use of 

capital over time. Capital expenses in any 

given year are determined by the stock of 

capital in that year (that is, capital that 

remains on hand from all current and prior 

capital acquisitions). An index measuring 

capital price changes needs to reflect this 

vintage nature of capital. Therefore, the CIPI 

was developed to capture the vintage nature 

of capital by using a weighted-average of past 

capital purchase prices up to and including 

the current year. 

We periodically update the base year for 

the operating and capital input prices to 

reflect the changing composition of inputs for 

operating and capital expenses. The CIPI was 

last rebased to FY 2002 in the FY 2006 IPPS 

final rule (70 FR 47387). 

2. Forecast of the CIPI for FY 2008 

Based on the latest forecast by Global 

Insight, Inc. (first quarter of 2007), we are 

forecasting the CIPI to increase 1.20 percent 

in FY 2008. This reflects a projected 1.9 

percent increase in vintage-weighted 

depreciation prices (building and fixed 

equipment, and movable equipment) and a 

3.0 percent increase in other capital expense 

prices in FY 2008, partially offset by a 2.5 

percent decline in vintage-weighted interest 

expenses in FY 2008. The weighted average 

of these three factors produces the 1.2 

percent increase for the CIPI as a whole in 

FY 2008. 

IV. Proposed Changes to Payment Rates for 

Excluded Hospitals and Hospital Units: 

Rate-of-Increase Percentages 

(If you choose to comment on issues in this 

section, please include the caption 

‘‘Excluded Hospitals Rate of Increase’’ at the 

beginning of your comments.) 

Historically, hospitals and hospital units 

excluded from the prospective payment 

system received payment for inpatient 

hospital services they furnished on the basis 

of reasonable costs, subject to a rate-ofincrease ceiling. An annual per discharge 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24849 

limit (the target amount as defined in §

413.40(a)) was set for each hospital or 

hospital unit based on the hospital’s own 

cost experience in its base year. The target 

amount was multiplied by the Medicare 

discharges and applied as an aggregate upper 

limit (the ceiling as defined in § 413.40(a)) 

on total inpatient operating costs for a 

hospital’s cost reporting period. Prior to 

October 1, 1997, these payment provisions 

applied consistently to all categories of 

excluded providers (rehabilitation hospitals 

and units (now referred to as IRFs), 

psychiatric hospitals and units (now referred 

to as IPFs), LTCHs, children’s hospitals, and 

cancer hospitals). 

Payment for children’s hospitals and 

cancer hospitals that are excluded from the 

IPPS continues to be subject to the rate-ofincrease ceiling based on the hospital’s own 

historical cost experience. (We note that, in 

accordance with § 403.752(a), RNHCIs are 

also subject to the rate-of-increase limits 

established under § 413.40. IRFs, IPFs, and 

LTCHs were paid previously under the 

reasonable cost methodology. However, the 

statute was amended to provide for the 

implementation of prospective payment 

systems for IRFs, IPFs, and LTCHs. In 

general, the prospective payment systems for 

IRFs, IPFs, and LTCHs provide(d) transition 

periods of varying lengths during which time 

a portion of the prospective payment is (was) 

based on cost-based reimbursement rules 

under Part 413 (certain providers do not 

receive a transition period or may elect to 

bypass the transition as applicable under 

Subparts N, O, and P.) We note that the 

various transition periods provided for under 

the IRF PPS, IPF PPS, and LTCH PPS have 

ended or will soon end. 

For cost reporting periods beginning on or 

after October 1, 2002, all IRFs are paid 100 

percent of the adjusted Federal rate under the 

IRF PPS. Therefore, for cost reporting periods 

beginning on or after October 1, 2002, no 

portion of an IRF PPS payment is subject to 

Part 413. Similarly, for cost reporting periods 

beginning on or after October 1, 2006, all 

LTCHs are paid 100 percent of the adjusted 

Federal rate under the LTCH PPS. Therefore, 

for cost reporting periods beginning on or 

after October 1, 2006, no portion of the LTCH 

PPS payment is subject to Part 413. However, 

except as provided in § 412.426(c), IPFs 

remain under a blend methodology for cost 

reporting periods beginning on or after 

January 1, 2005, and before January 1, 2008. 

For IPFs paid under the blend 

methodology, the portion of the IPF PPS 

payment that is based on reasonable cost 

principles is subject to the rules of Part 413. 

In order to calculate the portion of the PPS 

payment that is based on reasonable cost 

principles, it is necessary to determine 

whether the IPF would be considered 

‘‘existing’’ for purposes of section 

1886(b)(3)(H) of the Act or ‘‘new’’ for 

purposes of section 1886(b)(7) of the Act. We 

note that readers should not confuse an IPF 

that is considered ‘‘new’’ for purposes of 

section 1886(b)(7) of the Act and §

413.40(f)(2)(ii) with an IPF that is considered 

‘‘new’’ under § 412.426(c). Any IPF that, 

under present or previous ownership or both, 

has its first cost reporting period as an IPF 

beginning on or after January 1, 2005, is 

considered ‘‘new’’ for purposes of §

412.426(c). An IPF that is considered ‘‘new’’ 

under § 412.426(c) is paid based on 100 

percent of the Federal per diem payment 

amount. Consequently, only those IPFs 

considered ‘‘new’’ under section 1886(b)(7) 

of the Act, but not ‘‘new’’ under § 412.426(c) 

will be paid under a PPS blended payment 

methodology. An IPF considered ‘‘new’’ for 

purposes of § 413.40(f)(2)(ii) would have its 

‘‘reasonable-cost based’’ portion of its 

prospective payment subject to §

413.40(f)(2)(ii) and § 413.40(c)(4)(v), as 

applicable. An IPF considered ‘‘new’’ for 

purposes of section 1886(b)(7) of the Act has 

the target amount for its third cost reporting 

period determined in accordance with 

sections 1886(b)(7)(A)(ii) and 

1886(b)(3)(A)(ii) of the Act. For the fourth 

and subsequent cost reporting periods, the 

target amount is calculated in accordance 

with section 1886(b)(3)(A)(ii) of the Act. An 

IPF that would be considered ‘‘existing’’ for 

purposes of section 1886(b)(3)(H) of the Act 

has the target amount for the ‘‘reasonablecost based’’ portion of its prospective 

payment determined in accordance with 

section 1886(b)(3)(A)(ii) of the Act and §

413.40(c)(4)(ii). 

We are proposing that the applicable 

percentage increase to update the target 

amount for the reasonable cost-based portion 

of the PPS payment of an IPF that is 

considered existing under section 

1886(b)(3)(H) of the Act or new under section 

1886(b)(7) of the Act, but not new under §

412.426(c), is 3.4 percent using the first 

quarter of the 2007 forecast made by Global 

Insight, Inc. 

V. Tables 

This section contains the tables referred to 

throughout the preamble to this proposed 

rule and in this Addendum. Tables 1A, 1B, 

1C, 1D, 2, 3A, 3B, 4A, 4B, 4C, 4D, 4F, 4G, 

4H, 4J, 5, 6A, 6B, 6C, 6D, 6E, 6F, 6J, 6K, 7A, 

7B, 8A, 8B, 8C, 9A, 9C, 10, and 11 are 

presented below. As explained in sections 

II.D. 2. and II.G.8. of the preamble of this 

final rule, Table 6G—Additions to the CC 

Exclusions List, Table 6H, Deletions from the 

CC Exclusions List, and Table 6I—Complete 

List of Complication and Comorbidity (CC) 

Exclusions are available only through the 

Internet on the CMS Web site at: http:// 

www.cms.hhs.gov/ AcuteInpatientPPS/. The 

tables presented below are as follows: 

Table 1A—National Adjusted Operating 

Standardized Amounts, Labor/Nonlabor 

(69.7 Percent Labor Share/30.3 Percent 

Nonlabor Share If Wage Index Is Greater 

Than 1) 

Table 1B—National Adjusted Operating 

Standardized Amounts, Labor/Nonlabor 

(62 Percent Labor Share/38 Percent 

Nonlabor Share If Wage Index Is Less 

Than or Equal To 1) 

Table 1C—Adjusted Operating Standardized 

Amounts for Puerto Rico, Labor/ 

Nonlabor 

Table 1D—Capital Standard Federal Payment 

Rate 

Table 2—Hospital Case-Mix Indexes for 

Discharges Occurring in Federal Fiscal 

Year 2006; Hospital Wage Indexes for 

Federal Fiscal Year 2008; Hospital 

Average Hourly Wages for Federal Fiscal 

Years 2006 (2002 Wage Data), 2007 (2003 

Wage Data), and 2008 (2004 Wage Data); 

and 3-Year Average of Hospital Average 

Hourly Wages 

Table 3A—FY 2008 and 3-Year Average 

Hourly Wage for Urban Areas by CBSA 

Table 3B—FY 2008 and 3-Year Average 

Hourly Wage for Rural Areas by CBSA 

Table 4A—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Urban Areas by CBSA—FY 2008 

Table 4B—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Rural Areas by CBSA—FY 2008 

Table 4C—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Hospitals That Are Reclassified by 

CBSA—FY 2008 

Table 4F—Puerto Rico Wage Index and 

Capital Geographic Adjustment Factor 

(GAF) by CBSA—FY 2008 

Table 4J—Out-Migration Adjustment—FY 

2008 

Table 5—List of Proposed Medicare Severity 

Diagnosis-Related Groups (MS–DRGs), 

Relative Weighting Factors, and 

Geometric and Arithmetic Mean Length 

of Stay 

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 6J—Major Complication and 

Comorbidity (MCC) List 

Table 6K—Complications and Comorbidity 

(CC) List 

Table 7A—Medicare Prospective Payment 

System Selected Percentile Lengths of 

Stay: FY 2006 MedPAR Update— 

December 2006 GROUPER V24.0 CMS 

DRGs 

Table 7B—Medicare Prospective Payment 

System Selected Percentile Lengths of 

Stay: FY 2006 MedPAR Update— 

December 2006 GROUPER V25.0 MS– 

DRGs 

Table 8A—Proposed Statewide Average 

Operating Cost-to-Charge Ratios—March 

2007 

Table 8B—Proposed Statewide Average 

Capital Cost-to-Charge Ratios—March 

2007 

Table 8C—Proposed Statewide Average Total 

Cost-to-Charge Ratios for LTCHs—March 

2007 

Table 9A—Revised Hospital Reclassifications 

and Redesignations—FY 2008 

Table 9C—Hospitals Redesignated as Rural 

under Section 1886(d)(8)(E) of the Act— 

FY 2008 

Table 10—Geometric Mean Plus the Lesser of 

.75 of the National Adjusted Operating 

Standardized Payment Amount 

(Increased to Reflect the Difference 

Between Costs and Charges) or .75 of 

One Standard Deviation of Mean Charges 

by Proposed Medicare Severity 

Diagnosis-Related Group (MS–DRG)— 

April 2007 

Table 11—Proposed FY 2008 MS–LTC– 

DRGs, Relative Weights, Geometric 

Average Length of Stay, and 5/6ths of the 

Geometric Average Length of Stay 

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24850 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 1A.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS; LABOR/NONLABOR (69.7 PERCENT LABOR

SHARE/30.3 PERCENT NONLABOR SHARE IF WAGE INDEX GREATER THAN 1) 

Full update (3.3 percent) Reduced update (1.3 percent) 

Labor-related Nonlabor-related Labor-related Nonlabor-related 

$3,430.29 ............................................................................................................. $1,491.21 $3,363.88 $1,462.34 

TABLE 1B.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/ 

38 PERCENT NONLABOR SHARE IF WAGE INDEX LESS THAN OR EQUAL TO 1) 

Full update (3.3 percent) Reduced update (1.3 percent) 

Labor-related Nonlabor-related Labor-related Nonlabor-related 

$3,051.33 ............................................................................................................. $1,870.17 $2,992.26 $1,833.96 

TABLE 1C.—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO LABOR, LABOR/NONLABOR

Rates if wage index greater 

than 1 

Rates if wage index less than 

or equal to 1 

Labor Nonlabor Labor Nonlabor 

National ............................................................................................................ $3,430.29 $1,491.21 $3,051.33 $1,870.17 

Puerto Rico ...................................................................................................... 1,442.56 884.15 1,365.78 960.93 

TABLE 1D.—CAPITAL STANDARD

FEDERAL PAYMENT RATE

Urban 

rate Rural rate 

National ..................... $413.87 $417.26 

Puerto Rico ............... 195.60 197.21 

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24851 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

010001 ............................................................................. 1.5195 0.7598 21.6546 22.1989 23.2171 22.3607 

010005 ............................................................................. 1.1370 0.8760 22.4906 23.6022 23.0192 23.0412 

010006 ............................................................................. 1.5127 0.7971 23.4823 23.4975 25.1891 23.9924 

010007 ............................................................................. 1.0231 0.7598 18.2429 19.9329 21.2159 19.8249 

010008 ............................................................................. 1.0409 0.7843 20.4591 17.9533 22.0766 19.9260 

010009 ............................................................................. 0.9710 0.8760 23.2228 23.5626 25.8995 24.2263 

010010 ............................................................................. 1.1050 0.8737 21.4974 27.0385 22.8588 23.5938 

010011 ............................................................................. 1.6744 0.8873 27.4850 27.6658 27.4650 27.5387 

010012 ............................................................................. 1.2346 0.9391 22.7020 24.4059 25.5764 24.1955 

010015 ............................................................................. 1.0427 0.7641 21.5111 22.3383 27.0786 23.3434 

010016 ............................................................................. 1.5763 0.8873 25.1502 24.6488 26.8613 25.5445 

010018 ............................................................................. 1.7123 0.8873 22.2990 23.7048 24.6173 23.5172 

010019 ............................................................................. 1.2720 0.7971 22.0906 22.8766 23.3445 22.7780 

010021 ............................................................................. 1.1864 0.7598 18.6785 19.7367 21.0596 19.7966 

010022 ............................................................................. 0.9503 0.9845 24.5671 25.8404 27.4306 25.9296 

010023 ............................................................................. 1.8483 0.8366 27.6174 25.4272 27.5972 26.8926 

010024 ............................................................................. 1.6036 0.8366 20.7265 22.0819 25.0694 22.5299 

010025 ............................................................................. 1.3014 0.8594 21.2674 22.7635 23.6162 22.5532 

010027 ............................................................................. 0.7631 0.7598 15.3705 16.4682 17.0501 16.2714 

010029 ............................................................................. 1.5702 0.8594 22.6976 23.9007 25.0667 23.9196 

010032 ............................................................................. 0.9327 0.7918 19.1555 19.3311 20.5944 19.8444 

010033 ............................................................................. 2.0856 0.8873 26.3784 27.4181 28.9456 27.5755 

010034 ............................................................................. 1.0461 0.8366 16.9686 17.7457 19.1508 17.9500 

010035 ............................................................................. 1.3138 0.8737 22.2870 24.2425 24.2739 23.6060 

010036 ............................................................................. 1.1607 0.7598 22.9747 21.5796 24.2867 22.9472 

010038 ............................................................................. 1.2692 0.8081 21.4509 23.7039 27.0732 24.1203 

010039 ............................................................................. 1.6579 0.9175 25.8820 26.9919 29.2918 27.3990 

010040 ............................................................................. 1.6552 0.8129 22.8851 24.3207 24.7653 23.9965 

010043 ............................................................................. 1.0833 0.8873 22.5944 21.9774 23.9116 22.8203 

010044 ............................................................................. 1.0847 0.8737 21.4036 22.5009 24.4278 22.7205 

010045 ............................................................................. 1.2226 0.8737 19.8803 20.4927 23.1687 21.0753 

010046 ............................................................................. 1.5338 0.8129 21.6965 23.4219 25.7750 23.5002 

010047 ............................................................................. 0.8958 0.7777 21.0605 26.4851 19.7500 21.9482 

010049 ............................................................................. 1.1433 0.7598 20.2413 21.7888 22.4234 21.5067 

010050 ............................................................................. 1.0407 0.8873 22.1584 22.9620 24.4046 23.1653 

010051 ............................................................................. 0.8299 0.8534 15.2207 18.7701 18.0235 17.3856 

010052 ............................................................................. 0.8742 0.7722 16.4958 25.9233 36.3510 26.9113 

010053 ............................................................................. *** * 19.0108 * * 19.0108 

010054 ............................................................................. 1.0737 0.8760 22.5554 23.3624 24.4797 23.4775 

010055 ............................................................................. 1.6104 0.7598 22.3800 22.5396 22.4131 22.4446 

010056 ............................................................................. 1.6382 0.8873 23.7144 23.7398 25.3239 24.2816 

010058 ............................................................................. 1.0119 0.8873 18.5538 19.5092 17.0128 18.2407 

010059 ............................................................................. 1.0247 0.8760 21.3237 23.0012 24.8195 23.0576 

010061 ............................................................................. 0.9828 0.8164 21.9370 24.1185 25.2415 23.7777 

010062 ............................................................................. 1.0229 0.7598 18.3435 21.4805 21.6281 20.4629 

010064 ............................................................................. 1.6966 0.8873 26.1110 24.8155 27.6143 26.1440 

010065 ............................................................................. 1.5287 0.8737 21.3785 23.0477 24.3340 22.9445 

010066 ............................................................................. 0.8370 0.7598 17.6152 19.8692 25.1251 20.8278 

010068 ............................................................................. *** * 19.0789 22.7156 24.4131 22.0065 

010069 ............................................................................. 1.0243 0.7598 21.3609 23.1243 23.6305 22.6678 

010072 ............................................................................. *** * 21.8169 24.4989 25.9729 24.0804 

010073 ............................................................................. 0.9794 0.7598 16.4168 18.3963 19.0009 17.9403 

010078 ............................................................................. 1.6186 0.8081 21.6857 23.5279 24.3805 23.2222 

010079 ............................................................................. 1.2223 0.9175 21.8199 22.7337 22.1795 22.2414 

010083 ............................................................................. 1.1876 0.7950 22.3040 22.4279 24.0017 22.9546 

010084 ............................................................................. 1.3254 0.8873 24.7127 26.3238 26.5072 25.8381 

010085 ............................................................................. 1.3296 0.8760 24.4710 24.2609 24.1142 24.2806 

010086 ............................................................................. 1.1007 0.7598 18.6081 22.2096 21.5581 20.7408 

010087 ............................................................................. 1.9814 0.7950 22.5225 22.4318 24.8042 23.2180 

010089 ............................................................................. 1.2937 0.8873 22.8448 25.0811 26.2624 24.6787 

010090 ............................................................................. 1.7447 0.8544 23.6948 26.0494 26.3950 25.3394 

010091 ............................................................................. 0.9554 0.7641 18.6912 23.1310 22.5237 21.3015 

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24852 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

010092 ............................................................................. 1.5528 0.8534 24.4592 26.6796 26.9923 26.0268 

010095 ............................................................................. 0.8469 0.8534 13.9326 16.5250 16.9952 15.8664 

010097 ............................................................................. 0.7113 0.8366 16.7549 19.4511 19.2462 18.4993 

010098 ............................................................................. 0.9805 * 14.3076 * * 14.3076 

010099 ............................................................................. 0.9668 0.7598 18.7910 20.8383 20.6723 20.0887 

010100 ............................................................................. 1.6853 0.8127 21.2915 23.8919 25.1439 23.5423 

010101 ............................................................................. 1.1065 0.8737 21.6593 24.2575 25.0963 23.6319 

010102 ............................................................................. 0.9355 0.7598 21.0902 25.6158 26.9801 24.5958 

010103 ............................................................................. 1.8826 0.8873 26.1163 27.8272 28.9628 27.5988 

010104 ............................................................................. 1.8819 0.8873 24.7394 27.6471 28.3109 26.8460 

010108 ............................................................................. 1.0930 0.8366 28.4624 24.6740 27.0236 26.7335 

010109 ............................................................................. 0.9845 0.7967 21.6194 17.6733 21.0403 20.0217 

010110 ............................................................................. 0.7589 0.7901 17.5957 26.0038 19.8672 20.8809 

010112 ............................................................................. 0.9638 0.7598 16.8902 17.1833 20.4001 18.1174 

010113 ............................................................................. 1.6643 0.7950 21.4121 22.3282 24.7059 22.7828 

010114 ............................................................................. 1.3627 0.8873 22.3752 25.6152 25.7061 24.6261 

010115 ............................................................................. 0.6881 * 21.7477 * * 21.7477 

010118 ............................................................................. 1.2168 0.8166 19.7673 21.4630 22.7172 21.2736 

010120 ............................................................................. 0.9648 0.7598 20.9450 20.9019 22.1859 21.3550 

010121 ............................................................................. *** * 24.0867 * * 24.0867 

010125 ............................................................................. 1.0630 0.8069 18.4113 21.5123 22.8897 20.8635 

010126 ............................................................................. 1.1765 0.8366 23.1381 23.9327 24.4934 23.8544 

010128 ............................................................................. 0.8769 0.7641 21.4200 23.6647 24.9854 23.3827 

010129 ............................................................................. 1.0370 0.7723 21.3555 22.1574 21.8496 21.7886 

010130 ............................................................................. 1.0247 0.8873 23.2488 23.7528 24.5639 23.8766 

010131 ............................................................................. 1.3971 0.9175 25.7837 26.4297 27.2704 26.5326 

010137 ............................................................................. 1.2222 0.8873 24.7366 27.5782 28.5798 26.9175 

010138 ............................................................................. 0.6028 0.7711 13.8476 16.7602 14.5508 15.1016 

010139 ............................................................................. 1.5889 0.8873 25.3014 26.8726 28.1771 26.8342 

010143 ............................................................................. 1.2118 0.8737 22.0215 26.2762 24.0663 24.0857 

010144 ............................................................................. 1.6386 0.7950 20.8209 22.5133 22.3897 21.9331 

010145 ............................................................................. 1.4710 0.8534 24.9531 24.5092 25.8279 25.1079 

010146 ............................................................................. 1.0814 0.8081 20.8917 22.6586 22.6870 22.1060 

010148 ............................................................................. 0.8685 0.7598 20.5589 23.9246 23.5683 22.6789 

010149 ............................................................................. 1.2881 0.8366 26.5854 24.4805 26.7486 25.9662 

010150 ............................................................................. 1.0284 0.8366 21.6377 23.6080 24.4087 23.2036 

010152 ............................................................................. 1.2950 0.7950 22.6202 22.4075 23.7803 22.9411 

010157 ............................................................................. 1.1360 0.7971 24.3559 23.3828 25.4582 24.3716 

010158 ............................................................................. 1.1924 0.7927 24.3531 23.5533 25.5902 24.4669 

010162 ............................................................................. *** * * 33.8777 * 33.8777 

010163 ............................................................................. *** * * * 34.0293 34.0293 

010164 ............................................................................. 1.1750 0.8043 * * * * 

010165 ............................................................................. *** * * * 28.8030 28.8030 

010166 ............................................................................. *** * * * 29.7218 29.7218 

010167 ............................................................................. 1.4977 0.8873 * * * * 

010168 ............................................................................. 1.1410 0.9023 * * * * 

020001 ............................................................................. 1.7970 1.1840 32.8120 35.4232 36.5276 34.9502 

020004 ............................................................................. 1.1210 1.1817 32.0966 31.8004 33.5991 32.4852 

020006 ............................................................................. 1.3200 1.1840 36.0540 34.3752 37.0215 35.7759 

020008 ............................................................................. 1.2398 1.1840 35.9236 36.1250 39.3416 37.1498 

020012 ............................................................................. 1.3779 1.1817 31.8995 32.5975 33.9363 32.8387 

020014 ............................................................................. 1.1267 1.1817 32.0894 29.4472 30.9718 30.8220 

020017 ............................................................................. 1.9205 1.1840 33.5852 35.4119 35.8810 34.9151 

020018 ............................................................................. 0.9351 1.9287 * * * * 

020019 ............................................................................. 0.8687 1.9287 * * * * 

020024 ............................................................................. 1.1749 1.1817 33.0644 29.5195 38.6904 33.4491 

020026 ............................................................................. 1.4939 1.9287 * * * * 

020027 ............................................................................. 0.9384 1.9287 * * * * 

030001 ............................................................................. 1.5465 1.0115 29.9840 32.4791 33.4166 31.9038 

030002 ............................................................................. 2.0925 1.0115 29.0519 30.2200 31.0794 30.0867 

030006 ............................................................................. 1.6966 0.9484 25.8872 27.0599 27.8624 26.9763 

mmaher on DSK3CLS3C1PROD with $$_JOB

24853 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

030007 ............................................................................. 1.4533 0.9386 29.6174 31.1928 33.7190 31.5810 

030009 ............................................................................. *** * 22.3993 26.5408 * 23.8204 

030010 ............................................................................. 1.4068 0.9484 24.8275 28.5684 31.1684 28.1880 

030011 ............................................................................. 1.4906 0.9484 25.1361 28.1423 29.3385 27.6326 

030012 ............................................................................. 1.3882 0.9913 26.3859 27.3895 28.8355 27.5891 

030013 ............................................................................. 1.4760 0.9468 25.7050 27.0111 29.3504 27.3749 

030014 ............................................................................. 1.5924 1.0115 25.6259 29.6582 29.8251 28.4291 

030016 ............................................................................. 1.2381 1.0115 26.7003 29.1980 31.9830 29.4207 

030017 ............................................................................. 2.0661 1.0115 26.2452 30.6007 34.7863 30.8882 

030018 ............................................................................. 1.3196 1.0115 28.9476 29.4566 31.8047 30.0509 

030019 ............................................................................. 1.3553 1.0115 27.3156 29.5921 30.1929 29.0813 

030022 ............................................................................. 1.5745 1.0115 26.4404 30.5710 30.3718 29.2058 

030023 ............................................................................. 1.7864 1.1558 33.8333 34.2142 35.8265 34.6818 

030024 ............................................................................. 2.0620 1.0115 31.6658 31.9247 33.1810 32.2887 

030027 ............................................................................. 0.9709 * 20.4032 * * 20.4032 

030030 ............................................................................. 1.5755 1.0115 30.2712 32.0994 34.4162 32.2545 

030033 ............................................................................. 1.2964 1.1310 26.6531 28.7508 29.9363 28.4678 

030036 ............................................................................. 1.4582 1.0115 30.3521 30.9834 33.0517 31.6114 

030037 ............................................................................. 2.1468 1.0115 28.6453 31.2877 34.1070 31.4095 

030038 ............................................................................. 1.6738 1.0115 29.5509 29.9314 31.6720 30.2088 

030040 ............................................................................. 0.9098 0.9398 24.8145 27.5322 29.5727 27.3145 

030043 ............................................................................. 1.2683 0.9386 24.7932 26.5834 27.3802 26.2787 

030055 ............................................................................. 1.4609 0.9534 24.5202 27.1473 27.0569 26.3168 

030060 ............................................................................. 1.0905 0.9386 24.3523 24.8373 29.6494 26.3133 

030061 ............................................................................. 1.6820 1.0115 25.5529 28.0696 27.7958 27.1919 

030062 ............................................................................. 1.2021 0.9386 23.8068 26.6880 28.9557 26.5828 

030064 ............................................................................. 1.9609 0.9484 25.4922 28.3853 29.7464 27.9854 

030065 ............................................................................. 1.5921 1.0115 27.1646 29.5883 31.0784 29.3868 

030067 ............................................................................. 1.0573 0.9616 20.4376 20.7591 27.4426 22.9577 

030068 ............................................................................. 1.1143 0.9386 20.8846 23.1394 24.0540 22.7233 

030069 ............................................................................. 1.4255 0.9386 26.3518 30.2224 29.7783 28.7287 

030071 ............................................................................. 0.8871 1.4406 * * * * 

030073 ............................................................................. 0.8952 1.4406 * * * * 

030074 ............................................................................. 0.8727 1.4406 * * * * 

030077 ............................................................................. 0.7676 1.4406 * * * * 

030078 ............................................................................. 0.9879 1.4406 * * * * 

030080 ............................................................................. 1.5499 0.9484 25.2077 27.1360 28.7349 27.0418 

030083 ............................................................................. 1.4209 1.0115 27.5353 27.4983 33.5289 29.3975 

030084 ............................................................................. 0.9014 1.4406 * * * * 

030085 ............................................................................. 1.5899 0.9484 24.5792 26.8364 28.1362 26.6157 

030087 ............................................................................. 1.6946 1.0115 26.6594 29.5962 31.2063 29.3936 

030088 ............................................................................. 1.3692 1.0115 26.6796 27.8604 29.9743 28.2304 

030089 ............................................................................. 1.6385 1.0115 27.1835 28.9068 30.1558 28.8088 

030092 ............................................................................. 1.4976 1.0115 27.3203 31.7512 30.6298 30.0149 

030093 ............................................................................. 1.2964 1.0115 25.8955 26.4430 27.4271 26.6702 

030094 ............................................................................. 1.4055 1.0115 29.5948 31.5422 33.4045 31.6118 

030099 ............................................................................. 0.8736 0.9386 26.3236 27.1402 26.7474 26.7410 

030100 ............................................................................. 2.0536 0.9484 29.0691 31.5628 35.1381 31.9181 

030101 ............................................................................. 1.4386 1.1205 26.1927 27.8302 30.6747 28.3387 

030102 ............................................................................. 2.3668 1.0115 29.0942 31.6285 34.2046 31.6905 

030103 ............................................................................. 1.7576 1.0115 30.1994 31.7322 32.2839 31.3999 

030105 ............................................................................. 2.2412 1.0115 31.3094 31.2970 32.7440 31.8776 

030106 ............................................................................. 1.7570 1.0115 34.7221 32.9840 36.4650 34.9441 

030107 ............................................................................. 1.9168 1.0115 * 35.6197 35.5345 35.5697 

030108 ............................................................................. 2.0343 1.0115 * * 31.3337 31.3337 

030109 ............................................................................. *** * * 16.5906 32.6823 26.5780 

030110 ............................................................................. 1.6153 1.0115 * 31.4852 29.7956 30.5019 

030111 ............................................................................. 1.0328 0.9484 * * 34.7976 34.7976 

030112 ............................................................................. 1.9764 1.0115 * * 37.4931 37.4931 

030113 ............................................................................. 0.8965 1.4406 * * * * 

030114 ............................................................................. 1.3891 0.9484 * * * * 

mmaher on DSK3CLS3C1PROD with $$_JOB

24854 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

030115 ............................................................................. 1.3513 1.0115 * * * * 

030117 ............................................................................. 1.1172 0.9386 * * * * 

030118 ............................................................................. 1.0947 0.9913 * * * * 

030119 ............................................................................. 1.1646 1.0115 * * * * 

040001 ............................................................................. 1.0784 0.8876 23.7718 22.9327 22.9909 23.2119 

040002 ............................................................................. 1.2054 0.7519 20.1384 21.2020 24.9965 22.0316 

040004 ............................................................................. 1.7231 0.8876 25.0286 27.1741 28.1077 26.7777 

040007 ............................................................................. 1.7566 0.8965 25.7142 40.1291 29.1919 31.6848 

040010 ............................................................................. 1.4680 0.8876 23.0274 24.2315 26.5274 24.6221 

040011 ............................................................................. 1.0468 0.7519 20.3970 21.0967 22.2391 21.2815 

040014 ............................................................................. 1.3549 0.8721 25.3451 26.4777 29.0061 26.8567 

040015 ............................................................................. 0.9946 0.7519 19.2831 20.4279 20.1045 19.9373 

040016 ............................................................................. 1.7637 0.8965 22.1228 25.8056 26.5895 24.8381 

040017 ............................................................................. 1.0958 0.8719 21.9875 21.9147 23.8741 22.5732 

040018 ............................................................................. 1.0813 0.8056 23.6044 24.0026 25.6731 24.3846 

040019 ............................................................................. 1.1103 0.8951 23.7328 23.8706 24.9108 24.1693 

040020 ............................................................................. 1.5840 0.8951 21.6603 22.6497 23.9443 22.7533 

040021 ............................................................................. 1.5369 0.8965 25.6917 25.4046 26.1832 25.7531 

040022 ............................................................................. 1.5691 0.8876 25.4052 29.5000 27.9883 27.5941 

040026 ............................................................................. 1.5094 0.9110 25.4072 27.7931 29.5278 27.6084 

040027 ............................................................................. 1.4822 0.8943 21.1412 21.4252 23.8205 22.1269 

040029 ............................................................................. 1.4949 0.8965 24.0704 24.8409 25.1455 24.6984 

040036 ............................................................................. 1.6116 0.8965 26.3226 27.6234 29.7111 27.9661 

040039 ............................................................................. 1.2751 0.8145 19.5998 21.2712 21.4793 20.7967 

040041 ............................................................................. 1.1737 0.8721 22.1531 23.7787 26.4923 24.1425 

040042 ............................................................................. 1.3814 0.9291 19.9627 21.1716 19.8670 20.3330 

040045 ............................................................................. 1.0416 * 17.2281 * * 17.2281 

040047 ............................................................................. 1.1246 0.7636 21.9163 22.4249 22.9939 22.4384 

040050 ............................................................................. 1.2272 0.7519 16.3930 17.6906 18.5104 17.5655 

040051 ............................................................................. 0.9636 0.7519 19.1400 21.3342 22.0350 20.8371 

040053 ............................................................................. *** * 20.7823 * * 20.7823 

040054 ............................................................................. *** * 18.2685 18.0509 19.5333 18.6002 

040055 ............................................................................. 1.5255 0.8056 23.3156 23.0448 24.9139 23.7090 

040062 ............................................................................. 1.6634 0.8056 23.3082 23.8994 25.2283 24.1348 

040067 ............................................................................. 1.1389 0.7527 16.8800 19.0471 18.9849 18.2674 

040069 ............................................................................. 1.0195 0.8951 24.4662 24.8060 24.9975 24.7596 

040071 ............................................................................. 1.4618 0.8721 24.3824 25.4680 25.2804 25.0562 

040072 ............................................................................. 1.1155 0.7519 19.9009 22.4741 22.1027 21.4210 

040074 ............................................................................. 1.1976 0.8965 25.2423 25.2699 26.2628 25.5873 

040075 ............................................................................. *** * 18.3253 * * 18.3253 

040076 ............................................................................. 1.0003 0.8721 20.6272 23.5742 23.0930 22.4189 

040077 ............................................................................. 0.9991 * 18.2082 * * 18.2082 

040078 ............................................................................. 1.5953 0.8721 24.5377 23.5915 26.1923 24.6731 

040080 ............................................................................. 1.0440 0.8507 22.3392 24.1921 24.8730 23.8545 

040081 ............................................................................. 0.8586 0.7877 15.1081 16.8437 17.2484 16.4107 

040084 ............................................................................. 1.1954 0.8965 24.7225 27.7626 26.6430 26.4194 

040085 ............................................................................. 0.9761 0.8951 29.8444 22.9916 25.7190 25.8628 

040088 ............................................................................. 1.4629 0.7766 22.6183 22.4860 23.5774 22.9018 

040091 ............................................................................. 1.1778 0.8131 23.1320 24.2398 23.1902 23.5097 

040100 ............................................................................. 1.3421 0.8721 20.0460 21.3051 22.6107 21.3761 

040105 ............................................................................. 1.0556 * 18.2182 * * 18.2182 

040109 ............................................................................. 1.1066 * 22.8801 * * 22.8801 

040114 ............................................................................. 1.8067 0.8965 24.8992 26.7581 27.7902 26.5373 

040118 ............................................................................. 1.4739 0.8507 24.7363 26.0388 26.8888 25.8805 

040119 ............................................................................. 1.4199 0.8721 21.0103 24.3680 24.2386 23.2176 

040126 ............................................................................. *** * 14.0700 15.6985 17.3697 15.6131 

040132 ............................................................................. *** * 28.1393 * 22.0041 24.3526 

040134 ............................................................................. 2.3675 0.8965 27.3412 31.9325 32.2786 30.5646 

040137 ............................................................................. 1.3088 0.8965 25.2907 25.9979 27.7350 26.2747 

040138 ............................................................................. 1.4228 0.8876 25.7513 27.8584 28.3338 27.5135 

040141 ............................................................................. 0.8436 0.8876 24.0901 26.1041 30.3458 26.8841 

mmaher on DSK3CLS3C1PROD with $$_JOB

24855 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

040142 ............................................................................. 1.4686 0.9110 27.9696 21.4222 23.8619 24.1239 

040143 ............................................................................. *** * * 37.1976 * 37.1976 

040144 ............................................................................. *** * * 21.4008 * 21.4008 

040145 ............................................................................. 1.7857 0.8507 * * 24.4378 24.4378 

040146 ............................................................................. *** * * * 33.7847 33.7847 

040147 ............................................................................. 1.7126 0.8965 * * * * 

050002 ............................................................................. 1.3851 1.5308 34.1948 35.5184 41.7235 37.3172 

050006 ............................................................................. 1.6409 1.2666 30.5373 33.5751 37.1649 33.5394 

050007 ............................................................................. 1.4954 1.4906 38.7033 43.4440 44.3636 42.1957 

050008 ............................................................................. 1.2737 1.4766 39.1539 49.3167 46.6961 45.1213 

050009 ............................................................................. 1.8128 1.4201 39.6393 43.0584 46.2195 43.0446 

050013 ............................................................................. 1.9755 1.4201 31.9837 35.7591 42.0547 36.4664 

050014 ............................................................................. 1.2470 1.2853 33.0373 36.0305 36.6124 35.2529 

050015 ............................................................................. 1.3326 * 30.7940 32.2188 * 31.5274 

050016 ............................................................................. 1.3291 1.1912 26.2161 24.5768 30.7245 27.1606 

050017 ............................................................................. 1.9798 1.2999 36.6593 39.6653 41.8986 39.4161 

050018 ............................................................................. 1.1984 1.1633 22.3472 23.3204 32.0787 25.3874 

050022 ............................................................................. 1.5660 1.1607 29.8632 31.6467 33.0584 31.4880 

050024 ............................................................................. 1.1369 1.1607 27.5587 29.4062 33.4319 30.1998 

050025 ............................................................................. 1.8832 1.1607 36.1622 33.5466 32.7463 34.1066 

050026 ............................................................................. 1.5092 1.1607 28.3027 31.5250 33.1265 31.0369 

050028 ............................................................................. 1.2326 1.1607 26.6160 27.3826 28.5775 27.5352 

050030 ............................................................................. 1.2224 1.1607 24.9707 27.2945 30.8991 27.6427 

050036 ............................................................................. 1.5126 1.1607 32.7929 33.8000 36.1357 34.2635 

050038 ............................................................................. 1.6564 1.5378 38.7527 44.2265 47.1554 43.4736 

050039 ............................................................................. 1.6086 1.1607 31.6734 35.2630 36.6920 34.5165 

050040 ............................................................................. 1.2745 1.1633 34.3279 35.8322 35.7021 35.3245 

050042 ............................................................................. 1.5024 1.2666 33.9415 37.3760 40.3545 37.2138 

050043 ............................................................................. 1.6351 1.5308 43.1589 45.4887 46.5540 45.1118 

050045 ............................................................................. 1.3005 1.1607 23.8408 25.0150 27.0633 25.4065 

050046 ............................................................................. 1.1311 1.1607 25.6875 26.1926 29.1122 26.9714 

050047 ............................................................................. 1.7663 1.4766 40.9874 55.9367 45.1678 47.4628 

050054 ............................................................................. 1.1907 1.1607 24.1262 21.3650 24.3196 23.2719 

050055 ............................................................................. 1.3282 1.4766 37.5879 42.9516 44.2917 41.4280 

050056 ............................................................................. 1.3806 1.1633 27.9330 30.6126 32.7669 30.4544 

050057 ............................................................................. 1.6643 1.1607 29.4351 30.0236 31.7448 30.4500 

050058 ............................................................................. 1.6025 1.1633 33.8215 33.1409 36.7723 34.5428 

050060 ............................................................................. 1.4468 1.1607 27.3282 29.9762 32.0159 29.7243 

050061 ............................................................................. *** * 32.2172 * * 32.2172 

050063 ............................................................................. 1.3855 1.1633 33.3039 34.0906 36.3153 34.5052 

050065 ............................................................................. *** * 34.0280 34.9110 38.2458 35.7018 

050067 ............................................................................. 1.1904 1.1989 31.9597 38.8070 40.1284 37.4041 

050069 ............................................................................. 1.7481 1.1607 31.2172 34.6353 35.3837 33.8181 

050070 ............................................................................. 1.2855 1.4906 45.3382 47.4099 46.4023 46.4528 

050071 ............................................................................. 1.2901 1.5299 44.9464 50.7602 49.6475 48.7318 

050072 ............................................................................. 1.3299 1.5299 44.2651 49.4344 50.0340 48.1854 

050073 ............................................................................. 1.2899 1.5299 45.9765 49.9730 49.0059 48.5022 

050075 ............................................................................. 1.3067 1.5308 47.2356 54.4089 49.8285 50.5647 

050076 ............................................................................. 1.9114 1.5299 46.4991 52.3788 50.2028 49.9368 

050077 ............................................................................. 1.6174 1.1607 32.0245 34.8660 36.5360 34.5322 

050078 ............................................................................. 1.2621 1.1633 31.1425 32.0133 30.4267 31.1476 

050079 ............................................................................. 1.5036 1.5299 47.8597 47.3449 48.9005 47.9787 

050082 ............................................................................. 1.6860 1.1607 37.7783 38.2878 37.6622 37.9070 

050084 ............................................................................. 1.5634 1.1870 33.0179 35.5196 39.3825 35.9583 

050088 ............................................................................. *** * 25.7385 * * 25.7385 

050089 ............................................................................. 1.3526 1.1607 33.5324 33.9593 36.6955 34.6956 

050090 ............................................................................. 1.2774 1.4766 32.9584 33.8953 37.7343 34.8362 

050091 ............................................................................. 1.0225 1.1633 30.8560 32.1301 37.1046 33.3130 

050093 ............................................................................. 1.5010 1.1607 33.4118 36.9481 36.8258 35.7320 

050096 ............................................................................. 1.2246 1.1633 24.6679 34.9237 35.3586 31.7202 

050099 ............................................................................. 1.4900 1.1607 31.0437 33.4174 30.2843 31.6087 

mmaher on DSK3CLS3C1PROD with $$_JOB

24856 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

050100 ............................................................................. 1.8340 1.1607 29.6949 31.4404 33.3955 32.0304 

050101 ............................................................................. 1.2896 1.5299 40.3195 42.4589 47.1051 43.3558 

050102 ............................................................................. 1.2784 1.1607 29.1364 32.0617 33.1773 31.7561 

050103 ............................................................................. 1.5384 1.1633 34.2529 34.0935 35.6753 34.7042 

050104 ............................................................................. 1.4343 1.1633 29.7326 32.3043 33.6194 31.9097 

050107 ............................................................................. 1.5161 1.1607 33.1358 32.5846 33.3632 33.0279 

050108 ............................................................................. 1.9249 1.2999 35.5711 38.8672 41.2472 38.6817 

050110 ............................................................................. 1.2782 1.1607 26.1453 26.8408 28.0669 27.0290 

050111 ............................................................................. 1.2607 1.1633 28.1588 28.7875 31.8716 29.6669 

050112 ............................................................................. 1.5328 1.1633 36.8026 37.7281 38.9441 37.8605 

050113 ............................................................................. 1.2281 1.4906 33.8064 39.4882 42.8855 38.6355 

050114 ............................................................................. 1.4308 1.1633 31.1295 34.0309 35.7244 33.6736 

050115 ............................................................................. 1.4652 1.1607 30.9288 28.8051 31.3553 30.3610 

050116 ............................................................................. 1.7182 1.1633 34.5109 36.8825 37.7999 36.4915 

050117 ............................................................................. *** * 32.4413 34.2020 35.0365 33.2948 

050118 ............................................................................. 1.2267 1.1989 35.4044 39.9683 41.6676 39.0057 

050121 ............................................................................. 1.2979 1.1607 27.9537 30.6105 34.6208 31.1203 

050122 ............................................................................. 1.5166 1.1870 34.2416 33.9812 33.4644 33.8813 

050124 ............................................................................. 1.2868 1.1633 28.0288 30.2522 29.9912 29.4686 

050125 ............................................................................. 1.4991 1.5378 41.7020 44.9523 47.5179 44.7128 

050126 ............................................................................. 1.4832 1.1633 29.3360 31.7619 32.6678 31.2865 

050127 ............................................................................. 1.3323 1.2999 26.1222 32.0355 40.6863 31.7609 

050128 ............................................................................. 1.4725 1.1607 31.0662 31.1308 33.4220 31.8925 

050129 ............................................................................. 1.8434 1.1607 32.2680 34.7359 36.8660 34.5472 

050131 ............................................................................. 1.3349 1.4766 40.5321 45.3152 46.4089 44.1170 

050132 ............................................................................. 1.4284 1.1633 35.1544 35.9199 39.7742 36.9321 

050133 ............................................................................. 1.5409 1.2853 31.3530 31.9527 33.1808 32.2800 

050135 ............................................................................. 1.0356 1.1633 24.3927 25.1813 25.3138 25.0595 

050136 ............................................................................. 1.3586 1.4766 37.4560 43.3747 46.6589 42.5331 

050137 ............................................................................. 1.4390 1.1633 38.4827 39.1496 40.2454 39.4249 

050138 ............................................................................. 1.8383 1.1633 46.9557 45.3727 40.6348 43.8131 

050139 ............................................................................. 1.1867 1.1633 37.6217 37.8986 38.7381 38.1891 

050140 ............................................................................. 1.3250 1.1607 39.6269 40.9725 39.4950 39.9745 

050144 ............................................................................. *** * 33.5109 33.6662 38.2322 35.1744 

050145 ............................................................................. 1.4358 1.4408 42.3134 42.2921 47.7276 44.2033 

050146 ............................................................................. 1.7437 * * * * * 

050148 ............................................................................. 1.0844 * 27.3005 28.2305 * 27.7734 

050149 ............................................................................. 1.5003 1.1633 33.2270 35.8821 37.5338 35.8255 

050150 ............................................................................. 1.2112 1.2853 31.7560 33.6583 37.9935 34.4495 

050152 ............................................................................. 1.4654 1.4766 43.6487 46.1553 51.6554 47.1764 

050153 ............................................................................. 1.4478 1.5378 43.3190 42.8955 47.6370 44.7561 

050155 ............................................................................. *** * 21.8550 16.9516 16.7744 18.0647 

050158 ............................................................................. 1.3562 1.1633 35.1326 35.7805 39.9584 36.9833 

050159 ............................................................................. 1.4342 1.1607 31.3199 32.5704 34.6887 32.9759 

050167 ............................................................................. 1.3285 1.1870 28.5179 31.4798 34.0379 31.2291 

050168 ............................................................................. 1.6239 1.1607 33.2506 37.9784 40.5914 37.3803 

050169 ............................................................................. 1.4414 1.1633 27.4644 29.4693 31.4104 29.5643 

050172 ............................................................................. *** * 28.5604 * * 28.5604 

050173 ............................................................................. 1.3511 1.1607 30.3582 29.0576 31.6677 30.3441 

050174 ............................................................................. 1.5304 1.4766 40.1747 44.4199 46.5960 43.8522 

050175 ............................................................................. *** * 30.5733 33.3061 35.0178 32.9399 

050177 ............................................................................. *** * 25.1442 24.0717 * 24.6196 

050179 ............................................................................. 1.2436 1.1989 27.1155 30.4973 31.6619 30.0118 

050180 ............................................................................. 1.5479 1.5299 40.2504 42.0358 45.8035 42.8295 

050188 ............................................................................. 1.4249 1.5378 39.5110 41.0943 43.7368 41.3969 

050189 ............................................................................. 1.0036 1.4408 29.1279 30.1155 28.7585 29.3260 

050191 ............................................................................. 1.5059 1.1633 34.2091 37.7805 38.1482 36.6461 

050192 ............................................................................. 0.9796 1.1607 27.0424 27.1400 27.8369 27.3395 

050193 ............................................................................. 1.2019 1.1607 29.6421 33.9520 29.3437 30.8548 

050194 ............................................................................. 1.3917 1.5378 40.9096 44.7107 49.0012 44.8981 

050195 ............................................................................. 1.5361 1.5308 48.4358 48.8595 53.5569 50.3390 

mmaher on DSK3CLS3C1PROD with $$_JOB

24857 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

050196 ............................................................................. 1.0257 1.1607 32.1933 34.0956 32.8081 33.0293 

050197 ............................................................................. 2.1096 1.5299 48.9053 50.0728 53.0188 50.6957 

050204 ............................................................................. 1.4245 1.1633 28.6423 32.0121 35.3934 32.0132 

050205 ............................................................................. 1.4343 1.1633 27.8611 29.3334 30.6295 29.3017 

050207 ............................................................................. *** * 29.5214 30.0062 31.3426 30.2627 

050211 ............................................................................. 1.2807 1.5308 41.2166 35.0515 35.0280 36.9044 

050214 ............................................................................. *** * 23.9972 25.4647 * 24.7211 

050215 ............................................................................. *** * 43.7985 48.8112 50.7559 47.7254 

050219 ............................................................................. 1.2468 1.1633 22.4065 26.4143 25.8363 24.8922 

050222 ............................................................................. 1.7017 1.1607 29.1094 32.3882 33.7497 31.8383 

050224 ............................................................................. 1.7128 1.1607 29.3143 32.5010 35.6597 32.5126 

050225 ............................................................................. 1.4566 1.1607 29.9656 34.0836 35.1213 33.2219 

050226 ............................................................................. 1.6579 1.1607 30.5867 32.4411 35.4589 32.8047 

050228 ............................................................................. 1.2788 1.4766 42.4226 43.7939 47.1404 44.4641 

050230 ............................................................................. 1.5673 1.1607 32.9555 34.0600 35.8511 34.3224 

050231 ............................................................................. 1.6215 1.1633 30.9607 32.1813 33.7123 32.3028 

050232 ............................................................................. 1.7615 1.1912 27.4099 26.3004 33.8542 29.2047 

050234 ............................................................................. 1.1631 1.1607 29.6561 32.3726 34.8300 32.2029 

050235 ............................................................................. 1.5179 1.1633 29.2979 30.5405 37.0848 32.3685 

050236 ............................................................................. 1.4101 1.1607 32.1647 33.0686 32.6449 32.6397 

050238 ............................................................................. 1.5170 1.1633 31.1764 33.3346 33.6829 32.8238 

050239 ............................................................................. 1.6079 1.1633 31.0963 33.1148 35.9031 33.4237 

050240 ............................................................................. *** * 35.5735 36.1154 40.8103 37.5129 

050242 ............................................................................. 1.3921 1.5378 44.3130 46.4844 51.0202 47.3613 

050243 ............................................................................. 1.6372 1.1607 31.4883 32.9385 36.1250 33.6127 

050245 ............................................................................. 1.3931 1.1607 28.6527 27.3866 30.1898 28.7713 

050248 ............................................................................. 1.0716 1.4408 35.3864 * 37.5312 36.3536 

050251 ............................................................................. *** * 27.2675 27.8452 31.2316 28.9392 

050253 ............................................................................. *** * 24.0044 23.5381 * 23.7879 

050254 ............................................................................. 1.2481 1.2999 27.0041 31.2386 33.0846 30.5672 

050256 ............................................................................. *** * 29.8194 29.6793 32.7134 30.6554 

050257 ............................................................................. 0.9659 1.1607 21.3216 20.1829 24.0681 21.8475 

050261 ............................................................................. 1.3127 1.1607 27.3234 29.2150 30.8667 29.2674 

050262 ............................................................................. 2.1485 1.1633 44.0256 39.9946 41.4804 41.8523 

050264 ............................................................................. 1.3229 1.5308 41.1211 47.7024 42.5208 43.7371 

050270 ............................................................................. *** * 32.4812 33.6855 36.0101 34.0808 

050272 ............................................................................. 1.3845 1.1607 27.1989 29.4671 29.7379 28.8393 

050276 ............................................................................. 1.1469 1.5299 39.3778 41.1406 43.7919 41.5068 

050277 ............................................................................. 1.0179 1.1633 32.5213 35.4443 35.0053 34.2959 

050278 ............................................................................. 1.5501 1.1633 29.9244 31.8712 34.3775 32.1732 

050279 ............................................................................. 1.1687 1.1607 27.6573 29.7118 31.6720 29.7046 

050280 ............................................................................. 1.6972 1.2827 35.2030 38.8341 41.4106 38.4388 

050281 ............................................................................. 1.3952 1.1633 27.3824 29.4882 31.6589 29.5764 

050283 ............................................................................. 1.4814 1.5308 43.0638 44.3122 43.6531 43.6816 

050289 ............................................................................. 1.6758 1.4906 41.1774 44.2814 50.1743 45.4605 

050290 ............................................................................. 1.7004 1.1633 34.5482 37.3563 40.6183 37.4594 

050291 ............................................................................. 1.9448 1.4766 35.3653 38.4365 40.5938 38.0951 

050292 ............................................................................. 1.0728 1.1607 26.8879 26.9786 27.3320 27.0736 

050295 ............................................................................. 1.4731 1.1607 36.1950 34.7382 38.4514 36.5567 

050296 ............................................................................. 1.1731 1.5378 39.0060 39.9842 42.4133 40.4982 

050298 ............................................................................. 1.1705 1.1607 27.7416 30.2022 33.7827 30.5459 

050299 ............................................................................. *** * 31.5435 35.1249 32.3683 32.9738 

050300 ............................................................................. 1.4374 1.1607 30.7148 30.2874 33.6814 31.6607 

050301 ............................................................................. 1.2925 1.3959 31.9995 35.9491 37.1092 35.1038 

050305 ............................................................................. 1.4791 1.5308 44.8630 44.9681 48.5337 46.1773 

050308 ............................................................................. 1.5108 1.5378 43.0691 43.7413 46.4167 44.3891 

050309 ............................................................................. 1.4575 1.2999 34.4145 38.2659 39.4649 37.4701 

050312 ............................................................................. *** * 33.9022 36.8498 * 35.1423 

050313 ............................................................................. 1.2017 1.1870 31.8003 35.0478 36.4099 34.5831 

050315 ............................................................................. 1.2450 1.1607 28.5933 33.2038 32.7454 31.6158 

050320 ............................................................................. 1.3087 1.5308 40.2352 45.7686 46.2016 44.0250 

mmaher on DSK3CLS3C1PROD with $$_JOB

24858 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

050324 ............................................................................. 1.7816 1.1607 32.9792 34.5503 36.3466 34.6946 

050325 ............................................................................. 1.2711 1.1653 30.6116 31.3730 34.1213 32.1145 

050327 ............................................................................. 1.7344 1.1607 33.0087 33.9507 35.9352 34.3186 

050329 ............................................................................. 1.2920 1.1607 26.2121 23.2927 33.0376 27.5535 

050331 ............................................................................. 1.1678 * 20.2692 * * 20.2692 

050333 ............................................................................. 1.0014 1.1607 23.4009 19.6352 18.6523 20.3799 

050334 ............................................................................. 1.6310 1.4408 40.7467 43.9656 47.2949 44.0643 

050335 ............................................................................. 1.3975 1.1653 28.9403 30.9928 34.7177 31.6175 

050336 ............................................................................. 1.2358 1.1870 28.5659 30.4664 31.5467 30.2591 

050342 ............................................................................. 1.2392 1.1607 26.8507 29.2244 30.4210 28.9056 

050348 ............................................................................. 1.7661 1.1607 37.7898 31.5156 32.7100 33.8507 

050349 ............................................................................. 0.9614 1.1607 17.4791 24.4863 25.4172 22.6502 

050350 ............................................................................. 1.3638 1.1633 31.1833 31.0136 31.7899 31.3395 

050351 ............................................................................. 1.5080 1.1633 30.8661 30.6599 33.3053 31.6202 

050352 ............................................................................. 1.3698 1.2999 33.9362 36.7673 37.0787 35.9203 

050353 ............................................................................. 1.4800 1.1633 31.8291 29.4215 30.4196 30.5532 

050357 ............................................................................. 1.4453 1.1607 32.3095 32.6763 36.2079 33.9112 

050359 ............................................................................. 1.1700 1.1607 25.7739 29.8345 31.3346 29.0474 

050360 ............................................................................. 1.4970 1.4766 37.0769 47.4497 52.3803 45.4207 

050366 ............................................................................. 1.1799 1.1632 31.1854 33.6714 37.2628 33.8566 

050367 ............................................................................. 1.4038 1.5299 38.7727 38.6330 40.1880 39.2564 

050369 ............................................................................. 1.4156 1.1633 29.5697 30.6439 32.2454 30.8342 

050373 ............................................................................. 1.5222 1.1633 31.9271 35.1380 34.3691 33.8391 

050376 ............................................................................. 1.5665 1.1633 32.9393 34.3539 35.2799 34.2228 

050378 ............................................................................. 0.9465 1.1633 34.2417 37.9904 40.1809 37.5492 

050379 ............................................................................. *** * 32.9576 * * 32.9576 

050380 ............................................................................. 1.6825 1.5378 42.0781 46.0276 49.5391 45.8231 

050382 ............................................................................. 1.3846 1.1633 29.4323 30.4014 32.6664 30.8161 

050385 ............................................................................. 1.3037 1.4766 34.5183 36.8107 36.4189 35.9493 

050390 ............................................................................. 1.1270 1.1607 26.0066 27.3183 27.9319 27.0754 

050391 ............................................................................. *** * 18.1005 17.2141 * 17.6460 

050393 ............................................................................. 1.4106 1.1633 30.0661 34.1743 35.6327 33.2864 

050394 ............................................................................. 1.6045 1.1607 27.5061 27.4861 32.1896 29.1045 

050396 ............................................................................. 1.6169 1.1607 33.5699 32.4918 37.3957 34.4570 

050397 ............................................................................. 0.7585 1.1607 28.1639 28.3671 29.6760 28.7665 

050407 ............................................................................. 1.1110 1.4766 37.9066 42.2748 44.6803 41.6942 

050410 ............................................................................. *** * 21.3814 * * 21.3814 

050411 ............................................................................. 1.2156 1.1633 37.8064 38.8294 38.6322 38.4661 

050414 ............................................................................. 1.3232 1.2999 34.6672 38.7585 41.8000 38.4949 

050417 ............................................................................. 1.2775 1.1607 29.5031 32.9341 35.4935 32.6699 

050419 ............................................................................. 0.8450 * 33.3124 * * 33.3124 

050420 ............................................................................. *** * 24.9401 35.2869 39.9207 32.7471 

050423 ............................................................................. 1.0736 1.1607 30.6416 28.3768 31.9703 30.4039 

050424 ............................................................................. 1.9922 1.1607 31.0730 34.5680 36.6083 34.1649 

050425 ............................................................................. 1.3129 1.2999 42.4177 49.2245 46.6607 46.3205 

050426 ............................................................................. 1.4945 1.1607 30.6899 33.2031 34.9839 32.9980 

050430 ............................................................................. 0.9735 1.1607 25.0604 23.9045 24.5322 24.4190 

050432 ............................................................................. *** * 30.8030 33.1876 35.2390 33.0678 

050433 ............................................................................. 1.6238 1.1607 23.0807 21.3573 21.1315 21.8793 

050434 ............................................................................. 1.0477 1.1607 26.1622 32.6255 33.7752 31.2596 

050435 ............................................................................. 1.2739 1.1607 28.0305 30.6530 33.0355 30.6062 

050438 ............................................................................. 1.5355 1.1633 27.2662 36.3026 35.3864 33.0894 

050441 ............................................................................. 1.9488 1.5378 42.9765 44.5694 46.5348 44.7312 

050444 ............................................................................. 1.3278 1.2190 30.5504 34.6313 37.6608 34.7182 

050447 ............................................................................. 0.9388 1.1607 25.2573 26.7960 29.0758 27.0881 

050448 ............................................................................. 1.3448 1.1607 27.9759 30.6201 32.7714 30.3926 

050454 ............................................................................. 1.9034 1.4766 43.5311 38.5833 40.2800 40.7576 

050455 ............................................................................. 1.6170 1.1607 22.7235 30.4606 34.6359 29.0896 

050456 ............................................................................. 1.2382 1.1633 22.5630 21.6261 27.7648 24.0206 

050457 ............................................................................. 1.6418 1.4766 45.5828 47.8947 50.0192 47.8408 

050464 ............................................................................. 1.6913 1.1989 37.3692 38.3058 41.6239 39.0263 

mmaher on DSK3CLS3C1PROD with $$_JOB

24859 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

050468 ............................................................................. 1.5319 1.1633 29.5448 31.1111 35.7762 32.2134 

050469 ............................................................................. 1.0269 * 28.9080 30.6502 * 29.7684 

050470 ............................................................................. 1.1011 1.1607 24.6755 27.8678 31.0441 28.1043 

050471 ............................................................................. 1.7564 1.1633 34.5211 35.4768 36.9130 35.6374 

050476 ............................................................................. 1.4491 1.3959 34.6585 38.7856 40.0425 37.8312 

050477 ............................................................................. *** * 34.6995 37.7668 40.1536 37.8017 

050478 ............................................................................. 0.9888 1.1607 33.3999 40.2558 41.1616 38.4325 

050481 ............................................................................. 1.4433 1.1633 33.7445 36.1394 38.8656 36.2142 

050485 ............................................................................. 1.6549 1.1633 31.4233 36.1488 34.6206 34.0200 

050488 ............................................................................. 1.3383 1.5308 42.9904 42.6854 44.0641 43.2687 

050491 ............................................................................. *** * 32.1379 34.3598 * 33.1420 

050492 ............................................................................. 1.2507 1.1607 27.1540 28.0826 30.7637 28.6534 

050494 ............................................................................. 1.3609 1.2853 35.9910 38.1177 40.6396 38.1898 

050496 ............................................................................. 1.7129 1.5299 42.2672 48.2468 51.6358 47.5808 

050498 ............................................................................. 1.3359 1.2999 33.0298 37.1667 40.8114 36.9608 

050502 ............................................................................. 1.7107 1.1633 29.5616 28.7046 31.8871 30.0325 

050503 ............................................................................. 1.5082 1.1607 31.6418 34.0994 36.4360 34.1126 

050506 ............................................................................. 1.6141 1.1912 36.0164 37.7420 39.8585 37.9166 

050510 ............................................................................. 1.1758 1.5299 47.5510 52.5376 49.4515 49.9476 

050512 ............................................................................. 1.3824 1.5308 46.9233 50.9264 48.8054 49.0410 

050515 ............................................................................. 1.3440 1.1607 38.9978 38.9542 40.2968 39.4969 

050516 ............................................................................. 1.4933 1.2999 36.2772 39.8161 42.9590 39.7253 

050517 ............................................................................. 1.2446 1.1607 23.9007 20.0213 17.0548 19.9099 

050523 ............................................................................. 1.2609 1.5299 35.5452 40.6535 42.4719 39.5900 

050526 ............................................................................. 1.3227 1.1607 31.3744 28.1997 33.3951 30.8787 

050528 ............................................................................. 1.1384 1.1607 29.6838 31.4941 36.0123 32.5346 

050531 ............................................................................. 1.0428 1.1633 26.9420 27.1974 28.3319 27.4850 

050534 ............................................................................. 1.4831 1.1607 29.8603 33.1666 36.6525 33.1997 

050535 ............................................................................. *** * 32.3723 34.6143 37.8210 35.0693 

050537 ............................................................................. 1.4155 1.2999 31.3844 34.9931 37.4208 34.7283 

050539 ............................................................................. *** * 29.8242 * * 29.8242 

050541 ............................................................................. 1.5613 1.5299 46.1121 52.5908 48.0854 48.9361 

050543 ............................................................................. 0.7511 1.1607 26.1103 29.4443 24.4854 26.5566 

050545 ............................................................................. 0.8423 1.1633 30.5554 31.3080 35.3180 32.3823 

050546 ............................................................................. 0.6608 1.1607 30.2329 33.2245 36.5097 33.2376 

050547 ............................................................................. 0.9307 1.4766 33.2204 34.8401 33.8021 33.9238 

050548 ............................................................................. 0.8110 1.1607 30.3775 39.2234 41.0903 36.6511 

050549 ............................................................................. 1.5395 1.1607 34.9818 35.2792 38.3717 36.2083 

050550 ............................................................................. *** * 30.2301 30.9612 34.9589 31.9521 

050551 ............................................................................. 1.3357 1.1607 31.6165 34.0467 37.2494 34.3696 

050552 ............................................................................. 1.0550 1.1633 27.1744 33.0711 33.9787 31.2577 

050557 ............................................................................. 1.6018 1.1989 31.8048 33.3654 35.3341 33.5504 

050561 ............................................................................. 1.6005 1.1633 38.8652 38.0196 38.2536 38.3442 

050567 ............................................................................. 1.6021 1.1607 32.9829 35.7063 37.6375 35.4787 

050568 ............................................................................. 1.1551 1.1607 24.4061 25.2337 26.0875 25.2903 

050569 ............................................................................. 1.3174 * 33.0259 31.6785 * 32.3431 

050570 ............................................................................. 1.5427 1.1607 34.0171 34.5161 38.5202 35.7251 

050571 ............................................................................. *** * 33.6156 34.7627 39.0735 35.8473 

050573 ............................................................................. 1.6272 1.1607 34.1991 34.7279 35.2835 34.7592 

050575 ............................................................................. 1.2410 1.1633 25.2513 25.1457 23.7972 24.6719 

050577 ............................................................................. *** * 30.8841 32.3744 * 31.6437 

050578 ............................................................................. 1.4930 1.1633 33.8825 35.2390 31.3598 33.5038 

050579 ............................................................................. *** * 39.4976 42.5081 * 40.8657 

050580 ............................................................................. 1.2328 1.1607 31.6256 31.5806 34.1537 32.4723 

050581 ............................................................................. 1.4907 1.1633 32.1801 34.0136 37.7567 34.6700 

050583 ............................................................................. 1.6465 1.1607 33.3697 34.5747 37.4560 35.0083 

050584 ............................................................................. 1.3234 1.1607 24.8180 30.3434 30.7795 28.6016 

050585 ............................................................................. *** * 22.7121 22.2521 29.4264 24.4704 

050586 ............................................................................. 1.2846 1.1607 27.4173 26.4782 31.3482 28.3860 

050588 ............................................................................. 1.3412 1.1633 32.8212 32.7556 37.7367 34.4128 

050589 ............................................................................. 1.1523 1.1607 30.9546 34.5100 37.6873 34.3938 

mmaher on DSK3CLS3C1PROD with $$_JOB

24860 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

050590 ............................................................................. 1.2935 1.2999 32.2142 38.4971 41.6861 37.3399 

050591 ............................................................................. *** * 28.8549 30.6106 34.7108 31.3299 

050592 ............................................................................. *** * 24.4542 27.3606 31.8084 27.4577 

050594 ............................................................................. *** * 34.7946 36.5256 42.0829 37.6368 

050597 ............................................................................. 1.2589 1.1633 27.5691 28.8294 31.5618 29.3957 

050599 ............................................................................. 1.8935 1.2999 38.1975 32.7835 34.7192 35.1753 

050601 ............................................................................. 1.5556 1.1633 34.7409 36.0572 39.7718 36.8583 

050603 ............................................................................. 1.4451 1.1607 30.2464 34.0275 35.0261 33.2299 

050604 ............................................................................. 1.3991 1.5378 49.9428 55.0821 49.4433 51.2946 

050608 ............................................................................. 1.2668 1.1607 23.3630 30.4169 36.3844 29.5731 

050609 ............................................................................. 1.2823 1.1607 41.1797 41.7208 39.7400 40.7274 

050613 ............................................................................. *** * * 42.8108 42.9921 42.8888 

050615 ............................................................................. *** * 33.2909 35.9547 39.0455 36.0526 

050616 ............................................................................. 1.5105 1.1607 36.9017 37.7284 36.7844 37.1319 

050618 ............................................................................. 0.9805 1.1607 27.4539 31.3182 33.1445 30.7673 

050623 ............................................................................. *** * 32.0627 * * 32.0627 

050624 ............................................................................. 1.2791 1.1633 32.2907 33.9594 35.9335 34.1562 

050625 ............................................................................. 1.7399 1.1633 36.3631 38.6591 40.4646 38.5119 

050630 ............................................................................. *** * 30.9410 * * 30.9410 

050633 ............................................................................. 1.2279 1.1912 35.3734 36.8302 38.4914 36.8992 

050636 ............................................................................. 1.2912 1.1607 30.5156 32.5576 32.7924 31.9970 

050641 ............................................................................. 1.2917 1.1633 21.4612 39.6921 32.3562 29.3375 

050644 ............................................................................. 0.9882 1.1633 27.6547 28.8237 30.7956 29.0870 

050660 ............................................................................. 1.7424 * * * * * 

050662 ............................................................................. 0.8701 1.5378 32.6362 33.2446 38.2978 34.3623 

050663 ............................................................................. 1.2772 1.1633 25.7747 27.7334 17.7021 22.5197 

050667 ............................................................................. 0.8494 1.4201 26.3937 24.2771 25.9164 25.5328 

050668 ............................................................................. 1.2080 1.4766 31.8065 56.6555 51.6039 44.4443 

050674 ............................................................................. 1.1203 1.2999 42.6866 48.0893 47.0699 46.1683 

050677 ............................................................................. 1.4565 1.1633 38.7984 38.5770 39.2158 38.8993 

050678 ............................................................................. 1.3172 1.1607 30.7219 32.4473 33.7604 32.3831 

050680 ............................................................................. 1.2341 1.5299 38.3946 38.2871 37.9841 38.2002 

050682 ............................................................................. 0.8469 1.1607 21.7792 17.9077 22.2175 20.5426 

050684 ............................................................................. 1.1147 1.1607 26.4234 27.5256 28.8345 27.6181 

050686 ............................................................................. 1.2077 1.1607 40.9486 41.0188 39.7765 40.4756 

050688 ............................................................................. 1.2025 1.5378 41.9325 44.1510 49.4057 45.3228 

050689 ............................................................................. 1.5246 1.5299 42.2018 45.0951 48.8526 45.3622 

050690 ............................................................................. 0.9979 1.4766 47.2769 50.9094 49.0219 49.1860 

050693 ............................................................................. 1.3853 1.1607 35.0621 34.5797 39.7191 36.4072 

050694 ............................................................................. 1.0504 1.1607 28.9544 30.7858 32.1040 30.6710 

050695 ............................................................................. *** * 35.6548 39.6004 49.0312 41.9280 

050696 ............................................................................. 2.2819 1.1633 35.9220 37.3837 39.9251 37.7376 

050697 ............................................................................. 1.1042 1.2827 25.1984 16.6605 22.1435 20.8109 

050699 ............................................................................. *** * 26.8211 28.9083 21.5729 25.9116 

050701 ............................................................................. 1.3266 1.1607 29.6253 31.9529 34.9885 32.5135 

050704 ............................................................................. 1.0008 1.1633 25.3488 29.7740 31.6053 29.0130 

050707 ............................................................................. 1.2478 1.4906 34.0550 35.7311 43.5546 37.4835 

050708 ............................................................................. 1.5869 1.1607 22.5034 30.5860 31.8452 27.9330 

050709 ............................................................................. 1.4175 1.1607 25.6119 26.8549 24.5600 25.5795 

050710 ............................................................................. 1.4517 1.1607 39.9858 45.8022 44.2474 43.5806 

050713 ............................................................................. *** * 20.2803 21.1273 21.4809 20.8075 

050714 ............................................................................. 1.3837 1.5378 33.6676 31.9527 33.6833 33.1222 

050717 ............................................................................. 1.4243 1.1633 38.0796 39.3227 38.8757 38.7310 

050718 ............................................................................. *** * 21.4996 25.5140 31.9633 26.0532 

050720 ............................................................................. 0.9023 1.1607 30.0811 29.4726 30.3598 29.9464 

050722 ............................................................................. 0.9960 1.1607 * 31.4867 33.8005 32.6977 

050723 ............................................................................. 1.3624 1.1633 35.0119 38.5446 38.7138 37.6299 

050724 ............................................................................. 1.9836 1.1607 34.4267 31.6910 38.4705 34.9427 

050725 ............................................................................. 0.8893 1.1633 21.7816 24.3100 30.0558 25.0162 

050726 ............................................................................. 1.4929 1.1989 27.8433 30.6479 29.2940 29.3768 

050727 ............................................................................. 1.1939 1.1633 24.3026 33.9118 32.7726 30.6197 

mmaher on DSK3CLS3C1PROD with $$_JOB

24861 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

050728 ............................................................................. *** * 36.0820 39.3581 41.8244 38.7029 

050729 ............................................................................. *** * 34.2580 36.5432 38.1758 36.3888 

050730 ............................................................................. *** * 51.5425 37.0629 39.2017 42.2681 

050732 ............................................................................. 2.3945 1.1607 * * 33.6903 33.6903 

050733 ............................................................................. 1.6526 1.2827 * * 40.1993 40.1993 

050734 ............................................................................. *** * * * 31.2860 31.2860 

050735 ............................................................................. 1.3420 1.1633 * * * * 

050736 ............................................................................. 1.2208 1.1633 * * * * 

050737 ............................................................................. 1.4932 1.1633 * * * * 

050738 ............................................................................. 1.3746 1.1633 * * * * 

050739 ............................................................................. 1.6730 1.1633 * * * * 

050740 ............................................................................. 1.3849 1.1633 * * * * 

050741 ............................................................................. 1.4970 1.1633 * * * * 

050742 ............................................................................. 1.3975 1.1633 * * * * 

050744 ............................................................................. 1.9678 1.1613 * * * * 

050745 ............................................................................. 1.3654 1.1613 * * * * 

050746 ............................................................................. 1.7819 1.1613 * * * * 

050747 ............................................................................. 1.3997 1.1613 * * * * 

050748 ............................................................................. 1.0732 1.1870 * * * * 

050749 ............................................................................. 1.2517 1.1607 * * * * 

050750 ............................................................................. 1.4161 1.1989 * * * * 

050751 ............................................................................. 3.2977 1.1633 * * * * 

050752 ............................................................................. 1.4164 1.1633 * * * * 

050753 ............................................................................. 1.7096 1.1633 * * * * 

050754 ............................................................................. 1.3352 1.4906 * * * * 

050755 ............................................................................. 1.4093 1.1633 * * * * 

050756 ............................................................................. 1.9522 1.1612 * * * * 

060001 ............................................................................. 1.5646 1.0490 26.8470 29.6191 30.9980 29.1621 

060003 ............................................................................. 1.3969 1.0490 24.2224 29.4809 31.3617 28.3333 

060004 ............................................................................. 1.2516 1.0490 29.9649 32.4609 32.0087 31.4835 

060006 ............................................................................. 1.3325 0.9451 24.5704 25.2139 27.2049 25.6626 

060008 ............................................................................. 1.2017 0.9451 23.3859 23.0947 26.5156 24.3263 

060009 ............................................................................. 1.4938 1.0490 28.7645 31.5210 32.4188 30.9671 

060010 ............................................................................. 1.6914 0.9664 28.9850 27.1916 29.5311 28.5346 

060011 ............................................................................. 1.6393 1.0490 27.2833 35.1573 32.0985 31.3626 

060012 ............................................................................. 1.4822 0.9451 26.2469 27.3885 28.7720 27.4499 

060013 ............................................................................. 1.5070 0.9451 24.5994 26.8675 27.9147 26.4239 

060014 ............................................................................. 1.8624 1.0490 31.2588 31.0542 31.9644 31.4172 

060015 ............................................................................. 1.7856 1.0490 30.4533 32.5285 32.2927 31.6808 

060016 ............................................................................. 1.2375 0.9451 25.6527 26.5427 27.2625 26.4975 

060018 ............................................................................. 1.2860 0.9451 25.7628 24.1086 25.3951 25.0897 

060020 ............................................................................. 1.6180 0.9451 22.6748 24.5992 25.9131 24.3728 

060022 ............................................................................. 1.6508 0.9471 26.5238 28.2944 29.3376 28.0338 

060023 ............................................................................. 1.6737 1.0490 27.7644 29.5760 31.1545 29.4765 

060024 ............................................................................. 1.8352 1.0490 29.0130 30.0279 32.1201 30.4150 

060027 ............................................................................. 1.6708 1.0490 28.0909 29.6121 30.9359 29.6320 

060028 ............................................................................. 1.5172 1.0490 30.0448 31.6900 32.1646 31.3043 

060030 ............................................................................. 1.4469 0.9664 26.6251 27.8642 29.9492 28.1539 

060031 ............................................................................. 1.5587 0.9471 26.3650 27.8345 29.3903 27.8461 

060032 ............................................................................. 1.4866 1.0490 30.4247 31.0686 32.7381 31.4187 

060034 ............................................................................. 1.6603 1.0490 29.8445 30.9359 32.1087 30.9310 

060036 ............................................................................. 1.1013 0.9451 20.7131 20.3226 22.8253 21.2501 

060041 ............................................................................. 0.8769 0.9451 23.4978 24.6142 25.9681 24.7293 

060043 ............................................................................. 1.1879 0.9451 18.7897 18.2143 21.9824 19.6548 

060044 ............................................................................. 1.2127 0.9451 25.0360 26.5611 24.8343 25.4577 

060049 ............................................................................. 1.2785 0.9577 29.0598 29.3724 29.9878 29.4858 

060054 ............................................................................. 1.4507 1.0141 22.3490 24.3389 25.0987 23.9190 

060064 ............................................................................. 1.7291 1.0490 31.3105 32.3681 33.2430 32.1358 

060065 ............................................................................. 1.3997 1.0490 31.1987 32.4735 33.8541 32.5474 

060071 ............................................................................. 1.1696 0.9451 25.7248 27.6657 28.1744 27.2773 

060075 ............................................................................. 1.3332 1.0141 32.7563 32.2545 37.6040 34.1974 

mmaher on DSK3CLS3C1PROD with $$_JOB

24862 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

060076 ............................................................................. 1.2672 0.9451 26.8236 26.5631 30.7794 28.0379 

060096 ............................................................................. 1.5553 1.0490 30.0602 32.1310 37.8250 33.2700 

060100 ............................................................................. 1.6877 1.0490 32.1537 32.6104 33.2259 32.6698 

060103 ............................................................................. 1.3574 1.0490 30.3003 31.6314 32.9699 31.6641 

060104 ............................................................................. 1.3822 1.0490 32.0889 32.4232 35.4406 33.2463 

060107 ............................................................................. 1.4409 1.0490 26.1883 26.8388 28.0661 27.0406 

060112 ............................................................................. 1.6546 1.0490 * 34.9272 34.6910 34.8011 

060113 ............................................................................. 1.4263 1.0490 * * 32.6081 32.6081 

060114 ............................................................................. 1.3802 1.0490 * * 34.8551 34.8551 

060115 ............................................................................. 0.8095 0.9451 * * * * 

060116 ............................................................................. 1.4116 1.0490 * * * * 

060117 ............................................................................. 1.5193 0.9451 * * * * 

060118 ............................................................................. 1.1985 0.9451 * * * * 

070001 ............................................................................. 1.6168 1.2565 34.0302 35.8958 37.0362 35.6784 

070002 ............................................................................. 1.7626 1.2439 31.1530 33.4398 34.7608 33.1047 

070003 ............................................................................. 1.1121 1.2439 32.4197 34.1352 34.1274 33.5632 

070004 ............................................................................. 1.1692 1.2439 29.2544 29.4448 29.9492 29.5629 

070005 ............................................................................. 1.3946 1.2565 32.1668 33.7813 34.9377 33.6339 

070006 ............................................................................. 1.3747 1.2993 36.8469 37.9148 39.3915 38.0389 

070007 ............................................................................. 1.3254 1.2439 31.7125 35.9617 36.6407 34.7798 

070008 ............................................................................. 1.1970 1.2439 26.4806 28.5506 29.6687 28.2382 

070009 ............................................................................. 1.1839 1.2439 30.2706 32.9299 35.2475 32.8064 

070010 ............................................................................. 1.7654 1.2993 32.5798 35.3730 36.6948 34.9639 

070011 ............................................................................. 1.4451 1.2439 29.9105 31.8987 31.2283 31.0248 

070012 ............................................................................. 1.2709 1.2439 44.1424 29.4216 31.9349 33.9311 

070015 ............................................................................. 1.3970 1.2993 33.4595 35.3385 36.6708 35.2092 

070016 ............................................................................. 1.4996 1.2565 31.0904 31.4930 33.2371 31.9049 

070017 ............................................................................. 1.3568 1.2565 31.7223 34.0490 35.6418 33.8503 

070018 ............................................................................. 1.4233 1.2993 37.6081 39.7515 41.9173 39.8452 

070019 ............................................................................. 1.3270 1.2565 31.8148 34.5125 33.7229 33.3664 

070020 ............................................................................. 1.3297 1.2439 31.0935 33.6453 33.6696 32.8254 

070021 ............................................................................. 1.1568 1.2439 33.2357 36.9241 38.5585 36.2050 

070022 ............................................................................. 1.6749 1.2565 35.4120 39.0462 40.2702 38.3013 

070024 ............................................................................. 1.3613 1.2439 32.0430 35.2323 34.7400 34.0483 

070025 ............................................................................. 1.8064 1.2439 30.9938 32.4085 34.5858 32.6659 

070027 ............................................................................. 1.4451 1.2439 31.8018 29.8513 30.4430 30.7111 

070028 ............................................................................. 1.5984 1.2993 31.5035 35.1966 38.0833 34.9177 

070029 ............................................................................. 1.3083 1.2439 27.7213 30.9299 31.0636 29.9122 

070031 ............................................................................. 1.2711 1.2565 28.9189 30.1915 30.4044 29.8550 

070033 ............................................................................. 1.4708 1.2993 37.1929 40.1594 43.7004 40.4535 

070034 ............................................................................. 1.3980 1.2993 36.3899 38.3965 39.3798 38.0564 

070035 ............................................................................. 1.2872 1.2439 27.5585 30.7440 31.1401 29.7921 

070036 ............................................................................. 1.6067 1.2439 36.1610 38.3413 42.3416 39.0119 

070038 ............................................................................. 1.3936 1.2565 25.7516 25.7914 35.8029 27.8679 

070039 ............................................................................. 0.9377 1.2565 31.2269 36.1369 34.7131 33.8173 

070040 ............................................................................. 0.9996 1.2439 * * * * 

080001 ............................................................................. 1.6239 1.0778 30.0242 32.0105 33.5308 31.8695 

080002 ............................................................................. *** * 27.7932 29.6800 30.4575 29.3051 

080003 ............................................................................. 1.5693 1.0778 29.2266 30.7697 34.2596 31.4914 

080004 ............................................................................. 1.5151 1.0752 27.4921 30.1094 32.2239 29.9990 

080006 ............................................................................. 1.3057 1.0023 25.6160 27.4749 28.8828 27.4029 

080007 ............................................................................. 1.3920 1.0358 27.0074 30.1100 31.1628 29.4879 

090001 ............................................................................. 1.7712 1.0679 35.0413 36.6577 38.1321 36.5957 

090003 ............................................................................. 1.2511 1.0679 29.2660 31.0419 32.1944 30.9271 

090004 ............................................................................. 1.9599 1.0679 32.2021 35.6964 37.3772 35.0391 

090005 ............................................................................. 1.3874 1.0679 30.7728 33.0178 33.7415 32.5062 

090006 ............................................................................. 1.4067 1.0679 29.5590 29.4912 31.3551 30.1261 

090008 ............................................................................. 1.3393 1.0679 29.1059 32.0745 33.7464 31.3882 

090011 ............................................................................. 2.0566 1.0990 34.0693 36.7579 37.7551 36.1901 

100001 ............................................................................. 1.5278 0.9129 24.4060 26.4631 27.2801 26.0725 

100002 ............................................................................. 1.4353 1.0245 25.3389 27.2350 28.7046 27.1080 

mmaher on DSK3CLS3C1PROD with $$_JOB

24863 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

100004 ............................................................................. 0.9210 * 16.5974 * * 16.5974 

100006 ............................................................................. 1.6439 0.9383 26.3789 29.1505 29.0886 28.2008 

100007 ............................................................................. 1.6370 0.9383 26.5378 28.5702 29.1608 28.1327 

100008 ............................................................................. 1.7232 1.0023 27.4314 29.1705 30.3372 29.0485 

100009 ............................................................................. 1.4531 1.0023 25.9381 27.4424 27.8595 27.0413 

100012 ............................................................................. 1.6158 0.9490 26.3788 28.4600 29.8330 28.2805 

100014 ............................................................................. 1.4087 0.9245 24.5862 25.1524 27.4005 25.7596 

100015 ............................................................................. 1.3031 0.9174 24.6038 26.0916 27.2172 25.9252 

100017 ............................................................................. 1.6269 0.9245 26.1580 27.9654 28.2380 27.5012 

100018 ............................................................................. 1.6499 0.9756 28.1481 30.2423 30.6513 29.7097 

100019 ............................................................................. 1.6615 0.9385 27.6179 28.6630 30.2983 28.8662 

100020 ............................................................................. *** * 23.9414 27.1257 * 25.5458 

100022 ............................................................................. 1.7406 1.0245 29.9345 32.8088 36.7902 33.2230 

100023 ............................................................................. 1.5155 0.9245 23.0074 25.2652 25.4238 24.5727 

100024 ............................................................................. 1.1735 1.0023 30.2395 29.1894 29.5413 29.6467 

100025 ............................................................................. 1.6820 0.8749 22.1580 23.3843 26.7005 24.0623 

100026 ............................................................................. 1.5785 0.8749 21.4703 23.4730 25.3313 23.5015 

100027 ............................................................................. *** * 16.1223 18.9432 * 17.4007 

100028 ............................................................................. 1.3559 0.9385 26.8661 27.7497 27.5647 27.4069 

100029 ............................................................................. 1.2842 1.0023 27.5844 28.8842 30.5354 29.0520 

100030 ............................................................................. 1.2822 0.9383 24.0943 24.6314 25.3501 24.7166 

100032 ............................................................................. 1.8033 0.9174 25.2450 26.8162 26.9247 26.3589 

100034 ............................................................................. 1.8267 1.0023 25.9415 28.1280 27.2895 27.0668 

100035 ............................................................................. 1.5643 0.9758 26.9407 29.4803 29.9645 28.7904 

100038 ............................................................................. 1.8187 1.0245 29.8583 31.3403 31.6634 30.9762 

100039 ............................................................................. 1.5150 1.0245 28.4627 28.2531 29.3708 28.6925 

100040 ............................................................................. 1.7018 0.9129 23.6443 26.2429 27.2813 25.7448 

100043 ............................................................................. 1.3790 0.9174 25.2273 26.4221 27.0030 26.2279 

100044 ............................................................................. 1.4158 0.9990 28.3596 30.3659 33.1112 30.6144 

100045 ............................................................................. 1.3355 0.9245 26.9641 29.7375 26.5408 27.7585 

100046 ............................................................................. 1.3033 0.9174 26.3673 26.9469 26.7694 26.6960 

100047 ............................................................................. 1.8638 0.9758 25.0404 26.7674 29.9682 27.2642 

100048 ............................................................................. 0.9252 0.8749 18.8770 19.3226 20.2658 19.5008 

100049 ............................................................................. 1.1600 0.8839 22.9809 24.0385 24.5536 23.8777 

100050 ............................................................................. 1.1288 1.0023 19.8713 21.5101 25.3238 22.2723 

100051 ............................................................................. 1.3534 0.9383 23.1940 28.0946 28.7737 26.7720 

100052 ............................................................................. 1.4455 0.8839 22.3920 23.6796 23.4019 23.1671 

100053 ............................................................................. 1.2920 1.0023 27.3224 28.5118 31.7384 29.1111 

100054 ............................................................................. 1.3034 0.8749 28.0512 28.7646 30.5206 29.0875 

100055 ............................................................................. 1.4156 0.9174 23.5332 25.6243 27.3802 25.3794 

100057 ............................................................................. 1.4516 0.9383 25.3897 24.8010 26.3122 25.5302 

100061 ............................................................................. 1.5414 1.0023 29.2565 31.4413 30.4499 30.3963 

100062 ............................................................................. 1.6808 0.8749 25.2340 25.1280 25.9585 25.4595 

100063 ............................................................................. 1.3036 0.9174 24.7026 25.5097 26.4124 25.5740 

100067 ............................................................................. 1.4074 0.9174 26.1213 26.8628 27.4739 26.8557 

100068 ............................................................................. 1.6613 0.9245 25.9202 26.1341 27.6575 26.5514 

100069 ............................................................................. 1.4508 0.9174 24.7442 25.7450 27.2096 25.8883 

100070 ............................................................................. 1.7116 0.9758 24.8883 26.8461 29.1991 26.9663 

100071 ............................................................................. 1.2756 0.9174 24.9682 26.3768 25.3651 25.5845 

100072 ............................................................................. 1.3879 0.9245 26.0459 25.7962 27.1887 26.3539 

100073 ............................................................................. 1.7697 1.0245 30.3358 30.5845 28.7281 29.8848 

100075 ............................................................................. 1.4457 0.9174 25.1691 25.7612 27.6513 26.2369 

100076 ............................................................................. 1.1677 1.0023 21.9483 23.4551 24.0435 23.1100 

100077 ............................................................................. 1.3560 0.9758 26.0347 30.6925 30.7522 29.1481 

100079 ............................................................................. 1.4994 * * * * * 

100080 ............................................................................. 1.7074 1.0245 27.0126 28.2188 29.5332 28.2762 

100081 ............................................................................. 0.9413 0.8749 15.6661 16.9756 19.5662 17.4288 

100084 ............................................................................. 1.7880 0.9383 26.3393 27.4947 32.7477 28.7729 

100086 ............................................................................. 1.2961 1.0245 28.2641 28.5971 29.9082 28.9237 

100087 ............................................................................. 1.8973 0.9758 27.1531 29.5823 30.5733 29.1231 

100088 ............................................................................. 1.5785 0.9129 25.9182 26.7574 28.0793 26.9516 

mmaher on DSK3CLS3C1PROD with $$_JOB

24864 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

100090 ............................................................................. 1.4902 0.9129 24.2422 26.5703 27.6128 26.1872 

100092 ............................................................................. 1.5151 0.9385 28.4789 27.8341 26.6301 27.6308 

100093 ............................................................................. 1.7136 0.8749 21.3524 21.6438 22.5555 21.8792 

100099 ............................................................................. 1.0877 0.8839 21.3035 25.8454 26.2362 24.4514 

100102 ............................................................................. 1.0972 0.8749 23.8596 26.1015 27.9371 25.9898 

100105 ............................................................................. 1.4481 0.9990 26.8091 29.9745 30.9880 29.1998 

100106 ............................................................................. 1.0557 0.8749 24.0389 24.7650 24.8062 24.5422 

100107 ............................................................................. 1.2356 0.9490 26.1337 27.4760 30.5712 28.1061 

100108 ............................................................................. 0.8045 0.8749 22.0750 21.3540 22.6250 21.9874 

100109 ............................................................................. 1.2501 0.9245 24.9951 25.5669 26.2294 25.6245 

100110 ............................................................................. 1.6562 0.9383 29.1494 29.4788 29.5964 29.4181 

100113 ............................................................................. 2.0208 0.9306 26.3806 28.0440 29.2410 27.9265 

100114 ............................................................................. 1.3823 1.0023 29.2195 29.2862 30.2549 29.5960 

100117 ............................................................................. 1.2128 0.9129 26.4536 27.7198 28.5709 27.6304 

100118 ............................................................................. 1.3599 0.9129 28.0569 27.6438 27.0971 27.5184 

100121 ............................................................................. 1.1040 0.8839 24.8579 26.2990 27.9335 26.4257 

100122 ............................................................................. 1.2270 0.8749 23.4751 24.6285 26.7143 24.9527 

100124 ............................................................................. 1.1549 0.8749 22.7023 24.0333 24.8875 23.9085 

100125 ............................................................................. 1.1784 1.0023 26.7452 29.7750 31.7723 29.5535 

100126 ............................................................................. 1.3316 0.9174 24.4515 29.6247 28.3189 27.4135 

100127 ............................................................................. 1.5660 0.9174 24.4485 26.0923 27.4608 26.0307 

100128 ............................................................................. 2.2062 0.9174 29.4979 29.2566 30.0299 29.6024 

100130 ............................................................................. 1.1799 1.0245 24.2046 26.0268 28.3616 26.1493 

100131 ............................................................................. 1.4156 1.0023 29.2462 27.8164 29.7632 28.9648 

100132 ............................................................................. 1.2458 0.9174 24.3293 26.0526 27.2007 25.9267 

100134 ............................................................................. 0.8562 0.9129 20.9243 20.7367 21.6532 21.1182 

100135 ............................................................................. 1.6098 0.9032 24.0024 26.7030 29.1837 26.5344 

100137 ............................................................................. 1.2884 0.8839 25.1974 24.8519 26.8344 25.6687 

100139 ............................................................................. 0.8318 0.9306 17.5489 18.2197 21.1258 18.9546 

100140 ............................................................................. 1.0846 0.9129 26.4720 26.1352 27.8649 26.8242 

100142 ............................................................................. 1.2099 0.8749 22.9577 24.8853 25.5354 24.4855 

100150 ............................................................................. 1.2678 1.0023 26.1990 26.8492 27.7741 26.9186 

100151 ............................................................................. 1.7467 0.9129 28.1322 30.6447 30.6281 29.7879 

100154 ............................................................................. 1.5748 1.0023 27.6127 28.2506 29.7317 28.5810 

100156 ............................................................................. 1.1336 0.9306 26.7092 27.5706 28.3909 27.6104 

100157 ............................................................................. 1.5752 0.9174 27.3851 29.7455 30.3052 29.2294 

100160 ............................................................................. 1.1392 0.8749 26.9851 30.7454 30.6896 29.5443 

100161 ............................................................................. 1.5169 0.9383 28.8077 28.0545 29.5663 28.8152 

100166 ............................................................................. 1.4668 0.9758 27.9618 28.8685 30.1807 28.9923 

100167 ............................................................................. 1.3035 1.0245 30.3694 30.2166 31.7804 30.8185 

100168 ............................................................................. 1.4079 1.0245 27.1292 27.6739 27.0923 27.2992 

100172 ............................................................................. 1.2812 1.0023 18.2735 20.7857 22.2204 20.2640 

100173 ............................................................................. 1.6813 0.9174 24.8721 26.5436 28.6368 26.6618 

100175 ............................................................................. 0.9372 0.8749 23.5455 23.9665 25.0985 24.2176 

100176 ............................................................................. 1.9303 1.0245 31.2694 30.7087 33.3165 31.7296 

100177 ............................................................................. 1.3039 0.9385 26.6781 28.0089 29.6265 28.1065 

100179 ............................................................................. 1.8024 0.9129 29.5619 29.1111 29.0431 29.2333 

100180 ............................................................................. 1.3657 0.9174 27.1804 29.9238 31.0064 29.4502 

100181 ............................................................................. 1.0909 1.0023 21.8540 24.3708 23.9591 23.5687 

100183 ............................................................................. 1.2321 1.0023 27.4951 29.0270 30.5104 28.9871 

100187 ............................................................................. 1.2376 1.0023 27.3653 27.8144 30.7495 28.5855 

100189 ............................................................................. 1.3212 1.0245 28.4136 28.8320 29.9369 29.0845 

100191 ............................................................................. 1.3259 0.9174 26.6341 28.3710 29.4499 28.2023 

100200 ............................................................................. 1.3580 1.0245 29.8963 28.7694 29.6406 29.4299 

100204 ............................................................................. 1.5566 0.9306 25.7537 27.4763 27.2798 26.8486 

100206 ............................................................................. 1.3050 0.9174 25.2196 27.0295 27.7525 26.6834 

100209 ............................................................................. 1.4522 1.0023 26.6245 26.8473 28.5311 27.3559 

100210 ............................................................................. 1.6430 1.0245 28.9486 29.8515 32.0804 30.2950 

100211 ............................................................................. 1.2007 0.9174 24.7095 24.7533 26.2817 25.2452 

100212 ............................................................................. 1.5281 0.8749 24.7566 26.1846 27.7936 26.2582 

100213 ............................................................................. 1.5668 0.9758 27.1936 27.9283 29.5190 28.1989 

mmaher on DSK3CLS3C1PROD with $$_JOB

24865 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

100217 ............................................................................. 1.2132 0.9990 25.2907 27.3989 27.7642 26.8865 

100220 ............................................................................. 1.7260 0.9490 26.0905 28.3868 29.3570 28.0175 

100223 ............................................................................. 1.5835 0.8749 24.7015 25.0332 26.1109 25.3046 

100224 ............................................................................. 1.2839 1.0245 24.8077 26.6446 28.0429 26.4939 

100225 ............................................................................. 1.2937 1.0245 28.4316 28.5259 30.8876 29.2153 

100226 ............................................................................. 1.2744 0.9129 29.3317 28.8165 29.7725 29.3198 

100228 ............................................................................. 1.3709 1.0245 29.8952 28.1396 30.1621 29.3737 

100230 ............................................................................. 1.3733 1.0245 28.1703 29.8493 31.9424 29.9630 

100231 ............................................................................. 1.7080 0.8749 25.5175 25.7037 26.6772 25.9675 

100232 ............................................................................. 1.2524 0.9306 24.9322 28.5537 28.3856 27.3012 

100234 ............................................................................. 1.2976 1.0245 26.3601 27.4456 28.8835 27.5798 

100236 ............................................................................. 1.4832 0.9758 26.6585 28.9955 28.2984 27.9868 

100237 ............................................................................. 1.9057 1.0245 31.3543 31.7848 33.1739 32.0770 

100238 ............................................................................. 1.6522 0.9174 28.4302 30.1094 31.4171 30.0491 

100239 ............................................................................. 1.2460 0.9758 27.7592 28.6893 29.7638 28.7444 

100240 ............................................................................. 1.0076 1.0023 25.3265 27.3523 29.6971 27.5087 

100242 ............................................................................. 1.4479 0.8749 24.0990 25.6083 26.1976 25.3020 

100243 ............................................................................. 1.5946 0.9174 26.1131 27.4534 28.3866 27.3439 

100244 ............................................................................. 1.4203 0.9490 25.2584 26.6876 28.2865 26.8118 

100246 ............................................................................. 1.5758 0.9990 28.9894 29.3310 30.1050 29.4942 

100248 ............................................................................. 1.5253 0.9174 27.7798 28.8082 30.2111 28.9505 

100249 ............................................................................. 1.2737 0.9174 23.2084 24.9876 26.4639 24.9121 

100252 ............................................................................. 1.1792 0.9482 25.8540 27.8256 27.1607 26.9474 

100253 ............................................................................. 1.3715 1.0245 25.7121 27.4927 28.7770 27.3720 

100254 ............................................................................. 1.5090 0.9032 25.7338 26.1406 27.4880 26.4891 

100255 ............................................................................. 1.2936 0.9174 24.4808 26.5571 27.3842 26.1577 

100256 ............................................................................. 1.8521 0.9174 28.8856 30.3081 30.2061 29.8124 

100258 ............................................................................. 1.5130 1.0245 31.2482 31.2203 33.8699 32.1188 

100259 ............................................................................. 1.2828 0.9174 26.0175 27.4809 29.0586 27.5346 

100260 ............................................................................. 1.3245 0.9990 27.5188 26.7129 27.5087 27.2404 

100264 ............................................................................. 1.3422 0.9174 25.5489 26.8216 28.0330 26.7861 

100265 ............................................................................. 1.2694 0.9174 24.1454 25.7432 26.3305 25.4668 

100266 ............................................................................. 1.4188 0.8749 23.2340 23.0208 24.2518 23.5319 

100267 ............................................................................. 1.3150 0.9758 27.3769 28.7259 28.9660 28.3534 

100268 ............................................................................. 1.1556 1.0245 29.2898 29.0668 30.5747 29.6377 

100269 ............................................................................. 1.3559 1.0245 26.7450 26.6047 27.8403 27.0868 

100271 ............................................................................. 2.3619 * * * * * 

100275 ............................................................................. 1.2874 1.0245 26.0361 26.8943 28.6334 27.2552 

100276 ............................................................................. 1.2400 1.0245 30.0576 29.7606 30.5728 30.1330 

100277 ............................................................................. 1.4125 1.0023 16.5427 20.4791 30.6239 22.8795 

100279 ............................................................................. 1.3368 0.9490 26.8606 28.6383 29.2235 28.2854 

100281 ............................................................................. 1.3697 1.0245 28.6660 29.6698 30.9112 29.8011 

100284 ............................................................................. 1.0112 1.0023 23.8170 22.3134 25.2610 23.6819 

100285 ............................................................................. 1.2699 1.0245 * * 41.9448 41.9448 

100286 ............................................................................. 1.6117 0.9756 29.4284 28.3645 27.9816 28.5432 

100287 ............................................................................. 1.3865 1.0245 28.3427 28.1051 29.7774 28.7085 

100288 ............................................................................. 1.5054 1.0245 33.8141 28.7902 31.2667 31.1545 

100289 ............................................................................. 1.6862 1.0245 29.2915 29.6376 31.8991 30.3057 

100290 ............................................................................. 1.1911 0.9139 23.5080 27.1011 29.0093 26.4993 

100291 ............................................................................. 1.2462 0.9385 * 28.4722 28.1498 28.2965 

100292 ............................................................................. 1.3546 0.8749 * 26.7063 27.7643 27.2417 

100293 ............................................................................. *** * * 32.7963 * 32.7963 

100294 ............................................................................. *** * * 30.7557 * 30.7557 

100295 ............................................................................. *** * * 26.1983 * 26.1983 

100296 ............................................................................. 1.3420 1.0023 * * 29.3841 29.3841 

100297 ............................................................................. *** * * * 32.1504 32.1504 

100298 ............................................................................. 0.8097 0.9032 * * 19.0284 19.0284 

100299 ............................................................................. 1.2650 0.9758 * * 34.3125 34.3125 

100300 ............................................................................. 1.5491 0.9758 * * * * 

100301 ............................................................................. 2.4311 0.8749 * * * * 

100302 ............................................................................. 1.1202 0.9383 * * * * 

mmaher on DSK3CLS3C1PROD with $$_JOB

24866 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

110001 ............................................................................. 1.3403 0.8587 25.3102 26.4338 26.5634 26.1061 

110002 ............................................................................. 1.3617 0.9845 25.3897 26.4715 26.2215 26.0373 

110003 ............................................................................. 1.2936 0.7864 21.4002 22.7066 24.2076 22.7653 

110004 ............................................................................. 1.3585 0.8967 23.9911 24.9978 25.1820 24.7375 

110005 ............................................................................. 1.2330 0.9845 22.8999 28.1209 27.2810 26.2179 

110006 ............................................................................. 1.5291 1.0543 28.6090 28.3839 * 28.4953 

110007 ............................................................................. 1.5859 0.8671 23.8729 26.6396 26.3115 25.6309 

110008 ............................................................................. 1.3085 0.9845 27.1711 29.2947 30.9741 29.1802 

110010 ............................................................................. 2.2306 0.9845 29.7142 31.7185 33.2379 31.5593 

110011 ............................................................................. 1.2246 0.9845 26.0899 28.0598 28.5710 27.5776 

110015 ............................................................................. 1.0603 0.9845 26.6610 28.1274 28.8247 27.9582 

110016 ............................................................................. 1.2635 0.8594 21.7610 22.7263 24.3540 22.9370 

110018 ............................................................................. 1.1624 0.9845 28.2431 26.8016 30.1831 28.3506 

110020 ............................................................................. 1.3217 0.9845 26.8501 28.3822 27.5540 27.6137 

110023 ............................................................................. 1.2996 0.9845 27.3029 29.8061 29.4091 28.8898 

110024 ............................................................................. 1.4914 0.8987 25.7205 27.0225 27.9321 26.8777 

110025 ............................................................................. 1.4742 0.9768 26.1311 31.0703 30.2808 29.1365 

110026 ............................................................................. 1.1095 0.7864 21.2827 21.8018 22.8797 21.9817 

110027 ............................................................................. 1.0927 0.7864 20.2175 22.6058 25.5227 22.6306 

110028 ............................................................................. 1.7897 0.9600 28.1619 30.4641 31.4549 30.0483 

110029 ............................................................................. 1.8272 0.9845 24.8893 27.3618 29.2101 27.2811 

110030 ............................................................................. 1.3175 0.9845 26.4770 29.6841 29.9483 28.7919 

110031 ............................................................................. 1.2896 0.9845 24.7874 27.1989 29.5494 27.2201 

110032 ............................................................................. 1.1833 0.7864 21.9407 23.2586 25.1864 23.4269 

110033 ............................................................................. 1.4729 0.9845 28.3210 30.3415 32.4147 30.4690 

110034 ............................................................................. 1.7212 0.9600 26.9986 27.2338 28.7910 27.6793 

110035 ............................................................................. 1.7465 0.9845 27.4583 28.9408 30.1817 28.9116 

110036 ............................................................................. 1.8415 0.8987 26.8789 26.6664 27.4572 27.0225 

110038 ............................................................................. 1.5058 0.8458 21.2138 22.2720 22.9667 22.1527 

110039 ............................................................................. 1.3686 0.9600 24.7248 26.3503 26.2463 25.8073 

110040 ............................................................................. 1.0915 0.9845 19.7509 20.9487 23.9465 21.5965 

110041 ............................................................................. 1.2635 0.9845 23.4073 24.8864 26.1928 24.8269 

110042 ............................................................................. 1.0549 0.9845 28.6873 34.9954 33.4345 32.3594 

110043 ............................................................................. 1.7583 0.8987 26.6323 27.8477 28.8534 27.7746 

110044 ............................................................................. 1.1546 0.7864 20.9654 23.3039 24.3743 22.8665 

110045 ............................................................................. 1.0610 0.9845 24.9821 24.4275 27.7578 25.7221 

110046 ............................................................................. 1.1568 0.9845 23.8292 26.7464 * 25.2689 

110050 ............................................................................. 1.0878 0.8587 26.1319 27.5985 27.0646 26.9504 

110051 ............................................................................. 1.1326 0.7864 19.4276 20.1756 21.4871 20.4304 

110054 ............................................................................. 1.3876 0.9845 25.7085 28.9254 29.4622 28.1271 

110059 ............................................................................. 1.1627 0.7864 20.5565 23.2137 24.7765 22.7757 

110064 ............................................................................. 1.5562 0.9023 24.2739 24.1219 26.9345 25.1478 

110069 ............................................................................. 1.3180 0.9571 24.1669 26.2085 29.9100 26.8648 

110071 ............................................................................. 1.1303 0.7864 18.0224 21.3963 21.1989 20.2203 

110073 ............................................................................. 1.0754 0.7864 18.6336 18.5753 22.2470 19.7421 

110074 ............................................................................. 1.5617 1.0543 27.1207 27.9190 32.6801 29.0878 

110075 ............................................................................. 1.2369 0.8987 22.0935 23.7585 24.8206 23.5710 

110076 ............................................................................. 1.4782 0.9845 26.3506 28.7871 29.4324 28.2022 

110078 ............................................................................. 2.0225 0.9845 29.5779 29.9625 30.5184 30.0314 

110079 ............................................................................. 1.4284 0.9845 23.1024 26.8412 28.0337 25.8338 

110080 ............................................................................. *** * 22.3213 18.4714 * 20.3904 

110082 ............................................................................. 1.9490 0.9845 29.8366 30.8320 30.1059 30.2637 

110083 ............................................................................. 1.8986 0.9845 27.8245 30.4287 34.0590 30.7532 

110086 ............................................................................. 1.2924 0.7864 21.1508 21.6898 22.9935 21.9527 

110087 ............................................................................. 1.4777 0.9845 28.0471 28.1633 31.0389 29.1236 

110089 ............................................................................. 1.1256 0.7864 21.9509 23.9026 24.3270 23.4297 

110091 ............................................................................. 1.2981 0.9845 26.5523 29.5337 27.0969 27.7297 

110092 ............................................................................. 1.0712 0.7864 18.5527 20.8911 21.4146 20.2698 

110095 ............................................................................. 1.4672 0.8671 23.4846 26.3075 28.0497 25.9749 

110100 ............................................................................. 0.9766 0.8653 16.5600 16.2575 20.8152 17.8654 

110101 ............................................................................. 1.0211 0.7931 16.4269 19.4257 23.2580 19.5226 

mmaher on DSK3CLS3C1PROD with $$_JOB

24867 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

110104 ............................................................................. 1.0874 0.7864 18.7951 20.3777 21.8924 20.4307 

110105 ............................................................................. 1.3393 0.7864 21.1077 23.1405 23.3989 22.5523 

110107 ............................................................................. 1.9642 0.9753 26.2526 28.9352 30.0994 28.5415 

110109 ............................................................................. 1.0213 0.7864 21.4279 23.0376 21.5988 22.0288 

110111 ............................................................................. 1.1558 0.9600 29.2189 25.1270 25.6830 26.4544 

110112 ............................................................................. 0.9103 0.7864 24.2464 22.7672 26.4049 24.5402 

110113 ............................................................................. 0.9648 0.9600 19.1752 21.3417 21.9483 20.8449 

110115 ............................................................................. 1.6873 0.9845 32.0198 31.5074 32.7917 32.1142 

110121 ............................................................................. 1.0432 0.8458 21.6637 26.2336 23.4538 23.8292 

110122 ............................................................................. 1.5380 0.8458 23.7589 25.1934 25.4416 24.7892 

110124 ............................................................................. 1.0505 0.7864 22.7058 22.9212 22.9564 22.8635 

110125 ............................................................................. 1.2986 0.9571 22.4238 23.7834 24.7325 23.6383 

110128 ............................................................................. 1.2616 0.8987 24.4596 25.7839 25.4173 25.2192 

110129 ............................................................................. 1.5741 0.9023 23.3631 25.9625 30.0382 26.3966 

110130 ............................................................................. 0.9401 0.7864 18.7549 19.1284 20.4320 19.4659 

110132 ............................................................................. 0.9896 0.7864 19.2307 20.2502 21.2623 20.2550 

110135 ............................................................................. 1.2755 0.7864 20.4412 22.5346 23.7098 22.3469 

110136 ............................................................................. *** * 15.8573 18.8212 * 17.2827 

110142 ............................................................................. 0.9496 0.8066 18.1980 21.3935 21.6229 20.4888 

110143 ............................................................................. 1.4028 0.9845 27.7055 28.6583 29.9107 28.7952 

110146 ............................................................................. 1.0440 0.9129 23.9067 27.0987 29.0166 26.6342 

110149 ............................................................................. *** * 27.1477 28.4040 * 27.8380 

110150 ............................................................................. 1.3057 0.9845 22.6624 25.3742 26.9867 24.9549 

110153 ............................................................................. 1.1345 0.9571 24.5368 25.7467 29.3255 26.5464 

110161 ............................................................................. 1.5056 0.9845 29.3201 30.4885 31.4996 30.4387 

110163 ............................................................................. 1.4445 0.8671 26.0764 28.2169 27.7657 27.3535 

110164 ............................................................................. 1.6473 0.9753 27.0600 28.8946 29.9927 28.6570 

110165 ............................................................................. 1.3818 0.9845 26.8378 27.0977 28.7885 27.5696 

110166 ............................................................................. *** * 26.8070 * * 26.8070 

110168 ............................................................................. 1.8211 0.9845 27.0022 28.5700 29.7626 28.4639 

110172 ............................................................................. 1.3224 0.9845 29.1703 31.1234 31.3978 30.5995 

110177 ............................................................................. 1.7871 0.9600 26.7504 28.8356 29.7970 28.4770 

110179 ............................................................................. *** * 26.0759 * * 26.0759 

110183 ............................................................................. 1.2702 0.9845 29.6132 28.6208 28.3576 28.8287 

110184 ............................................................................. 1.2372 0.9845 26.5240 28.3545 28.9228 28.0035 

110186 ............................................................................. 1.3737 0.9023 25.0298 27.4925 28.2840 26.9603 

110187 ............................................................................. 1.2184 0.9845 24.2933 25.2139 26.9609 25.5777 

110189 ............................................................................. 1.1273 0.9845 26.7654 26.1418 26.2773 26.3807 

110190 ............................................................................. 1.0375 0.8106 14.2518 23.3204 24.5194 20.0516 

110191 ............................................................................. 1.3326 0.9845 26.8277 27.7760 30.8738 28.4664 

110192 ............................................................................. 1.3983 0.9845 26.7852 28.8267 30.0811 28.6170 

110193 ............................................................................. *** * 27.3341 27.9161 * 27.6234 

110194 ............................................................................. 0.9362 0.7864 18.4776 19.1920 21.0803 19.6202 

110198 ............................................................................. 1.3960 0.9845 31.7748 31.0557 32.8394 31.8698 

110200 ............................................................................. 1.9208 0.9023 22.3249 24.9236 27.2957 24.7898 

110201 ............................................................................. 1.4602 0.9753 28.2232 31.0841 32.0685 30.4669 

110203 ............................................................................. 0.9675 0.9845 26.8768 29.7888 32.3439 29.6045 

110205 ............................................................................. 1.1514 0.8378 19.7408 22.0207 23.9713 21.9556 

110209 ............................................................................. 0.5322 0.7864 19.0450 21.1534 21.2405 20.5449 

110212 ............................................................................. 1.1996 0.8208 40.5120 * * 40.5120 

110214 ............................................................................. *** * * 37.1450 * 37.1450 

110215 ............................................................................. 1.2923 0.9845 25.7886 27.5566 29.5222 27.7244 

110219 ............................................................................. 1.4243 0.9845 27.0362 28.8814 32.1875 29.3856 

110220 ............................................................................. *** * * 37.5741 * 37.5741 

110221 ............................................................................. *** * * 28.0500 * 28.0500 

110222 ............................................................................. *** * * 35.6189 * 35.6189 

110223 ............................................................................. *** * * * 25.3054 25.3054 

110224 ............................................................................. *** * * * 33.6431 33.6431 

110225 ............................................................................. 1.1643 0.9845 * * 29.5367 29.5367 

110226 ............................................................................. 1.1727 0.9845 * * * * 

120001 ............................................................................. 1.7822 1.1289 34.7715 34.1385 39.6365 36.0758 

mmaher on DSK3CLS3C1PROD with $$_JOB

24868 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

120002 ............................................................................. 1.2099 1.0751 29.9913 32.3784 34.2093 32.2039 

120004 ............................................................................. 1.3321 1.1289 28.6527 30.0668 31.3533 30.0073 

120005 ............................................................................. 1.3153 1.0751 29.3405 31.1985 33.6910 31.4352 

120006 ............................................................................. 1.2715 1.1289 31.2285 31.6785 34.2215 32.3967 

120007 ............................................................................. 1.7204 1.1289 30.4247 30.2473 30.8768 30.5121 

120010 ............................................................................. 1.8846 1.1289 30.1659 29.5714 30.8509 30.1898 

120011 ............................................................................. 1.5402 1.1289 34.1643 37.1792 39.1930 36.8947 

120014 ............................................................................. 1.2834 1.0751 28.6416 30.3463 30.9833 30.0254 

120016 ............................................................................. *** * 19.6039 * * 19.6039 

120019 ............................................................................. 1.1324 1.0751 30.3809 30.4257 33.0105 31.2828 

120022 ............................................................................. 1.9143 1.1289 26.6100 29.9527 32.5281 29.5900 

120025 ............................................................................. *** * 30.2367 * * 30.2367 

120026 ............................................................................. 1.4053 1.1289 30.3293 32.4566 33.3760 32.1741 

120027 ............................................................................. 1.3450 1.1289 28.6717 28.7905 29.5804 29.0480 

120028 ............................................................................. 1.2954 1.1289 30.3794 32.4847 34.0426 32.3412 

120029 ............................................................................. *** * * * 44.6372 44.6372 

130002 ............................................................................. 1.4431 0.8780 23.6078 24.7871 25.0585 24.5110 

130003 ............................................................................. 1.3979 0.9620 27.6345 28.6158 28.6132 28.2893 

130005 ............................................................................. *** * 25.7523 * * 25.7523 

130006 ............................................................................. 1.7739 0.9501 25.3221 27.2158 28.0040 26.8672 

130007 ............................................................................. 1.8211 0.9501 24.9562 28.7246 30.4947 27.9564 

130013 ............................................................................. 1.3826 0.9501 27.9209 30.9609 36.1511 31.7450 

130014 ............................................................................. 1.2242 0.9501 24.3885 27.2543 27.5904 26.3556 

130018 ............................................................................. 1.6969 0.9158 26.4125 27.3439 28.3984 27.3763 

130021 ............................................................................. *** * 16.1658 * * 16.1658 

130024 ............................................................................. 1.1828 0.8301 23.3347 23.6212 24.8040 23.9295 

130025 ............................................................................. 1.2433 0.7879 20.1452 21.1998 22.7959 21.4284 

130028 ............................................................................. 1.4838 0.9158 26.3443 27.2195 28.3768 27.4425 

130049 ............................................................................. 1.6070 1.0220 26.9749 27.3597 29.0154 27.8217 

130062 ............................................................................. *** * 20.6642 25.6467 29.1889 24.9258 

130063 ............................................................................. 1.3933 0.9501 22.5904 26.0955 27.7566 25.3649 

130065 ............................................................................. 1.9742 0.9352 * 21.9792 30.4515 26.6732 

130066 ............................................................................. 2.0918 0.9679 * * 28.9875 28.9875 

130067 ............................................................................. 0.5728 0.9352 * * 21.3846 21.3846 

130068 ............................................................................. 2.6786 0.9679 * * * * 

140001 ............................................................................. 1.1037 0.8717 22.3170 22.3001 22.2001 22.2725 

140002 ............................................................................. 1.3394 0.8885 24.6954 27.0165 27.4774 26.4099 

140007 ............................................................................. 1.3528 1.0455 28.3482 30.7378 31.4003 30.1858 

140008 ............................................................................. 1.4476 1.0455 28.5297 29.1767 31.7996 29.7868 

140010 ............................................................................. 1.5346 1.0455 35.1024 31.8806 38.1652 34.8498 

140011 ............................................................................. 1.1266 0.8355 22.4091 23.8575 25.8844 24.1276 

140012 ............................................................................. 1.1597 1.0455 28.6564 29.0336 31.8902 29.7936 

140013 ............................................................................. 1.4751 0.9374 23.3065 23.9269 25.0217 24.0534 

140015 ............................................................................. 1.4264 0.8885 23.0600 24.4687 24.6395 24.0656 

140016 ............................................................................. 1.0141 * 18.1242 * * 18.1242 

140018 ............................................................................. 1.4726 1.0455 27.7548 26.3533 30.4549 28.1330 

140019 ............................................................................. 0.9079 0.8355 18.9228 21.3438 22.3154 20.8677 

140024 ............................................................................. *** * 17.5249 * * 17.5249 

140026 ............................................................................. 1.1365 0.8643 23.0470 25.9669 26.0469 25.0148 

140029 ............................................................................. 1.5607 1.0455 28.6565 30.2688 34.0184 30.9961 

140030 ............................................................................. 1.5584 1.0455 29.7771 30.2776 31.6814 30.5817 

140032 ............................................................................. 1.2249 0.8885 24.0573 26.7310 27.5346 26.1088 

140033 ............................................................................. 0.7961 1.0455 25.6068 27.9993 29.5213 27.5598 

140034 ............................................................................. 1.1477 0.8885 23.0033 24.0470 24.4638 23.8456 

140040 ............................................................................. 1.2142 0.9217 22.2969 23.2293 24.5572 23.3448 

140043 ............................................................................. 1.2818 0.8898 26.7996 27.3469 29.8613 28.0415 

140045 ............................................................................. *** * 20.6548 * * 20.6548 

140046 ............................................................................. 1.5062 0.8885 23.2127 24.7334 25.6221 24.5832 

140048 ............................................................................. 1.2927 1.0455 28.2222 29.3877 31.1842 29.5804 

140049 ............................................................................. 1.4736 1.0455 27.4009 29.0976 26.9354 27.8062 

140051 ............................................................................. 1.5046 1.0455 27.7901 30.9696 31.8207 30.1641 

mmaher on DSK3CLS3C1PROD with $$_JOB

24869 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

140052 ............................................................................. 1.2921 0.8885 23.5662 25.9617 26.9889 25.4996 

140053 ............................................................................. 1.8971 0.8947 24.8455 27.4518 28.4493 26.9022 

140054 ............................................................................. 1.4490 1.0455 31.8564 33.1406 33.1984 32.7274 

140058 ............................................................................. 1.2533 0.8885 22.8423 24.6058 25.2553 24.2520 

140059 ............................................................................. 1.0745 0.8885 22.4652 22.6743 21.6222 22.2387 

140061 ............................................................................. *** * 20.8063 * * 20.8063 

140062 ............................................................................. 1.3499 1.0455 34.7704 34.1230 35.0300 34.6455 

140063 ............................................................................. 1.4129 1.0455 27.8306 28.6559 30.3699 28.9237 

140064 ............................................................................. 1.1958 0.9217 22.0407 23.8639 25.7536 23.9574 

140065 ............................................................................. 1.4079 1.0455 29.4678 30.1856 31.2501 30.2861 

140066 ............................................................................. 1.0941 0.8885 21.9771 22.1524 22.0209 22.0493 

140067 ............................................................................. 1.8444 0.9374 25.3986 28.3506 29.8952 27.9255 

140068 ............................................................................. 1.2095 1.0455 27.3956 28.3938 26.2136 27.3581 

140075 ............................................................................. 1.3302 1.0455 27.9325 26.2626 35.9501 29.4586 

140077 ............................................................................. 1.0119 0.8885 19.1363 20.3999 21.6458 20.4041 

140080 ............................................................................. 1.4034 1.0455 23.2575 28.8791 29.8040 27.0165 

140082 ............................................................................. 1.5858 1.0455 25.6645 28.3429 30.4657 28.1091 

140083 ............................................................................. 0.9164 1.0455 26.2972 26.8919 28.2249 27.1579 

140084 ............................................................................. 1.3044 1.0455 29.2515 30.5036 30.7227 30.1514 

140088 ............................................................................. 1.9222 1.0455 32.4978 30.5450 32.1232 31.7009 

140089 ............................................................................. 1.2577 0.8355 23.3401 24.1066 24.9116 24.1079 

140091 ............................................................................. 1.7612 0.9320 26.8518 27.8536 28.2076 27.6623 

140093 ............................................................................. 1.2233 0.9250 25.3127 28.3298 28.6735 27.3134 

140094 ............................................................................. 1.0630 1.0455 27.9273 27.3841 27.1458 27.4606 

140095 ............................................................................. 1.1848 1.0455 27.6799 28.7617 30.7468 28.9831 

140100 ............................................................................. 1.4123 1.0455 37.0820 41.3374 37.4204 38.7591 

140101 ............................................................................. 1.2093 1.0455 28.5365 29.4081 28.9681 28.9900 

140103 ............................................................................. 1.1489 1.0455 23.3258 23.6406 24.0915 23.6943 

140105 ............................................................................. 2.4503 1.0455 27.4531 29.5274 29.6559 28.8375 

140109 ............................................................................. 1.2813 * 19.5675 * * 19.5675 

140110 ............................................................................. 1.1015 1.0455 27.9844 28.6364 30.2949 28.9917 

140113 ............................................................................. 1.6269 0.9320 26.7969 29.5452 30.2650 28.8697 

140114 ............................................................................. 1.4992 1.0455 28.3014 28.2151 29.2174 28.5888 

140115 ............................................................................. 1.1220 1.0455 25.1498 26.0383 26.1931 25.7916 

140116 ............................................................................. 1.2809 1.0455 31.9902 34.5537 34.3854 33.6663 

140117 ............................................................................. 1.5470 1.0455 26.8802 27.7201 28.9000 27.8446 

140118 ............................................................................. 1.5344 1.0455 29.7570 32.5518 32.3262 31.5081 

140119 ............................................................................. 1.8434 1.0455 36.1419 34.2118 32.2183 34.0198 

140120 ............................................................................. 1.2653 0.9374 22.7375 23.9724 25.9262 24.2579 

140122 ............................................................................. 1.4641 1.0455 28.4188 30.5653 30.3888 29.7745 

140124 ............................................................................. 1.2574 1.0455 36.1327 35.7563 36.8811 36.2568 

140125 ............................................................................. 1.1737 0.8885 20.4014 22.7571 26.5780 23.2030 

140127 ............................................................................. 1.5914 0.9488 24.1658 25.6668 27.8334 25.8831 

140130 ............................................................................. 1.2375 1.0455 29.5247 32.6209 32.3345 31.5415 

140133 ............................................................................. 1.2957 1.0455 28.0339 31.0269 30.3222 29.7591 

140135 ............................................................................. 1.4311 0.8355 22.3264 23.3196 24.6627 23.4674 

140137 ............................................................................. 1.0306 0.8885 21.4699 23.4174 31.4330 24.5875 

140141 ............................................................................. *** * 21.7872 * * 21.7872 

140143 ............................................................................. 1.1599 1.0455 26.2954 27.4499 26.1598 26.6232 

140145 ............................................................................. 1.0894 0.8885 23.4608 26.0875 25.2020 24.9373 

140147 ............................................................................. 1.1116 0.8355 19.8541 21.0686 21.1816 20.6906 

140148 ............................................................................. 1.7302 0.8947 24.7031 25.5677 27.0025 25.7602 

140150 ............................................................................. 1.7104 1.0455 35.2711 52.0970 35.5387 41.0090 

140151 ............................................................................. 0.8042 1.0455 23.4879 27.0312 26.0771 25.5353 

140152 ............................................................................. 1.1878 1.0455 27.6086 30.2209 29.8651 29.2052 

140155 ............................................................................. 1.3645 1.0455 28.9724 29.5734 32.7948 30.4667 

140158 ............................................................................. 1.3840 1.0455 27.0986 27.3721 30.9913 28.4461 

140160 ............................................................................. 1.2239 0.9659 24.5373 25.8684 28.2651 26.1623 

140161 ............................................................................. 1.0974 1.0455 23.1647 25.2898 28.8243 25.7885 

140162 ............................................................................. 1.5875 0.9488 27.4471 29.4121 32.1785 29.6154 

140164 ............................................................................. 1.8228 0.8885 23.7457 24.6009 25.9708 24.8069 

mmaher on DSK3CLS3C1PROD with $$_JOB

24870 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

140165 ............................................................................. *** * 16.6304 * * 16.6304 

140166 ............................................................................. 1.1618 0.8355 23.1005 26.4800 26.2861 25.2805 

140167 ............................................................................. 1.1617 0.8355 22.8911 22.8703 24.9899 23.5834 

140172 ............................................................................. 1.3657 1.0455 29.8568 32.1220 33.3088 31.7850 

140174 ............................................................................. 1.5727 1.0455 27.8131 30.5905 30.2862 29.6018 

140176 ............................................................................. 1.2302 1.0455 31.3490 32.9794 32.6124 32.3400 

140177 ............................................................................. 0.9043 1.0455 22.5610 26.4340 25.5687 24.9308 

140179 ............................................................................. 1.2690 1.0455 27.6376 29.3657 30.0402 29.0241 

140180 ............................................................................. 1.1754 1.0455 28.3629 27.8887 29.4333 28.5589 

140181 ............................................................................. 1.1327 1.0455 25.0101 25.0226 28.8391 26.2494 

140182 ............................................................................. 1.5032 1.0455 28.2211 30.1755 31.5975 29.8792 

140184 ............................................................................. 1.2950 0.8355 21.1802 25.2327 26.6072 24.4269 

140185 ............................................................................. 1.4647 0.8885 23.8531 25.2423 26.5377 25.2109 

140186 ............................................................................. 1.5405 1.0455 30.6951 29.8022 38.6436 32.7202 

140187 ............................................................................. 1.5457 0.8885 23.2892 24.8332 25.5863 24.5665 

140189 ............................................................................. 1.1672 0.8355 23.7198 22.5965 24.6993 23.6830 

140190 ............................................................................. *** * 19.8296 * * 19.8296 

140191 ............................................................................. 1.3320 1.0455 25.8678 28.5836 31.2506 28.4103 

140197 ............................................................................. 1.2420 1.0455 23.0684 24.0463 24.9086 23.9560 

140199 ............................................................................. 1.0545 * 22.0315 * * 22.0315 

140200 ............................................................................. 1.4398 1.0455 26.3379 28.8435 30.7340 28.6128 

140202 ............................................................................. 1.5519 1.0455 29.7870 32.7915 32.9414 31.9574 

140206 ............................................................................. 1.2672 1.0455 30.6561 29.7953 29.0219 29.8266 

140207 ............................................................................. 1.2156 1.0455 24.1048 26.0535 28.2239 26.0077 

140208 ............................................................................. 1.6599 1.0455 29.4708 29.5380 30.9464 29.9911 

140209 ............................................................................. 1.5590 0.9374 24.5376 26.3230 29.5947 26.7186 

140210 ............................................................................. 1.0674 0.8355 19.2640 20.6954 19.2050 19.6893 

140211 ............................................................................. 1.3080 1.0455 29.7054 30.3286 31.2117 30.4786 

140213 ............................................................................. 1.2474 1.0455 30.2945 31.6926 32.1006 31.3680 

140217 ............................................................................. 1.5469 1.0455 31.5324 32.1277 37.4373 33.6828 

140223 ............................................................................. 1.4766 1.0455 30.4923 31.7267 33.4712 31.9196 

140224 ............................................................................. 1.3766 1.0455 28.2177 29.6181 30.0109 29.2702 

140228 ............................................................................. 1.5676 0.9659 25.6419 27.9456 28.2837 27.2857 

140231 ............................................................................. 1.4308 1.0455 30.6410 30.0236 34.5759 31.7645 

140233 ............................................................................. 1.6659 1.0455 28.6305 29.7093 31.5127 29.9816 

140234 ............................................................................. 1.0449 0.8643 23.6928 24.5476 25.7284 24.6519 

140239 ............................................................................. 1.5972 0.9659 29.0092 31.1879 29.9224 30.0310 

140240 ............................................................................. 1.4146 1.0455 28.7310 31.5637 29.6215 29.9537 

140242 ............................................................................. 1.5035 1.0455 32.0522 34.6120 35.2330 33.9219 

140250 ............................................................................. 1.2383 1.0455 28.5971 29.6305 30.9236 29.7408 

140251 ............................................................................. 1.3945 1.0455 27.1687 28.0622 28.5295 27.9306 

140252 ............................................................................. 1.4015 1.0455 33.3351 34.4268 35.9410 34.5696 

140258 ............................................................................. 1.5168 1.0455 30.2639 34.2333 33.0067 32.5344 

140275 ............................................................................. 1.3109 0.8898 26.1473 27.8186 28.5054 27.4336 

140276 ............................................................................. 1.8663 1.0455 29.8325 31.6359 31.5673 31.0394 

140280 ............................................................................. 1.4652 0.8898 23.4447 24.9401 26.6521 24.9136 

140281 ............................................................................. 1.7579 1.0455 30.4838 33.3903 35.4009 33.0950 

140285 ............................................................................. *** * 20.7576 * * 20.7576 

140286 ............................................................................. 1.1525 1.0455 29.1543 30.3237 30.9916 30.1576 

140288 ............................................................................. 1.5216 1.0455 29.3988 31.5197 31.5935 30.8906 

140289 ............................................................................. 1.3073 0.8885 22.6211 23.8452 25.6053 24.0376 

140290 ............................................................................. 1.3588 1.0455 31.7341 31.8135 32.5219 32.0520 

140291 ............................................................................. 1.6125 1.0455 29.8958 31.9052 33.4588 31.8392 

140292 ............................................................................. 1.1018 1.0455 27.6285 28.5094 31.4636 29.0642 

140294 ............................................................................. 1.1266 0.8355 23.4503 24.0750 26.1581 24.6191 

140300 ............................................................................. 1.1893 1.0455 34.8568 35.1494 41.7895 37.1471 

140301 ............................................................................. 1.1592 1.0455 31.7073 49.9507 36.3852 36.8862 

140303 ............................................................................. 2.2098 1.0455 * 29.6470 * 29.6470 

150001 ............................................................................. 1.1317 0.9723 29.6844 28.9075 31.8065 30.1183 

150002 ............................................................................. 1.4425 1.0455 25.0063 26.6222 27.6466 26.6689 

150003 ............................................................................. 1.7495 0.8682 25.3458 26.7585 26.9767 26.3732 

mmaher on DSK3CLS3C1PROD with $$_JOB

24871 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

150004 ............................................................................. 1.4758 1.0455 26.8458 28.7336 30.9613 28.8233 

150005 ............................................................................. 1.2795 0.9723 27.2369 29.5371 30.5354 29.1851 

150006 ............................................................................. 1.3972 0.9488 26.4062 25.6265 27.1359 26.4178 

150007 ............................................................................. 1.3722 0.9468 26.6073 29.4971 30.0493 28.8173 

150008 ............................................................................. 1.3877 1.0455 26.6928 27.5703 27.0507 27.1181 

150009 ............................................................................. 1.4332 0.9045 22.2147 25.4496 25.7590 24.5202 

150010 ............................................................................. 1.4964 0.9468 26.8523 27.2272 28.4110 27.4598 

150011 ............................................................................. 1.2442 0.9723 24.3490 25.3178 26.7670 25.4609 

150012 ............................................................................. 1.5635 0.9649 27.3029 30.0348 31.2245 29.5420 

150013 ............................................................................. *** * 21.8465 * * 21.8465 

150015 ............................................................................. 1.3255 0.8876 26.2434 28.0931 27.3806 27.2242 

150017 ............................................................................. 1.8579 0.9046 25.2342 26.3973 26.3375 26.0050 

150018 ............................................................................. 1.7216 0.9488 26.3289 27.3689 28.6052 27.4720 

150021 ............................................................................. 1.8099 0.9046 29.6967 28.9196 30.0025 29.5365 

150022 ............................................................................. 1.0830 0.8750 22.6773 23.1041 23.8966 23.1998 

150023 ............................................................................. 1.5634 0.8828 23.7159 26.9095 27.7498 25.8885 

150024 ............................................................................. 1.4799 0.9723 27.1589 28.1655 28.4136 27.8886 

150026 ............................................................................. 1.3156 0.9488 28.1127 28.6517 30.4957 29.1720 

150027 ............................................................................. 1.0482 * 17.4862 * * 17.4862 

150029 ............................................................................. 1.4693 0.9649 26.9680 28.7187 29.9297 28.4268 

150030 ............................................................................. 1.1962 0.9723 26.9534 29.1493 29.3548 28.5129 

150033 ............................................................................. 1.5588 0.9723 27.9995 28.6838 29.7732 28.8056 

150034 ............................................................................. 1.4551 1.0455 26.0465 28.6429 28.0423 27.6123 

150035 ............................................................................. 1.5978 0.9246 26.6620 26.9700 27.8888 27.1974 

150037 ............................................................................. 1.3215 0.9723 28.5451 31.0935 29.0142 29.5229 

150038 ............................................................................. 1.1335 0.9723 28.8054 29.3156 33.0091 30.3929 

150042 ............................................................................. 1.3921 0.8828 23.0102 22.8786 25.1381 23.6707 

150044 ............................................................................. 1.3933 0.9045 23.7066 25.2137 25.2653 24.7681 

150045 ............................................................................. 1.0745 0.9046 25.2225 26.9818 27.5333 26.5864 

150046 ............................................................................. 1.4897 0.8828 21.9369 24.5593 26.5855 24.4151 

150047 ............................................................................. 1.7148 0.9046 25.8348 25.5194 25.8493 25.7349 

150048 ............................................................................. 1.3885 0.9654 27.1817 27.1233 28.1517 27.5020 

150049 ............................................................................. 1.3621 * 22.3370 * * 22.3370 

150051 ............................................................................. 1.6351 0.9723 23.7061 26.5655 28.9114 26.4833 

150052 ............................................................................. 1.0751 * 20.6339 * * 20.6339 

150056 ............................................................................. 1.9411 0.9723 28.2842 28.8727 29.3498 28.8452 

150057 ............................................................................. 2.0977 0.9723 24.8605 28.9529 30.3290 27.8808 

150058 ............................................................................. 1.5682 0.9649 27.5341 29.1444 29.1247 28.6422 

150059 ............................................................................. 1.5558 0.9723 28.5715 31.4987 31.3363 30.4971 

150060 ............................................................................. *** * 24.8544 * * 24.8544 

150061 ............................................................................. 1.1276 0.8599 22.2822 21.3711 22.6744 22.1017 

150062 ............................................................................. 1.1339 * 24.6088 * * 24.6088 

150064 ............................................................................. 1.2004 0.8599 23.7707 25.4987 28.7959 26.0974 

150065 ............................................................................. 1.2639 0.9723 25.9461 27.9283 30.2038 27.9980 

150069 ............................................................................. 1.1735 0.9654 25.2656 26.2028 26.0888 25.8557 

150072 ............................................................................. 1.1652 0.8700 20.5111 21.2120 21.7638 21.1631 

150074 ............................................................................. 1.4434 0.9723 25.2586 25.9321 28.5642 26.5896 

150075 ............................................................................. 1.0984 0.9046 24.0745 25.1568 25.7242 24.9786 

150076 ............................................................................. 1.2878 0.9488 28.1874 29.3249 30.1109 29.2163 

150079 ............................................................................. 1.1099 * 21.4067 * * 21.4067 

150082 ............................................................................. 1.6791 0.8599 25.5860 28.3494 26.4526 26.8041 

150084 ............................................................................. 1.8404 0.9723 29.3905 31.1720 33.1783 31.1870 

150086 ............................................................................. 1.1730 0.9654 23.9404 25.1992 26.6732 25.3038 

150088 ............................................................................. 1.2755 0.9723 23.6253 27.2103 29.1480 26.6296 

150089 ............................................................................. 1.6030 0.8599 25.0449 24.7233 24.8038 24.8594 

150090 ............................................................................. 1.6395 1.0455 26.2899 30.4835 30.6398 29.1396 

150091 ............................................................................. 1.1639 0.9046 30.6209 30.4234 32.1616 31.1002 

150097 ............................................................................. 1.1292 0.9723 25.0367 27.7468 29.1332 27.3211 

150100 ............................................................................. 1.6890 0.8599 24.3530 25.7997 26.9731 25.6241 

150101 ............................................................................. 1.0674 0.9046 29.1657 29.0301 30.5475 29.5655 

150102 ............................................................................. 1.0330 0.9246 24.5923 25.7424 25.8716 25.4594 

mmaher on DSK3CLS3C1PROD with $$_JOB

24872 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

150104 ............................................................................. 1.0855 0.9723 25.5872 28.2552 28.7782 27.5175 

150106 ............................................................................. 1.0158 * 20.9387 * * 20.9387 

150109 ............................................................................. 1.4646 0.8682 23.5865 25.3367 26.8460 25.2374 

150112 ............................................................................. 1.4973 0.9723 26.5643 28.0068 29.8515 28.1779 

150113 ............................................................................. 1.2888 0.9723 24.8760 24.7960 25.9794 25.2152 

150115 ............................................................................. 1.4221 0.8599 19.3411 22.0747 22.5784 21.2668 

150122 ............................................................................. 1.3185 0.9723 26.0173 * 29.1651 27.6449 

150124 ............................................................................. *** * 21.3933 * * 21.3933 

150125 ............................................................................. 1.5108 1.0455 26.7666 27.6535 29.3573 27.9334 

150126 ............................................................................. 1.4163 1.0455 26.9887 28.9454 29.4277 28.4460 

150128 ............................................................................. 1.4408 0.9723 26.4976 28.7810 29.4982 28.2798 

150129 ............................................................................. 1.1548 0.9723 29.9099 29.7398 31.4309 30.3982 

150130 ............................................................................. 1.6136 * 21.7400 * * 21.7400 

150132 ............................................................................. *** * 25.6257 27.6560 * 26.6249 

150133 ............................................................................. 1.2465 0.9046 22.7292 25.1322 24.2528 24.0310 

150134 ............................................................................. 1.0184 0.9045 23.8525 26.3249 21.6507 23.7520 

150136 ............................................................................. *** * 26.2704 * * 26.2704 

150146 ............................................................................. 1.1375 0.9046 29.3383 29.5256 30.3340 29.7675 

150147 ............................................................................. 1.5119 1.0455 22.8456 27.2339 26.1631 25.6991 

150149 ............................................................................. 1.0014 0.8599 23.6360 23.7026 24.9628 24.1402 

150150 ............................................................................. 1.3168 0.9046 25.5331 27.0542 26.7708 26.4923 

150151 ............................................................................. *** * 38.1445 * * 38.1445 

150152 ............................................................................. *** * 44.7145 * * 44.7145 

150153 ............................................................................. 2.4179 0.9723 * 32.1022 35.0601 33.7419 

150154 ............................................................................. 2.5731 0.9723 * 29.8514 29.8867 29.8697 

150155 ............................................................................. *** * * 45.0121 * 45.0121 

150156 ............................................................................. *** * * 25.9681 * 25.9681 

150157 ............................................................................. 1.6752 0.9723 * * 32.3095 32.3095 

150158 ............................................................................. 1.2386 0.9723 * * * * 

150160 ............................................................................. 2.0084 0.9723 * * * * 

150161 ............................................................................. 1.4704 0.9723 * * * * 

150162 ............................................................................. 1.7757 0.9723 * * * * 

150163 ............................................................................. 1.1085 0.9045 * * * * 

160001 ............................................................................. 1.2040 0.9227 25.1220 24.5108 25.7253 25.1337 

160005 ............................................................................. 1.2097 0.8480 21.8949 23.1034 24.7751 23.2876 

160008 ............................................................................. 1.0520 0.8480 20.7200 22.1402 22.4752 21.7844 

160013 ............................................................................. 1.2954 0.8659 23.7163 24.0956 24.4092 24.0732 

160014 ............................................................................. *** * 20.5882 * * 20.5882 

160016 ............................................................................. 1.5631 0.9227 23.3619 24.5338 27.1450 24.9572 

160020 ............................................................................. 1.1531 * 19.5554 * * 19.5554 

160024 ............................................................................. 1.5664 0.9162 26.2392 27.4158 29.3740 27.6163 

160026 ............................................................................. *** * 24.7424 * * 24.7424 

160028 ............................................................................. 1.3103 0.9419 26.2948 27.8535 30.0834 28.2015 

160029 ............................................................................. 1.6376 0.9428 27.9277 28.7324 30.6688 29.0932 

160030 ............................................................................. 1.3828 0.9982 26.7068 28.7786 30.9401 28.8516 

160031 ............................................................................. 0.7988 * 19.7368 * * 19.7368 

160032 ............................................................................. 1.0670 0.8715 23.4727 25.4662 26.2923 25.1089 

160033 ............................................................................. 1.7494 0.8898 24.6768 26.5315 27.2044 26.1333 

160034 ............................................................................. 1.0217 * 19.3503 * * 19.3503 

160039 ............................................................................. 0.9129 * 22.1180 * * 22.1180 

160040 ............................................................................. 1.2918 0.8891 23.9053 25.9032 26.8096 25.5667 

160045 ............................................................................. 1.6888 0.8689 25.4153 26.6463 27.5279 26.5336 

160047 ............................................................................. 1.3942 0.9419 25.2072 26.0227 28.1257 26.4461 

160048 ............................................................................. *** * 19.5831 * * 19.5831 

160050 ............................................................................. 1.0566 * 24.5402 * * 24.5402 

160057 ............................................................................. 1.2586 0.9142 23.0937 25.1272 25.6262 24.6658 

160058 ............................................................................. 1.9687 0.9428 27.1646 28.4167 28.9914 28.2022 

160064 ............................................................................. 1.6018 0.8891 28.6139 28.7668 28.4201 28.5965 

160066 ............................................................................. 0.9354 * 22.7709 * * 22.7709 

160067 ............................................................................. 1.3642 0.8891 23.4060 24.8137 26.0201 24.7707 

160069 ............................................................................. 1.5288 0.8874 25.3402 27.4473 27.6151 26.8148 

mmaher on DSK3CLS3C1PROD with $$_JOB

24873 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

160079 ............................................................................. 1.4776 0.8689 23.7234 24.7372 26.1612 24.8785 

160080 ............................................................................. 1.2820 0.8898 23.1837 25.8252 27.2360 25.4030 

160081 ............................................................................. *** * 23.1930 * * 23.1930 

160082 ............................................................................. 1.7712 0.9162 26.4398 27.4718 28.7814 27.5576 

160083 ............................................................................. 1.6609 0.9162 28.2193 27.3004 28.3914 27.9723 

160089 ............................................................................. 1.2895 0.9142 22.6551 23.2149 23.2885 23.0561 

160091 ............................................................................. *** * 17.9862 * * 17.9862 

160101 ............................................................................. 1.0822 0.9162 25.1000 25.0503 25.4729 25.2118 

160104 ............................................................................. 1.6559 0.8898 24.9134 28.1891 29.8108 27.8792 

160110 ............................................................................. 1.5339 0.8891 24.9434 26.6633 28.8124 26.8746 

160112 ............................................................................. 1.2909 0.8480 23.0672 24.7957 25.2879 24.4324 

160117 ............................................................................. 1.3812 0.8874 25.0278 25.4659 27.3401 25.9559 

160118 ............................................................................. *** * 19.7764 * * 19.7764 

160122 ............................................................................. 1.0949 0.8480 22.5872 23.9177 24.4983 23.6840 

160124 ............................................................................. 1.1525 0.8480 23.1690 22.5482 24.2654 23.3247 

160126 ............................................................................. 1.0265 * 19.8323 * * 19.8323 

160146 ............................................................................. 1.3905 0.9220 22.9897 22.6949 25.9575 23.8222 

160147 ............................................................................. 1.2917 0.9227 26.6438 28.6303 29.8976 28.4670 

160153 ............................................................................. 1.7355 0.9220 28.9881 29.9378 30.6170 29.8519 

160154 ............................................................................. 0.9478 * * * * * 

170001 ............................................................................. 1.1452 0.7989 21.9131 23.1260 23.8847 22.9700 

170006 ............................................................................. 1.3255 0.9040 21.9019 24.2068 27.1291 24.4623 

170009 ............................................................................. 1.0521 0.9321 29.2588 30.9025 29.6048 29.9146 

170010 ............................................................................. 1.2446 0.7989 24.0008 23.9707 25.5578 24.5520 

170012 ............................................................................. 1.6138 0.8761 24.7392 26.1367 27.1174 25.9599 

170013 ............................................................................. 1.6219 0.8761 25.0419 25.2476 26.7123 25.6576 

170014 ............................................................................. 1.0198 0.9321 23.5960 23.8135 24.1592 23.8605 

170015 ............................................................................. *** * 20.2368 * * 20.2368 

170016 ............................................................................. 1.6404 0.8561 25.9482 25.8061 26.7533 26.1670 

170017 ............................................................................. 1.0741 0.9009 24.7771 26.9657 25.7301 25.8416 

170019 ............................................................................. 1.1990 * 22.0251 * * 22.0251 

170020 ............................................................................. 1.5979 0.8761 23.1800 23.2757 24.1120 23.5234 

170022 ............................................................................. 1.1485 * 22.2878 * * 22.2878 

170023 ............................................................................. 1.4202 0.8761 23.9808 24.0561 23.9805 24.0052 

170027 ............................................................................. 1.3965 0.7989 22.5103 23.1766 23.4023 23.0164 

170033 ............................................................................. 1.3534 0.8761 20.7864 21.9709 24.1874 22.2849 

170039 ............................................................................. 0.9441 0.9009 21.5203 26.9852 26.0906 24.6284 

170040 ............................................................................. 1.9811 0.9321 28.2856 28.4458 30.2460 29.0254 

170049 ............................................................................. 1.5233 0.9321 24.7895 25.2070 26.4091 25.4878 

170052 ............................................................................. *** * 18.5291 * * 18.5291 

170058 ............................................................................. 1.1011 0.9321 23.3398 22.9210 26.5943 24.2597 

170068 ............................................................................. 1.2238 0.9141 22.6087 23.0635 23.8790 23.1876 

170070 ............................................................................. *** * 16.0162 * * 16.0162 

170074 ............................................................................. 1.2234 0.7989 21.0565 23.7829 23.1854 22.7215 

170075 ............................................................................. 0.8299 0.7989 16.5444 19.7760 19.9316 18.7462 

170085 ............................................................................. 0.6104 * * * * * 

170086 ............................................................................. 1.5817 0.8561 24.0812 26.1362 26.3581 25.5514 

170093 ............................................................................. *** * 16.5553 * * 16.5553 

170094 ............................................................................. 0.9370 0.7989 21.3887 21.5295 16.5371 19.6987 

170098 ............................................................................. *** * 20.1242 * * 20.1242 

170103 ............................................................................. 1.2881 0.9009 22.8707 23.8042 24.1990 23.6448 

170104 ............................................................................. 1.4659 0.9321 26.9671 26.2990 27.5482 26.9346 

170105 ............................................................................. 1.0954 0.7989 21.4422 21.9606 22.7400 22.0339 

170109 ............................................................................. 1.0332 0.9321 23.2626 23.1088 23.8520 23.4043 

170110 ............................................................................. 0.8843 0.7989 22.9195 23.3260 23.9496 23.4209 

170114 ............................................................................. 0.9064 * 18.9158 * * 18.9158 

170120 ............................................................................. 1.3879 0.9040 21.0499 22.0253 22.2797 21.7557 

170122 ............................................................................. 1.6841 0.9009 25.3982 26.6605 28.3325 26.7103 

170123 ............................................................................. 1.6957 0.9009 27.2239 27.6653 28.4687 27.7816 

170133 ............................................................................. 1.0455 0.9321 22.9309 23.1226 25.2821 23.8233 

170137 ............................................................................. 1.2780 0.7989 23.8862 24.7096 25.4425 24.7034 

mmaher on DSK3CLS3C1PROD with $$_JOB

24874 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

170142 ............................................................................. 1.4027 0.8455 22.5778 23.9527 24.5814 23.7373 

170143 ............................................................................. *** * 20.4459 * * 20.4459 

170144 ............................................................................. *** * 24.6259 * * 24.6259 

170145 ............................................................................. 1.0836 0.7989 21.5756 23.2162 23.3953 22.7060 

170146 ............................................................................. 1.5040 0.9321 29.1358 29.8858 29.0538 29.3514 

170147 ............................................................................. *** * 21.4753 22.4973 24.3378 22.5659 

170150 ............................................................................. 1.1592 0.8165 18.5744 20.9448 19.5537 19.7042 

170166 ............................................................................. 0.9974 0.7989 19.2842 21.0762 22.6927 21.0426 

170175 ............................................................................. 1.4188 0.8761 23.9304 25.6281 26.7215 25.4230 

170176 ............................................................................. 1.5962 0.9321 26.2366 27.2332 29.0423 27.5653 

170180 ............................................................................. *** * 25.1368 32.5010 17.4887 26.4266 

170182 ............................................................................. 1.4423 0.9321 25.7443 27.3503 29.0642 27.4067 

170183 ............................................................................. 1.9419 0.9009 24.5539 25.8340 26.1875 25.5204 

170185 ............................................................................. 1.2362 0.9321 26.7797 27.8139 28.1777 27.6777 

170186 ............................................................................. 2.6637 0.9009 31.7896 32.8392 30.2636 31.6204 

170187 ............................................................................. 1.4879 0.7989 23.3702 22.8493 24.1467 23.4567 

170188 ............................................................................. 1.9751 0.9321 29.9751 30.6844 32.2575 31.0138 

170190 ............................................................................. 1.0179 0.8455 22.8729 22.9540 26.2542 24.0445 

170191 ............................................................................. 1.7210 0.7989 21.3069 22.1197 24.3772 22.6585 

170192 ............................................................................. 1.9138 0.9009 27.9704 26.2724 27.8171 27.3379 

170193 ............................................................................. 1.4210 0.8761 24.7429 20.6821 24.8461 23.2169 

170194 ............................................................................. 1.0788 0.9321 27.9903 29.9014 27.6979 28.5234 

170195 ............................................................................. 2.2822 0.9321 * 30.1001 29.5948 29.8108 

170196 ............................................................................. 2.3751 0.9009 * * 33.9653 33.9653 

180001 ............................................................................. 1.2529 0.9654 25.4217 27.6917 29.7401 27.6436 

180002 ............................................................................. 1.0605 0.8095 22.9727 25.7862 26.5375 25.1104 

180004 ............................................................................. 1.0975 0.7812 19.5437 22.0797 20.8790 20.8280 

180005 ............................................................................. 1.1216 0.8706 24.5561 24.9779 25.6139 25.0800 

180006 ............................................................................. *** * 14.8011 * * 14.8011 

180007 ............................................................................. 1.5270 0.9027 22.7606 25.7042 27.1922 25.2358 

180009 ............................................................................. 1.7023 0.8845 25.3837 26.4101 27.3217 26.4312 

180010 ............................................................................. 1.8869 0.9027 24.7256 25.6153 27.5042 25.9590 

180011 ............................................................................. 1.5431 0.8815 22.7364 25.5463 24.9907 24.4167 

180012 ............................................................................. 1.4916 0.9045 24.6642 25.6000 26.7267 25.6686 

180013 ............................................................................. 1.5075 0.9408 22.9512 23.7075 24.8114 23.8153 

180016 ............................................................................. 1.3308 0.9045 23.1832 24.8408 24.7149 24.2505 

180017 ............................................................................. 1.3241 0.7983 20.8630 21.8885 21.9702 21.5929 

180018 ............................................................................. 1.3149 0.7812 19.0992 20.9857 23.3022 21.1380 

180019 ............................................................................. 1.0936 0.9654 24.1342 24.0283 24.6269 24.2636 

180020 ............................................................................. 1.0484 0.7812 21.9494 24.6953 25.9626 24.2590 

180021 ............................................................................. 0.9695 0.7812 18.5966 20.7950 22.0692 20.5351 

180024 ............................................................................. 1.1161 0.9045 32.1824 31.1159 26.3521 29.7116 

180025 ............................................................................. 1.1404 0.9045 19.1543 22.6897 28.5920 23.5032 

180026 ............................................................................. 1.0693 * 18.2120 * * 18.2120 

180027 ............................................................................. 1.2463 0.8116 23.8763 20.8303 21.7638 22.0496 

180028 ............................................................................. 0.9145 * 24.7967 * * 24.7967 

180029 ............................................................................. 1.3855 0.8815 23.0536 25.6479 26.1493 24.9987 

180035 ............................................................................. 1.6206 0.9654 29.8438 31.0794 32.3484 31.1163 

180036 ............................................................................. 1.2432 0.8845 25.1154 25.2972 25.6952 25.3661 

180037 ............................................................................. 1.3242 0.9045 25.7361 26.3132 27.8489 26.6113 

180038 ............................................................................. 1.5454 0.8801 24.6348 26.0440 27.2813 25.9999 

180040 ............................................................................. 1.9659 0.9045 26.2125 27.9979 28.5206 27.6117 

180043 ............................................................................. 1.1551 0.7812 19.0617 20.9326 20.6423 20.2174 

180044 ............................................................................. 1.7151 0.8706 23.0971 24.4569 25.8053 24.4867 

180045 ............................................................................. 1.3294 0.9654 25.8349 27.4732 29.4298 27.6399 

180046 ............................................................................. 0.9468 0.9027 27.2244 27.1034 27.0962 27.1405 

180047 ............................................................................. *** * 21.8036 * * 21.8036 

180048 ............................................................................. 1.2958 0.9045 21.6571 23.9230 24.3681 23.3115 

180049 ............................................................................. 1.4452 0.8815 23.3407 22.4769 24.3690 23.3958 

180050 ............................................................................. 1.1562 0.7840 22.6473 26.3604 25.9528 24.9966 

180051 ............................................................................. 1.2881 0.8223 21.3312 23.5299 24.3892 23.1284 

mmaher on DSK3CLS3C1PROD with $$_JOB

24875 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

180053 ............................................................................. 0.9917 0.7812 19.1578 21.3044 22.1656 20.9703 

180055 ............................................................................. 1.1922 * 20.7237 * * 20.7237 

180056 ............................................................................. 1.1792 0.8469 22.8910 24.3074 24.5323 23.9076 

180063 ............................................................................. 1.1034 * 17.9741 * * 17.9741 

180064 ............................................................................. 1.1673 0.8132 16.2638 17.1009 20.1789 17.8235 

180066 ............................................................................. 1.0846 0.9408 24.9543 22.2713 23.7855 23.6483 

180067 ............................................................................. 2.0226 0.9027 25.4080 26.0238 27.9851 26.5261 

180069 ............................................................................. 1.0877 0.8706 22.3673 26.3701 26.5123 25.1423 

180070 ............................................................................. 1.1704 0.8052 20.1308 20.6741 20.2176 20.3429 

180078 ............................................................................. 1.1538 0.8706 26.2636 27.6806 28.2744 27.4277 

180079 ............................................................................. 1.1904 0.8076 19.7791 20.2100 23.5989 21.2535 

180080 ............................................................................. 1.2800 0.8043 21.7380 21.5818 23.7258 22.3548 

180087 ............................................................................. 1.2583 0.7812 18.4331 20.8841 22.0260 20.4628 

180088 ............................................................................. 1.6703 0.9045 27.5767 28.0916 28.6098 28.1048 

180092 ............................................................................. 1.1856 0.9027 22.5679 23.7909 23.7858 23.3986 

180093 ............................................................................. 1.6485 0.8127 20.5422 20.5807 21.4392 20.8528 

180095 ............................................................................. 1.0480 0.7812 17.9677 17.9146 21.5629 18.9607 

180101 ............................................................................. 1.1642 0.9027 25.4796 27.4506 28.1621 27.0742 

180102 ............................................................................. 1.5957 0.8116 18.4388 21.0896 25.2335 21.3174 

180103 ............................................................................. 2.1735 0.9027 26.9407 28.4583 28.7043 28.0357 

180104 ............................................................................. 1.5681 0.8116 24.9441 25.6157 25.9724 25.5137 

180105 ............................................................................. 0.8867 0.7812 19.7615 21.6002 23.1861 21.5257 

180106 ............................................................................. 0.8975 0.7812 17.8020 20.2884 20.7179 19.6699 

180115 ............................................................................. 0.9142 0.7812 20.9831 20.5539 20.3082 20.6168 

180116 ............................................................................. 1.2136 0.8116 22.7353 23.5354 25.8909 24.0619 

180117 ............................................................................. 0.9574 0.7812 21.1854 22.8469 24.7355 22.8804 

180124 ............................................................................. 1.3107 0.9408 23.1917 24.8292 25.4651 24.5479 

180127 ............................................................................. 1.3506 0.9045 23.4765 24.6774 26.3498 24.8205 

180128 ............................................................................. 0.9287 0.7812 20.8406 22.6056 23.8117 22.4352 

180130 ............................................................................. 1.6785 0.9045 26.0278 27.8900 29.1689 27.7419 

180132 ............................................................................. 1.4706 0.8815 23.7652 24.5105 25.3772 24.5770 

180134 ............................................................................. 0.9988 * 18.6779 * * 18.6779 

180138 ............................................................................. 1.2338 0.9045 27.3400 28.1901 29.3488 28.3067 

180139 ............................................................................. 0.9711 0.7812 23.5363 23.3569 24.7565 23.8893 

180141 ............................................................................. 1.7986 0.9045 25.3042 25.3357 27.7799 26.1558 

180143 ............................................................................. 1.6391 0.9027 25.1613 28.1924 30.8722 28.2377 

180144 ............................................................................. *** * * 29.5052 * 29.5052 

180146 ............................................................................. *** * * * 39.8522 39.8522 

180147 ............................................................................. *** * * * 31.1601 31.1601 

180148 ............................................................................. *** * * * 30.1239 30.1239 

180149 ............................................................................. 0.9790 0.7812 * * * * 

190001 ............................................................................. 1.1333 0.7591 19.7516 22.1394 22.1542 21.3054 

190002 ............................................................................. 1.6405 0.8323 22.0056 23.3368 24.6968 23.3287 

190003 ............................................................................. 1.4815 0.8323 23.4977 25.8294 26.7813 25.3494 

190004 ............................................................................. 1.5567 0.7980 23.3290 25.3473 25.0771 24.6162 

190005 ............................................................................. 4.8105 0.8732 22.3208 22.6029 24.2903 23.0170 

190006 ............................................................................. 1.4353 0.8323 22.2467 22.7979 24.8816 23.2624 

190007 ............................................................................. 1.1757 0.7591 19.7528 21.8205 23.1401 21.5662 

190008 ............................................................................. 1.7630 0.7980 24.0111 24.6074 26.3623 24.9673 

190009 ............................................................................. 1.2905 0.7982 19.8404 21.1005 24.0685 21.5282 

190010 ............................................................................. *** * 21.6889 * * 21.6889 

190011 ............................................................................. 0.9928 0.7872 19.7319 21.4052 21.6962 20.9421 

190013 ............................................................................. 1.4551 0.7787 20.8626 21.4573 23.7328 22.0203 

190014 ............................................................................. 1.1835 0.7591 22.4596 22.7151 22.6381 22.6119 

190015 ............................................................................. 1.3255 0.8732 22.8875 23.7789 25.1756 23.9762 

190017 ............................................................................. 1.3888 0.7775 21.5033 24.5390 24.7505 23.6069 

190019 ............................................................................. 1.7979 0.7982 23.7168 24.0468 25.4650 24.4147 

190020 ............................................................................. 1.2332 0.8014 21.6136 22.1967 23.4576 22.4009 

190025 ............................................................................. 1.3044 0.7591 20.8950 23.5007 24.6432 22.9599 

190026 ............................................................................. 1.6216 0.7982 22.5087 23.7702 24.1540 23.4852 

190027 ............................................................................. 1.6703 0.7787 21.2526 24.3006 26.7106 24.0302 

mmaher on DSK3CLS3C1PROD with $$_JOB

24876 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

190034 ............................................................................. 1.2388 0.7779 19.6943 20.7334 21.2104 20.5402 

190036 ............................................................................. 1.7113 0.8732 24.8152 25.4164 25.6548 25.3040 

190037 ............................................................................. 0.6483 0.7787 18.6393 19.4071 20.7258 19.5618 

190039 ............................................................................. 1.6431 0.8732 25.6665 24.4386 26.1249 25.3976 

190040 ............................................................................. 1.3443 0.8732 26.7428 28.6297 28.0162 27.7945 

190041 ............................................................................. 1.4784 0.8615 24.6734 28.5376 28.9554 27.3327 

190043 ............................................................................. *** * 17.3477 * * 17.3477 

190044 ............................................................................. 1.3215 0.7850 19.5567 20.9993 21.2561 20.6002 

190045 ............................................................................. 1.6092 0.8732 25.3854 25.8238 27.1982 26.1752 

190046 ............................................................................. 1.4988 0.8732 24.2128 23.8552 24.7362 24.2695 

190048 ............................................................................. 1.0173 * 19.6288 * * 19.6288 

190050 ............................................................................. 1.0982 0.7635 19.1076 21.0259 20.9111 20.3638 

190053 ............................................................................. 1.1453 0.7691 16.4968 17.9788 18.5781 17.7244 

190054 ............................................................................. 1.3652 0.7676 20.1108 23.1471 22.7018 22.0096 

190060 ............................................................................. 1.4952 0.7787 23.6278 23.7393 22.6278 23.3255 

190064 ............................................................................. 1.6402 0.8014 23.3617 23.1358 23.7283 23.4081 

190065 ............................................................................. 1.6040 0.8014 23.7450 22.1880 23.1207 23.0049 

190077 ............................................................................. 0.9332 * 18.8409 * * 18.8409 

190078 ............................................................................. 1.0564 0.7775 21.3786 22.2431 22.2313 21.9581 

190079 ............................................................................. 1.2248 0.8732 21.2546 24.0985 23.8184 23.0907 

190081 ............................................................................. 0.8766 0.7591 15.6146 20.0121 21.4422 18.9706 

190086 ............................................................................. 1.3003 0.7766 19.8823 22.0610 22.2872 21.4347 

190088 ............................................................................. 1.0986 0.8615 22.3480 23.8562 23.1624 23.1091 

190090 ............................................................................. 1.0652 0.7591 20.2045 23.1241 24.3261 22.5629 

190095 ............................................................................. *** * 18.0174 * * 18.0174 

190098 ............................................................................. 1.7622 0.8615 24.6353 25.6854 25.7430 25.3592 

190099 ............................................................................. 1.0523 0.8014 20.4597 22.0610 23.2316 21.9191 

190102 ............................................................................. 1.5318 0.8323 25.2267 27.3126 26.9670 26.4739 

190106 ............................................................................. 1.1180 0.7982 21.7228 23.5376 26.6201 23.8308 

190109 ............................................................................. 1.2707 * 18.6524 * * 18.6524 

190111 ............................................................................. 1.6579 0.8615 24.4998 25.5729 26.5701 25.5474 

190114 ............................................................................. 1.0545 0.7591 15.8031 17.2678 19.1533 17.4110 

190115 ............................................................................. 1.2581 0.8615 26.6295 28.2066 26.0782 26.9661 

190116 ............................................................................. 1.1767 0.7675 20.3845 22.3710 23.3978 22.0626 

190118 ............................................................................. 0.9130 0.8615 19.7024 22.8809 21.2519 21.3058 

190122 ............................................................................. 1.3212 0.8014 23.7082 22.0072 22.2352 22.6295 

190124 ............................................................................. *** * 24.6675 26.0032 27.7799 26.1591 

190125 ............................................................................. 1.6008 0.7872 23.9649 25.5463 24.8247 24.7613 

190128 ............................................................................. 1.1165 0.8014 27.9136 28.3257 29.6644 28.6603 

190131 ............................................................................. 1.2880 0.8014 25.1917 27.8465 28.6764 27.2755 

190133 ............................................................................. 0.9001 0.7692 13.6266 18.2045 22.4265 19.4499 

190135 ............................................................................. *** * 26.8238 27.7540 30.5687 28.1641 

190140 ............................................................................. 0.9712 0.7625 17.6936 18.9652 23.0383 19.9091 

190144 ............................................................................. 1.1643 0.8615 21.7547 22.9181 23.7865 22.8277 

190145 ............................................................................. 0.9240 0.7681 18.9678 19.9265 20.8537 19.9351 

190146 ............................................................................. 1.5652 0.8732 26.1792 27.4824 28.7186 27.4154 

190149 ............................................................................. 1.0427 * 18.8819 * * 18.8819 

190151 ............................................................................. 0.9491 0.7591 18.6293 18.7467 18.8350 18.7414 

190152 ............................................................................. 1.5642 0.8732 27.6099 28.1334 30.8510 28.8848 

190158 ............................................................................. *** * 26.3042 26.4787 30.6477 27.6762 

190160 ............................................................................. 1.6099 0.7872 21.6740 22.9325 24.7806 22.9867 

190161 ............................................................................. 1.2439 0.7787 19.1022 22.6187 22.9017 21.4139 

190162 ............................................................................. *** * 25.0328 25.2953 * 25.1543 

190164 ............................................................................. 1.1710 0.8204 22.8599 25.2560 26.6165 24.9924 

190167 ............................................................................. 1.2685 0.8323 24.3185 26.4669 25.3251 25.3437 

190175 ............................................................................. 1.3812 0.8732 27.1531 26.0547 27.4234 26.8723 

190176 ............................................................................. 1.7573 0.8732 25.6997 25.8826 26.2601 25.9478 

190177 ............................................................................. 1.7189 0.8732 27.4621 27.7792 28.2738 27.8343 

190182 ............................................................................. *** * 28.4799 27.1682 29.8646 28.5185 

190183 ............................................................................. 1.1704 0.7980 19.8084 22.6928 22.0098 21.4396 

190184 ............................................................................. 1.0119 0.7766 23.9608 24.9476 24.1551 24.3727 

mmaher on DSK3CLS3C1PROD with $$_JOB

24877 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

190185 ............................................................................. *** * 24.7912 25.6394 28.9749 26.4361 

190190 ............................................................................. 0.9347 0.7666 16.1195 24.3327 26.6988 22.8823 

190191 ............................................................................. 1.3282 0.8323 23.5734 24.1923 26.1592 24.6307 

190196 ............................................................................. 0.9301 0.8323 24.7135 24.0385 25.8459 24.8783 

190197 ............................................................................. 1.3888 0.7872 24.3735 25.8071 26.4794 25.5487 

190199 ............................................................................. 0.9962 0.8014 14.1409 27.3304 31.9843 22.9932 

190200 ............................................................................. *** * 27.5681 28.8173 27.4772 27.9970 

190201 ............................................................................. 1.2434 0.7787 24.5877 25.1010 24.4557 24.7118 

190202 ............................................................................. 1.4035 0.8014 24.7944 27.6084 29.6583 27.4867 

190203 ............................................................................. *** * 26.8795 28.1832 29.9743 28.2126 

190204 ............................................................................. 1.5156 0.8732 28.3684 28.1033 30.5137 28.9471 

190205 ............................................................................. 1.6777 0.8323 24.4540 26.6832 28.2453 26.4792 

190206 ............................................................................. 1.5774 0.8732 26.0139 26.7401 29.2352 27.2855 

190208 ............................................................................. 0.8622 0.7591 24.2588 28.7308 27.9789 27.1350 

190218 ............................................................................. 1.1036 0.8615 25.0356 26.7262 28.1014 26.6009 

190236 ............................................................................. 1.4949 0.8615 23.6824 24.7142 26.4588 24.9853 

190241 ............................................................................. 1.2210 0.7980 23.9700 25.2123 25.7878 25.0872 

190242 ............................................................................. 1.1667 0.8014 23.0072 24.8461 25.0011 24.3286 

190245 ............................................................................. 1.7065 0.7872 27.1786 25.5751 26.7636 26.5208 

190246 ............................................................................. 1.6693 0.7666 * * 22.7824 22.7824 

190247 ............................................................................. *** * * 32.7499 * 32.7499 

190248 ............................................................................. *** * * 23.2220 * 23.2220 

190249 ............................................................................. 1.8972 0.8014 * 20.0468 25.2505 22.1285 

190250 ............................................................................. 2.1200 0.8732 * 31.5101 33.3274 32.3417 

190251 ............................................................................. 1.2888 0.8014 * 21.4464 23.8397 22.5827 

190252 ............................................................................. *** * * 23.6924 * 23.6924 

190253 ............................................................................. *** * * 22.8060 23.8029 23.3045 

190254 ............................................................................. *** * * 32.9290 * 32.9290 

190255 ............................................................................. 0.7428 0.8323 * 22.2412 16.1597 18.3000 

190256 ............................................................................. 0.7572 0.8732 * * 25.9565 25.9565 

190257 ............................................................................. 1.6034 0.7641 * * 26.5480 26.5480 

190258 ............................................................................. 1.0329 0.8615 * 31.3715 26.1129 28.3727 

190259 ............................................................................. 1.8027 0.8323 * * 26.5073 26.5073 

190260 ............................................................................. *** * * * 29.3937 29.3937 

190261 ............................................................................. 1.6302 0.7872 * * 27.0423 27.0423 

190262 ............................................................................. *** * * * 30.3709 30.3709 

190263 ............................................................................. 2.4724 0.8323 * * 26.1353 26.1353 

190264 ............................................................................. *** * * * 26.5809 26.5809 

190265 ............................................................................. 0.7095 0.7872 * * 22.6214 22.6214 

190266 ............................................................................. 1.9489 0.8014 * * * * 

190267 ............................................................................. 1.1620 0.8732 * * * * 

190268 ............................................................................. 1.3593 0.8323 * * * * 

190270 ............................................................................. 1.7989 0.8732 * * * * 

190272 ............................................................................. 1.5539 0.8323 * * * * 

190273 ............................................................................. 1.6476 0.8014 * * * * 

200001 ............................................................................. 1.3871 0.9860 25.1144 25.2542 25.8813 25.4247 

200002 ............................................................................. 1.0767 0.8412 25.7478 25.7212 27.1134 26.1897 

200008 ............................................................................. 1.3366 1.0008 27.4412 27.7137 29.1729 28.1437 

200009 ............................................................................. 1.9757 1.0008 31.1056 30.7510 32.5792 31.4767 

200012 ............................................................................. 1.3501 * 25.7623 * * 25.7623 

200013 ............................................................................. *** * 24.4131 * * 24.4131 

200018 ............................................................................. 1.2572 0.8412 23.6337 23.5632 22.5017 23.1550 

200019 ............................................................................. 1.2471 1.0008 25.1367 25.6649 27.7886 26.2301 

200020 ............................................................................. 1.2349 1.0179 31.7083 32.6436 34.0918 32.8280 

200021 ............................................................................. 1.2518 1.0008 24.5519 27.1381 29.2049 27.0894 

200024 ............................................................................. 1.5842 0.9601 26.0080 27.5410 29.7792 27.8456 

200025 ............................................................................. 1.1474 1.0008 26.0573 26.3124 28.5747 27.0014 

200027 ............................................................................. *** * 26.3118 * * 26.3118 

200028 ............................................................................. *** * 24.3271 * * 24.3271 

200031 ............................................................................. 1.2585 0.8412 21.9489 21.2370 22.2140 21.8009 

200032 ............................................................................. 1.1124 0.8728 25.5227 26.3322 26.8986 26.2491 

mmaher on DSK3CLS3C1PROD with $$_JOB

24878 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

200033 ............................................................................. 1.8739 0.9860 28.6479 29.3108 31.6996 29.9418 

200034 ............................................................................. 1.3348 0.9601 26.2926 27.0582 27.0093 26.8000 

200037 ............................................................................. 1.2314 0.8412 23.2333 24.1732 24.9410 24.1296 

200039 ............................................................................. 1.3026 0.9601 25.1196 25.1179 26.6405 25.6397 

200040 ............................................................................. 1.2321 1.0008 25.5405 25.9893 28.5564 26.8006 

200041 ............................................................................. 1.1532 0.8412 24.5532 24.9670 26.6764 25.4292 

200050 ............................................................................. 1.2564 0.9860 26.4992 27.6825 29.5020 27.9403 

200052 ............................................................................. 1.0964 0.8412 21.8726 22.5159 24.3571 22.9652 

200063 ............................................................................. 1.1435 0.9601 25.0167 25.8623 27.9736 26.3217 

210001 ............................................................................. 1.3542 0.9443 27.7561 28.2858 29.3435 28.4858 

210002 ............................................................................. 1.9660 1.0108 26.4992 32.3005 36.0667 31.3519 

210003 ............................................................................. 1.6629 1.0679 29.8684 34.1109 30.7342 31.5420 

210004 ............................................................................. 1.4235 1.0990 34.2392 33.6056 31.7115 33.1029 

210005 ............................................................................. 1.2775 1.0990 28.7557 28.9554 29.5819 29.1061 

210006 ............................................................................. 1.0872 1.0108 25.4081 25.9005 27.3618 26.2241 

210007 ............................................................................. 1.8897 1.0108 30.2548 31.8767 30.7107 30.9321 

210008 ............................................................................. 1.3824 1.0108 25.2833 24.3341 28.8840 26.1400 

210009 ............................................................................. 1.6952 1.0108 26.2360 27.7900 30.2658 28.0854 

210010 ............................................................................. *** * 25.7775 * * 25.7775 

210011 ............................................................................. 1.3763 1.0108 27.5031 30.8575 31.5191 30.0101 

210012 ............................................................................. 1.6038 1.0108 27.4103 30.3078 31.1748 29.7268 

210013 ............................................................................. 1.2768 1.0108 25.1348 28.5328 28.9896 27.5055 

210015 ............................................................................. 1.2773 1.0108 28.2029 29.9261 32.2753 30.1829 

210016 ............................................................................. 1.7524 1.0990 32.2081 32.3506 33.5480 32.6959 

210017 ............................................................................. 1.1893 0.8917 23.2167 25.1890 26.8569 25.0995 

210018 ............................................................................. 1.1888 1.0990 29.1870 29.5533 29.6505 29.4657 

210019 ............................................................................. 1.7923 0.8917 26.1824 27.3731 28.7828 27.4738 

210022 ............................................................................. 1.3936 1.0990 33.8015 35.4727 37.3067 35.4764 

210023 ............................................................................. 1.4340 1.0178 30.4656 32.1812 32.9572 31.9405 

210024 ............................................................................. 1.7289 1.0108 29.5579 30.6359 32.9413 31.0661 

210025 ............................................................................. 1.2738 0.8917 26.0771 23.8552 24.8558 24.7696 

210027 ............................................................................. 1.5328 0.8917 26.0111 24.6343 24.4810 25.0054 

210028 ............................................................................. 1.0549 0.9273 25.9221 26.3469 26.7453 26.3458 

210029 ............................................................................. 1.2581 1.0108 27.9741 31.0266 31.8522 30.2804 

210030 ............................................................................. 1.2162 0.8917 29.5635 26.9763 32.2035 29.6025 

210032 ............................................................................. 1.1541 1.0752 26.1829 27.0727 27.9355 27.1027 

210033 ............................................................................. 1.1657 1.0108 29.0420 28.5534 29.2497 28.9509 

210034 ............................................................................. 1.3012 1.0108 28.4308 30.2908 32.3804 30.4301 

210035 ............................................................................. 1.2771 1.0679 26.1083 28.6484 27.3876 27.3991 

210037 ............................................................................. 1.1898 0.8917 27.0973 27.3287 27.8387 27.4523 

210038 ............................................................................. 1.2283 1.0108 29.5980 29.8121 32.3190 30.5512 

210039 ............................................................................. 1.1414 1.0679 27.6940 30.4991 32.4126 30.2663 

210040 ............................................................................. 1.2135 1.0108 29.3514 28.3559 29.2360 28.9742 

210043 ............................................................................. 1.2986 1.0178 27.5657 26.6524 32.6967 28.8479 

210044 ............................................................................. 1.3219 1.0108 28.8700 29.7339 30.3340 29.6364 

210045 ............................................................................. 0.9653 0.8917 15.6380 14.2223 16.3687 15.4676 

210048 ............................................................................. 1.2738 1.0108 28.4638 27.5043 26.0631 27.2649 

210049 ............................................................................. 1.2021 1.0108 26.9656 26.0900 27.0156 26.6995 

210051 ............................................................................. 1.3641 1.0679 29.2998 29.8892 30.4320 29.8760 

210054 ............................................................................. 1.2925 1.0679 26.2295 27.4328 27.7592 27.1401 

210055 ............................................................................. 1.1649 1.0679 29.9708 30.6941 31.4895 30.7115 

210056 ............................................................................. 1.2979 1.0108 28.6091 30.0810 32.3482 30.4741 

210057 ............................................................................. 1.3579 1.0990 32.2883 31.6787 32.8280 32.2611 

210058 ............................................................................. 1.0861 1.0108 29.7841 31.0873 31.6688 30.9534 

210060 ............................................................................. 1.1807 1.0679 28.5087 27.1764 29.9635 28.5560 

210061 ............................................................................. 1.2431 0.8917 23.6662 23.1645 25.0234 23.9963 

220001 ............................................................................. 1.2013 1.1256 29.0014 30.6070 31.2364 30.2908 

220002 ............................................................................. 1.3849 1.1256 30.3598 32.4356 33.6641 32.2134 

220003 ............................................................................. 1.1827 * 22.0549 * * 22.0549 

220006 ............................................................................. *** * 30.8599 30.7673 33.6421 31.7227 

220008 ............................................................................. 1.2815 1.1256 30.1043 31.3385 34.5830 32.0429 

mmaher on DSK3CLS3C1PROD with $$_JOB

24879 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

220010 ............................................................................. 1.2469 1.1256 29.7998 30.7804 31.9799 30.8557 

220011 ............................................................................. 1.1289 1.1256 34.4064 34.7655 36.5621 35.2403 

220012 ............................................................................. 1.5401 1.2617 35.7872 37.8763 39.7533 37.8795 

220015 ............................................................................. 1.1911 1.0236 28.3397 29.6315 32.4890 30.2084 

220016 ............................................................................. 1.1228 1.0236 28.0608 30.4813 31.3113 29.9507 

220017 ............................................................................. 1.2759 1.1710 29.7108 31.6170 33.2998 31.5458 

220019 ............................................................................. 1.0827 1.1256 23.2544 24.4009 25.7854 24.4946 

220020 ............................................................................. 1.2031 1.1256 26.5305 28.5288 31.0989 28.7645 

220024 ............................................................................. 1.2986 1.0236 27.3488 28.7342 31.9477 29.2908 

220025 ............................................................................. 1.0403 1.1256 23.0637 25.6478 30.4365 26.1068 

220028 ............................................................................. *** * 32.0980 31.7122 39.3268 34.1946 

220029 ............................................................................. 1.1325 1.1256 28.6970 30.6935 31.6352 30.3488 

220030 ............................................................................. 1.1318 1.0236 24.4289 26.8849 28.1322 26.5391 

220031 ............................................................................. 1.6575 1.1710 34.8183 36.8477 38.9417 36.9168 

220033 ............................................................................. 1.2129 1.1256 28.2539 31.8249 32.3475 30.8015 

220035 ............................................................................. 1.4185 1.1256 28.6238 31.4470 29.7381 29.8711 

220036 ............................................................................. 1.5118 1.1710 31.5184 33.1436 35.9106 33.5792 

220046 ............................................................................. 1.4766 1.0071 28.1396 30.4460 31.4997 30.0722 

220049 ............................................................................. 1.2129 1.1256 27.7518 30.4740 32.4636 30.2579 

220050 ............................................................................. 1.0822 1.0236 26.3768 28.3434 29.0272 27.9399 

220051 ............................................................................. 1.3072 0.9739 29.8380 30.2552 30.1012 30.0680 

220052 ............................................................................. 1.1348 1.1710 29.8577 32.4130 31.6356 31.2805 

220058 ............................................................................. 0.9616 1.1256 24.9642 25.7247 27.8893 26.1882 

220060 ............................................................................. 1.1736 1.1710 32.3362 32.5477 34.7327 33.2257 

220062 ............................................................................. 0.5719 1.1256 24.2779 25.0766 25.4179 24.9410 

220063 ............................................................................. 1.2562 1.1256 27.3968 30.2866 32.9101 30.2203 

220065 ............................................................................. 1.2427 1.0236 26.5513 27.6009 30.0468 28.0391 

220066 ............................................................................. 1.3446 1.0236 27.1317 27.8073 28.9742 27.9354 

220067 ............................................................................. 1.1851 1.1710 29.8911 30.2222 32.4000 30.8641 

220070 ............................................................................. 1.1334 1.1256 31.9283 33.1299 34.2574 33.1431 

220071 ............................................................................. 1.8646 1.1710 32.2936 36.5065 37.4053 35.4736 

220073 ............................................................................. 1.1771 1.1256 31.3566 34.2989 36.0252 33.8940 

220074 ............................................................................. 1.3059 1.1710 28.4930 30.5607 31.4701 30.1999 

220075 ............................................................................. 1.5111 1.1710 29.1588 30.9175 31.3628 30.4689 

220076 ............................................................................. *** * 29.7507 27.5148 * 28.6235 

220077 ............................................................................. 1.6760 1.0955 30.2684 31.7325 33.0291 31.6979 

220080 ............................................................................. 1.2069 1.1256 28.9835 29.9595 31.1248 30.0444 

220082 ............................................................................. 1.2848 1.1256 26.9841 30.0611 30.8211 29.3136 

220083 ............................................................................. 1.0840 1.1710 32.9143 34.5118 34.5698 33.9822 

220084 ............................................................................. 1.2047 1.1256 32.5711 30.9527 31.6948 31.7155 

220086 ............................................................................. 1.8174 1.1710 34.3667 34.2388 34.5669 34.3947 

220088 ............................................................................. 1.8786 1.1710 28.5462 35.8255 37.4460 33.3973 

220089 ............................................................................. *** * 31.1708 32.6305 34.7959 32.8331 

220090 ............................................................................. 1.1952 1.1256 30.8685 32.9011 33.8958 32.6221 

220095 ............................................................................. 1.1079 1.1256 27.4273 28.0673 30.1157 28.5485 

220098 ............................................................................. 1.1442 1.1256 28.8314 30.5869 31.5393 30.3882 

220100 ............................................................................. 1.3485 1.1710 29.6912 31.9859 34.6575 32.1939 

220101 ............................................................................. 1.2852 1.1256 33.1690 35.3464 37.5665 35.4542 

220105 ............................................................................. 1.2082 1.1256 31.9421 33.2625 32.8161 32.6900 

220108 ............................................................................. 1.1274 1.1710 30.6252 32.6131 33.8841 32.3642 

220110 ............................................................................. 2.0174 1.1710 36.6084 39.2167 41.0472 39.0591 

220111 ............................................................................. 1.2048 1.1710 31.1850 33.6167 34.8506 33.2566 

220116 ............................................................................. 1.9490 1.1710 32.9988 36.4149 38.8221 35.9865 

220119 ............................................................................. 1.0935 1.1710 30.1056 30.9965 32.0844 31.1223 

220126 ............................................................................. 1.1449 1.1710 28.7805 31.4882 32.5432 30.9197 

220133 ............................................................................. *** * 33.6003 29.4855 34.8935 32.6268 

220135 ............................................................................. 1.3229 1.2617 33.9866 36.0203 37.5164 35.8937 

220153 ............................................................................. *** * * * 19.8073 19.8073 

220154 ............................................................................. 0.9781 1.1710 28.6461 * 28.7843 28.7087 

220162 ............................................................................. 1.6507 * * * * * 

220163 ............................................................................. 1.5700 1.1256 33.6484 34.4874 37.4931 35.2930 

mmaher on DSK3CLS3C1PROD with $$_JOB

24880 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

220171 ............................................................................. 1.7192 1.1256 30.4036 32.7414 35.9925 33.0852 

220174 ............................................................................. 1.2036 1.1256 31.7572 30.0406 30.9354 30.8546 

220175 ............................................................................. 1.2654 * * * * * 

220176 ............................................................................. 1.6837 1.1341 * * * * 

230002 ............................................................................. 1.2951 1.0138 29.1410 32.9010 34.0440 32.0073 

230003 ............................................................................. 1.2255 0.9472 26.1278 27.5824 28.4694 27.4073 

230004 ............................................................................. 1.7409 0.9935 26.7206 29.3934 31.2926 29.2276 

230005 ............................................................................. 1.2575 0.9372 24.1902 25.8768 27.7463 25.8963 

230006 ............................................................................. 1.0740 * 23.8835 * * 23.8835 

230013 ............................................................................. 1.3227 1.0272 23.7822 24.6511 27.2066 25.1217 

230015 ............................................................................. 1.1463 0.9196 24.6571 26.2782 27.2542 26.0748 

230017 ............................................................................. 1.7002 1.0505 29.5178 31.8821 32.5376 31.3890 

230019 ............................................................................. 1.6505 1.0272 28.4575 32.3401 34.3193 31.6359 

230020 ............................................................................. 1.7492 1.0138 29.2869 28.5646 29.4792 29.1157 

230021 ............................................................................. 1.5950 1.0151 24.9551 26.5659 28.6153 26.7251 

230022 ............................................................................. 1.3120 0.9933 23.3000 25.6683 30.1226 26.2395 

230024 ............................................................................. 1.6703 1.0138 30.0813 32.1483 32.5866 31.6095 

230027 ............................................................................. 1.0649 * 23.5511 * * 23.5511 

230029 ............................................................................. 1.6011 1.0272 29.0935 32.3538 32.3835 31.2335 

230030 ............................................................................. 1.2717 0.8979 22.3174 23.8082 25.1077 23.7832 

230031 ............................................................................. 1.3725 1.0040 25.4679 29.7232 30.0088 28.2704 

230034 ............................................................................. 1.3787 0.8899 26.7967 24.4845 24.4133 25.2367 

230035 ............................................................................. 1.2605 0.9380 21.2317 24.8822 24.9648 23.8027 

230036 ............................................................................. 1.4572 0.9399 28.3622 29.3754 29.9622 29.2264 

230037 ............................................................................. 1.3454 1.0138 26.2000 28.9244 28.5469 27.9089 

230038 ............................................................................. 1.7903 0.9472 26.3480 28.2012 29.1247 27.9594 

230040 ............................................................................. 1.2075 0.9380 24.2349 25.5154 26.3754 25.4050 

230041 ............................................................................. 1.6026 0.9399 26.1760 27.8853 27.9569 27.3833 

230042 ............................................................................. *** * 26.2037 * * 26.2037 

230046 ............................................................................. 1.9037 1.0504 30.3591 31.6235 32.2914 31.4688 

230047 ............................................................................. 1.4047 1.0092 28.1351 31.1771 31.7053 30.3603 

230053 ............................................................................. 1.6336 1.0138 29.8703 32.5711 32.1537 31.5469 

230054 ............................................................................. 1.8873 0.9339 24.9905 25.7591 26.0031 25.5906 

230055 ............................................................................. 1.2628 0.8899 25.4143 27.4349 28.4779 27.1071 

230058 ............................................................................. 1.1265 0.8899 24.0657 25.9291 27.1214 25.7327 

230059 ............................................................................. 1.5531 0.9472 25.5350 27.9091 28.5859 27.3987 

230060 ............................................................................. 1.2198 0.8899 25.5015 28.2874 27.0286 26.9332 

230065 ............................................................................. *** * 28.4631 32.6255 * 29.9929 

230066 ............................................................................. 1.3087 0.9935 27.4928 30.6184 30.2070 29.5125 

230069 ............................................................................. 1.1594 1.0138 29.5556 30.2663 31.3407 30.4158 

230070 ............................................................................. 1.6381 0.9127 24.2342 25.6778 26.8296 25.5681 

230071 ............................................................................. 0.8679 1.0272 26.3907 28.3064 29.6710 28.1425 

230072 ............................................................................. 1.3914 0.9472 24.4933 26.2838 27.4723 26.0939 

230075 ............................................................................. 1.3793 1.0090 27.6193 28.2540 30.8862 28.9422 

230077 ............................................................................. 1.9012 1.0272 27.6157 29.8538 30.5516 29.3453 

230078 ............................................................................. 1.0892 0.8899 23.9902 25.6809 25.7228 25.1288 

230080 ............................................................................. 1.3068 0.9399 21.2314 24.1573 24.5418 23.3433 

230081 ............................................................................. 1.1913 0.8899 23.0788 24.7374 26.4321 24.7713 

230082 ............................................................................. 1.6774 * 22.2165 * * 22.2165 

230085 ............................................................................. 1.1930 1.0505 22.7313 23.4959 25.4277 23.9142 

230087 ............................................................................. *** * 16.9168 * * 16.9168 

230089 ............................................................................. 1.3349 1.0138 28.7015 31.0522 32.8429 30.6482 

230092 ............................................................................. 1.3637 1.0138 26.3584 28.6829 29.3419 28.2028 

230093 ............................................................................. 1.2101 0.8959 26.4967 25.5804 27.4458 26.5307 

230095 ............................................................................. 1.3066 0.8899 21.3916 22.8681 25.1829 23.1772 

230096 ............................................................................. 1.1221 1.0151 28.7681 30.6024 31.7385 30.4262 

230097 ............................................................................. 1.7992 0.9380 26.5773 28.2526 29.8946 28.2263 

230099 ............................................................................. 1.2069 1.0138 26.4882 29.0221 29.3700 28.3176 

230100 ............................................................................. 1.1878 0.8899 21.8895 24.1881 25.2112 23.7860 

230101 ............................................................................. 1.2004 0.8899 24.3772 25.4839 28.4355 26.1552 

230103 ............................................................................. *** * 21.6609 * * 21.6609 

mmaher on DSK3CLS3C1PROD with $$_JOB

24881 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

230104 ............................................................................. 1.5972 1.0138 30.5570 32.4634 32.4102 31.7987 

230105 ............................................................................. 1.8553 0.9399 27.2705 32.4583 30.5507 30.1271 

230106 ............................................................................. 1.1795 0.9472 24.3980 25.3243 27.8566 25.9485 

230108 ............................................................................. 1.1243 0.8899 18.4064 20.2539 24.4337 20.8956 

230110 ............................................................................. 1.2976 0.8899 28.7704 27.0040 25.7173 27.1019 

230117 ............................................................................. 1.8708 1.0505 29.4775 32.7994 33.0575 31.7174 

230118 ............................................................................. 1.0456 0.8899 22.3636 23.6110 24.8873 23.5918 

230119 ............................................................................. 1.3915 1.0138 30.2441 30.7488 31.9681 31.0533 

230120 ............................................................................. 1.1881 * 24.1485 * * 24.1485 

230121 ............................................................................. 1.2797 0.9933 24.5220 26.4940 26.8351 25.9742 

230130 ............................................................................. 1.7334 1.0272 26.6076 30.1608 31.2720 29.4071 

230132 ............................................................................. 1.4190 1.1078 30.5318 32.3939 35.5753 32.8039 

230133 ............................................................................. 1.3873 0.8899 24.3174 23.9442 25.0634 24.4534 

230135 ............................................................................. 1.4715 1.0138 25.8407 25.9583 23.6004 25.1117 

230141 ............................................................................. 1.6569 1.1078 28.6326 31.6152 33.8730 31.3710 

230142 ............................................................................. 1.2441 1.0138 26.9433 27.8377 29.7407 28.1855 

230143 ............................................................................. *** * 21.4083 * * 21.4083 

230144 ............................................................................. 2.3494 1.0504 * * * * 

230146 ............................................................................. 1.3935 1.0138 26.3432 26.8156 27.2610 26.8176 

230151 ............................................................................. 1.3152 1.0272 28.2243 27.4546 29.8352 28.4827 

230153 ............................................................................. *** * 22.8644 * * 22.8644 

230156 ............................................................................. 1.6276 1.0504 31.1909 32.3755 33.9016 32.4963 

230165 ............................................................................. 1.6917 1.0138 28.9636 29.6376 31.4221 30.0161 

230167 ............................................................................. 1.6184 1.0053 27.4562 29.8071 31.0585 29.4605 

230169 ............................................................................. *** * 31.8442 * * 31.8442 

230172 ............................................................................. 1.1867 * 25.7402 * * 25.7402 

230174 ............................................................................. 1.2752 0.9472 27.6920 30.0563 29.7361 29.1540 

230176 ............................................................................. 1.2857 1.0138 27.3605 28.1498 25.8188 27.0655 

230180 ............................................................................. 1.1332 0.8899 24.7358 26.0707 24.9693 25.2513 

230184 ............................................................................. *** * 23.6706 34.6295 * 25.2502 

230186 ............................................................................. *** * 26.2282 * * 26.2282 

230189 ............................................................................. *** * 23.0100 * * 23.0100 

230190 ............................................................................. 0.8738 1.0505 29.9603 30.7875 33.8238 31.5782 

230193 ............................................................................. 1.2840 1.0040 23.3565 25.1626 26.4717 25.0021 

230195 ............................................................................. 1.4440 1.0092 28.2892 29.5656 30.9245 29.6342 

230197 ............................................................................. 1.5802 1.1078 30.0367 32.0063 33.6990 31.9260 

230204 ............................................................................. 1.3301 1.0092 29.1466 31.5615 32.2850 31.0158 

230207 ............................................................................. 1.3447 1.0272 24.5201 25.4268 25.2547 25.0743 

230208 ............................................................................. 1.1990 0.9380 21.9651 23.7523 24.3741 23.3710 

230212 ............................................................................. 0.9926 1.0504 29.7981 31.9818 32.8564 31.5064 

230216 ............................................................................. 1.5508 1.0040 27.5230 29.0147 29.2047 28.5834 

230217 ............................................................................. 1.3812 0.9933 28.6074 30.1136 31.9706 30.2655 

230222 ............................................................................. 1.3799 0.9399 26.9724 29.9341 30.6473 29.2057 

230223 ............................................................................. 1.2979 1.0272 29.2854 28.6745 29.8419 29.2657 

230227 ............................................................................. 1.4986 1.0092 29.5798 30.8218 33.6697 31.2203 

230230 ............................................................................. 1.5219 1.0053 27.9607 29.8763 31.1701 29.6591 

230235 ............................................................................. 1.0691 * 21.8777 * * 21.8777 

230236 ............................................................................. 1.5046 0.9472 28.4754 31.3110 30.8531 30.2122 

230239 ............................................................................. 1.2710 0.8899 22.1040 21.0814 22.1569 21.7756 

230241 ............................................................................. 1.2149 1.0040 27.4890 27.6106 28.5505 27.9009 

230244 ............................................................................. 1.4355 1.0138 26.4326 29.6283 30.0355 28.6450 

230254 ............................................................................. 1.5080 1.0272 28.1216 29.2653 29.5865 28.9731 

230257 ............................................................................. 0.9510 1.0092 27.8198 29.6712 30.6373 29.3897 

230259 ............................................................................. 1.2666 1.0504 26.8677 27.4217 27.5982 27.2972 

230264 ............................................................................. 1.8606 1.0092 19.2398 22.7768 28.5389 23.0403 

230269 ............................................................................. 1.5016 1.0272 28.8187 31.3226 31.3773 30.6050 

230270 ............................................................................. 1.2640 1.0138 27.8488 28.5372 28.8505 28.4218 

230273 ............................................................................. 1.5123 1.0138 29.9307 31.9862 31.5372 31.1375 

230275 ............................................................................. 0.4718 0.9127 23.1095 23.8104 25.2117 24.0696 

230277 ............................................................................. 1.4037 1.0272 29.1973 29.8372 31.4001 30.1455 

230279 ............................................................................. 0.4947 1.0138 24.7673 27.2816 27.9709 26.6920 

mmaher on DSK3CLS3C1PROD with $$_JOB

24882 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

230283 ............................................................................. *** * 26.2622 33.5531 * 27.8105 

230289 ............................................................................. *** * 29.7721 * * 29.7721 

230291 ............................................................................. *** * 30.9656 * * 30.9656 

230292 ............................................................................. *** * 31.8943 * * 31.8943 

230294 ............................................................................. *** * * 31.6195 * 31.6195 

230295 ............................................................................. *** * * 27.1298 * 27.1298 

230296 ............................................................................. *** * * * 34.2091 34.2091 

230297 ............................................................................. 1.6725 1.0092 * * * * 

230299 ............................................................................. 0.7569 1.0092 * * * * 

230300 ............................................................................. 2.9372 1.0092 * * * * 

240001 ............................................................................. 1.5321 1.0961 31.5753 33.1499 34.9488 33.2343 

240002 ............................................................................. 1.8802 1.0151 28.9860 31.6000 33.5414 31.3640 

240004 ............................................................................. 1.5917 1.0961 30.8072 32.7010 32.0885 31.8534 

240006 ............................................................................. 1.0930 1.0761 30.1949 31.0777 34.0824 31.7954 

240010 ............................................................................. 2.0488 1.0761 31.3733 33.4668 33.9391 32.9198 

240013 ............................................................................. *** * 28.3860 * * 28.3860 

240014 ............................................................................. 1.0233 1.0961 29.8623 29.8905 31.5902 30.4899 

240016 ............................................................................. 1.2758 * 26.7814 * * 26.7814 

240017 ............................................................................. 1.1862 * 24.4417 24.3596 * 24.4015 

240018 ............................................................................. 1.2795 1.0085 25.6236 28.1432 29.6619 27.8174 

240019 ............................................................................. 1.0510 1.0151 28.6723 33.7546 32.9757 31.6807 

240020 ............................................................................. 1.0696 1.0961 31.2443 31.3874 33.4700 32.0413 

240021 ............................................................................. 1.0320 * 27.1236 * * 27.1236 

240022 ............................................................................. 1.0296 0.9212 25.2066 26.1920 27.4384 26.3075 

240027 ............................................................................. 0.9334 * 18.2482 * * 18.2482 

240029 ............................................................................. 0.9036 * 25.3568 * * 25.3568 

240030 ............................................................................. 1.3356 1.0390 24.7154 26.5508 27.1291 26.1210 

240031 ............................................................................. *** * 26.7778 * * 26.7778 

240036 ............................................................................. 1.6917 1.0961 28.0812 32.7028 34.2927 31.6446 

240038 ............................................................................. 1.5420 1.0961 31.0779 31.9891 33.2977 32.1250 

240040 ............................................................................. 1.0727 1.0151 27.4895 27.5074 29.2269 28.0678 

240043 ............................................................................. 1.2145 0.9212 21.8684 23.3489 24.2153 23.1696 

240044 ............................................................................. 1.0574 0.9883 22.0973 25.0988 26.8667 24.6227 

240047 ............................................................................. 1.5016 1.0151 28.8289 28.6406 29.7813 29.0973 

240050 ............................................................................. 1.1126 1.0961 26.4854 27.5553 31.2060 28.4938 

240052 ............................................................................. 1.2197 0.9212 26.4256 28.7206 29.4594 28.2281 

240053 ............................................................................. 1.4802 1.0961 29.5315 31.4324 33.1815 31.4253 

240056 ............................................................................. 1.2486 1.0961 31.6623 33.1728 33.9981 32.9754 

240057 ............................................................................. 1.8365 1.0961 30.6258 30.7703 33.6438 31.6657 

240059 ............................................................................. 1.1404 1.0961 29.7916 31.0911 33.3840 31.4927 

240061 ............................................................................. 1.8183 1.0761 30.6383 33.1799 32.1083 31.9962 

240063 ............................................................................. 1.6444 1.0961 32.3487 33.7895 35.3585 33.8590 

240064 ............................................................................. 1.1841 1.0020 29.9662 34.3757 27.2367 30.4831 

240066 ............................................................................. 1.5085 1.0961 33.4532 35.3441 36.1920 35.0530 

240069 ............................................................................. 1.2060 1.0761 28.9496 29.3718 31.1575 29.8505 

240071 ............................................................................. 1.1294 1.0761 28.0586 28.6950 31.7403 29.4814 

240075 ............................................................................. 1.1560 1.0390 26.1956 27.5039 29.1165 27.5981 

240076 ............................................................................. 1.0348 1.0961 29.8561 30.6936 33.0908 31.3206 

240078 ............................................................................. 1.7539 1.0961 32.3235 32.5785 35.5096 33.5022 

240080 ............................................................................. 1.9135 1.0961 31.6828 32.5725 34.9990 33.0567 

240083 ............................................................................. 1.2282 * 26.6582 * * 26.6582 

240084 ............................................................................. 1.1715 1.0151 26.8141 26.5975 26.6137 26.6743 

240088 ............................................................................. 1.2868 1.0390 28.0825 28.0603 30.7452 28.9706 

240093 ............................................................................. 1.4141 1.0961 25.5805 27.2928 29.1386 27.3669 

240100 ............................................................................. 1.3062 0.9212 27.6299 30.8391 31.5746 30.0094 

240101 ............................................................................. 1.1577 0.9212 25.5355 25.6963 26.8837 26.0839 

240103 ............................................................................. *** * 22.7077 * * 22.7077 

240104 ............................................................................. 1.1355 1.0961 31.4306 31.6511 34.8590 32.7610 

240106 ............................................................................. 1.6068 1.0961 29.3455 30.5927 33.3656 31.1028 

240109 ............................................................................. 0.8676 * 16.5051 * * 16.5051 

240115 ............................................................................. 1.5324 1.0961 31.3869 32.0107 33.7716 32.4047 

mmaher on DSK3CLS3C1PROD with $$_JOB

24883 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

240117 ............................................................................. 1.1786 0.9805 23.6230 24.5750 27.6916 25.3192 

240123 ............................................................................. *** * 21.7500 * * 21.7500 

240128 ............................................................................. *** * 21.5791 23.3334 * 22.4504 

240132 ............................................................................. 1.2801 1.0961 31.7139 32.1233 34.6782 32.8020 

240141 ............................................................................. 1.1202 1.0961 26.4016 31.4468 32.3861 30.2635 

240143 ............................................................................. 0.8966 * 21.7416 * * 21.7416 

240152 ............................................................................. *** * 29.6196 * * 29.6196 

240162 ............................................................................. *** * 22.2722 * * 22.2722 

240166 ............................................................................. 1.1548 0.9212 25.7509 27.6987 29.6615 27.8068 

240187 ............................................................................. 1.3295 1.0961 27.8811 27.8844 29.6502 28.5206 

240196 ............................................................................. 0.8200 1.0961 30.7720 31.5965 34.1199 32.1844 

240206 ............................................................................. 0.8831 1.4406 * * * * 

240207 ............................................................................. 1.1958 1.0961 31.7665 32.5589 34.9881 33.1636 

240210 ............................................................................. 1.2897 1.0961 32.1564 32.7123 34.4858 33.1223 

240211 ............................................................................. 0.9769 0.9598 18.8503 22.5430 29.3644 22.2558 

240213 ............................................................................. 1.3950 1.0961 32.7532 33.8680 35.9799 34.2403 

250001 ............................................................................. 1.9054 0.8273 22.7827 23.5222 24.5227 23.6272 

250002 ............................................................................. 0.9546 0.7971 23.3844 23.4063 25.4201 24.0840 

250004 ............................................................................. 1.9123 0.8951 24.1065 24.7907 25.8710 24.9580 

250006 ............................................................................. 1.1113 0.8951 24.0191 24.4282 25.9197 24.8139 

250007 ............................................................................. 1.2347 0.8618 25.8710 24.8929 27.7647 26.1856 

250009 ............................................................................. 1.2422 0.8432 22.2323 23.0352 23.4128 22.8968 

250010 ............................................................................. 0.9918 0.7915 19.4402 21.4322 21.8643 20.9156 

250012 ............................................................................. 0.9475 0.9291 20.2922 21.5540 23.3688 21.7206 

250015 ............................................................................. 1.1234 0.7915 20.7555 22.0067 22.2776 21.6577 

250017 ............................................................................. 1.0264 0.7915 21.3950 22.7660 33.6797 25.4557 

250018 ............................................................................. 0.8932 0.7915 16.6292 17.1276 17.9011 17.2147 

250019 ............................................................................. 1.5216 0.8618 23.9741 25.7376 26.2315 25.3074 

250020 ............................................................................. 0.9941 0.7915 21.4019 22.1851 23.7217 22.4960 

250021 ............................................................................. *** * 20.3564 * * 20.3564 

250023 ............................................................................. 0.8676 0.8223 16.2418 18.0108 18.4674 17.5916 

250025 ............................................................................. 1.0998 0.7915 20.5258 22.5621 23.1721 22.1086 

250027 ............................................................................. 0.9597 0.7915 17.3481 24.4937 26.9874 22.7342 

250031 ............................................................................. 1.3175 0.8273 21.4326 24.8139 55.6623 27.5006 

250034 ............................................................................. 1.5394 0.8951 24.3189 26.1887 27.0455 25.8383 

250035 ............................................................................. 0.8591 0.7915 17.2046 20.1622 19.6892 19.0949 

250036 ............................................................................. 1.0384 0.8544 19.1975 20.3625 19.7915 19.8090 

250037 ............................................................................. 0.9020 * 17.4012 * * 17.4012 

250038 ............................................................................. 0.9401 0.8273 18.9050 22.2571 26.9582 22.1495 

250039 ............................................................................. 0.9692 * 17.3155 * * 17.3155 

250040 ............................................................................. 1.4830 0.8223 23.2285 24.5962 27.3356 25.0598 

250042 ............................................................................. 1.2092 0.8951 23.4135 25.6807 26.1154 25.0557 

250043 ............................................................................. 1.0145 0.7915 19.8097 18.8979 20.8820 19.8715 

250044 ............................................................................. 1.0512 0.7971 23.3862 24.0508 24.9245 24.1146 

250045 ............................................................................. 0.8706 * 26.3831 * * 26.3831 

250048 ............................................................................. 1.6243 0.8273 22.9765 25.2092 24.7651 24.3109 

250049 ............................................................................. 0.8732 0.7915 17.7005 19.1044 20.4694 19.2002 

250050 ............................................................................. 1.1890 0.7915 19.1467 20.8084 21.1669 20.4034 

250051 ............................................................................. 0.8083 0.7915 10.6095 14.3741 13.9457 12.9300 

250057 ............................................................................. 1.1224 0.7915 20.1900 22.7601 24.3633 22.3987 

250058 ............................................................................. 1.2423 0.7915 18.1704 19.2502 18.9952 18.8123 

250059 ............................................................................. 0.9230 0.7915 19.2976 23.8997 26.7379 23.0872 

250060 ............................................................................. 0.7986 0.7915 16.8247 28.1431 25.4705 22.9625 

250061 ............................................................................. 0.9038 0.7915 12.8174 17.8267 18.7359 16.2197 

250067 ............................................................................. 1.0777 0.7915 21.6911 23.1193 25.2181 23.3708 

250069 ............................................................................. 1.4806 0.8166 22.8162 22.6353 22.4221 22.6169 

250072 ............................................................................. 1.6976 0.8273 24.6587 25.8399 25.5321 25.3433 

250077 ............................................................................. 0.9345 0.7915 14.7632 18.3735 19.0379 17.4294 

250078 ............................................................................. 1.6953 0.8223 20.9354 22.1243 22.8399 21.9357 

250079 ............................................................................. 0.8536 0.8273 38.0032 45.5166 43.0813 42.6359 

250081 ............................................................................. 1.3342 0.8166 24.7031 23.9995 25.6789 24.7909 

mmaher on DSK3CLS3C1PROD with $$_JOB

24884 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

250082 ............................................................................. 1.4651 0.7959 19.6966 23.0287 23.5384 22.0708 

250084 ............................................................................. 1.2101 0.7915 18.5775 19.6492 19.1096 19.1057 

250085 ............................................................................. 1.0005 0.7915 19.7008 22.5513 24.2875 22.2560 

250093 ............................................................................. 1.1880 0.7915 21.3237 23.0984 23.9098 22.7648 

250094 ............................................................................. 1.7339 0.8223 22.7312 24.1422 24.7709 23.8832 

250095 ............................................................................. 1.0360 0.7915 21.3511 21.7488 23.6079 22.2424 

250096 ............................................................................. 1.1761 0.8273 22.6298 24.9187 26.3717 24.6250 

250097 ............................................................................. 1.6174 0.8014 20.1687 21.8139 22.0204 21.3427 

250099 ............................................................................. 1.2805 0.8273 19.5797 21.1269 21.9028 20.8103 

250100 ............................................................................. 1.4738 0.8166 24.2209 25.6846 27.0283 25.6565 

250101 ............................................................................. *** * 19.3543 * * 19.3543 

250102 ............................................................................. 1.5948 0.8273 24.2868 24.6652 25.4029 24.7878 

250104 ............................................................................. 1.4895 0.8166 22.6591 23.4303 24.4287 23.5414 

250105 ............................................................................. 0.9250 * 18.1195 * * 18.1195 

250107 ............................................................................. 0.5882 * 17.8999 * * 17.8999 

250112 ............................................................................. 0.9900 0.7915 21.2824 24.3069 26.3311 23.9682 

250117 ............................................................................. 1.1064 0.8223 23.3673 22.2450 23.7325 23.1044 

250120 ............................................................................. *** * 23.4277 24.6370 26.6502 24.9393 

250122 ............................................................................. 1.1114 0.7915 24.5854 27.2795 27.4403 26.3821 

250123 ............................................................................. 1.3317 0.8618 24.5115 26.6221 27.9144 26.3804 

250124 ............................................................................. 0.8188 0.8273 17.2181 20.4394 20.5596 19.3903 

250125 ............................................................................. 1.2236 0.8618 27.7077 27.5158 26.8377 27.3634 

250126 ............................................................................. 0.9502 0.7915 21.7112 24.4126 25.6980 23.8290 

250127 ............................................................................. 0.8851 1.4406 * * * * 

250128 ............................................................................. 0.9292 0.8308 17.6269 17.7624 21.7827 19.2616 

250134 ............................................................................. 0.8844 0.8273 25.8369 22.2167 21.0199 22.9407 

250136 ............................................................................. 1.0311 0.8273 23.0637 22.9468 25.2250 23.7174 

250138 ............................................................................. 1.3295 0.8273 23.8861 24.3018 25.2632 24.4952 

250141 ............................................................................. 1.5450 0.9291 27.6158 28.5922 30.5462 28.9990 

250146 ............................................................................. 0.7934 * 18.6486 * * 18.6486 

250149 ............................................................................. 0.8346 0.7915 15.0641 16.8796 17.2245 16.4086 

250151 ............................................................................. 0.4710 0.7915 17.2205 18.8846 22.8221 18.4859 

250152 ............................................................................. 0.8555 0.8273 25.7837 26.9334 26.4561 26.3576 

250153 ............................................................................. *** * 29.0461 * * 29.0461 

250155 ............................................................................. *** * * 22.5728 * 22.5728 

250156 ............................................................................. *** * * * 16.8646 16.8646 

250157 ............................................................................. *** * * * 29.6366 29.6366 

250160 ............................................................................. 1.4401 0.8308 * * * * 

250161 ............................................................................. 2.1565 0.8273 * * * * 

260001 ............................................................................. 1.6521 0.9318 25.9250 27.9230 29.5231 27.7476 

260002 ............................................................................. *** * 26.4879 * * 26.4879 

260004 ............................................................................. 0.9694 0.8145 16.9422 20.3217 21.3539 19.5722 

260005 ............................................................................. 1.5541 0.8885 26.5773 27.7855 27.9465 27.4311 

260006 ............................................................................. 1.4864 0.8145 26.7587 30.3440 27.3734 28.2406 

260008 ............................................................................. *** * 18.9522 * * 18.9522 

260009 ............................................................................. 1.1616 0.9321 22.1816 24.2360 25.7517 24.0687 

260011 ............................................................................. 1.5006 0.8706 22.7062 25.6387 27.5729 25.2802 

260012 ............................................................................. *** * 20.3061 * * 20.3061 

260013 ............................................................................. *** * 20.5007 * * 20.5007 

260015 ............................................................................. 1.0081 0.8507 22.5409 24.6139 25.0595 24.0549 

260017 ............................................................................. 1.3305 0.8706 22.7022 23.5713 24.9740 23.7836 

260018 ............................................................................. 1.0396 * 17.0434 * * 17.0434 

260020 ............................................................................. 1.7371 0.8885 26.0407 27.4730 29.3071 27.6646 

260021 ............................................................................. 1.3993 0.8885 27.6329 29.3646 31.7013 29.4504 

260022 ............................................................................. 1.4087 0.8480 22.8085 23.3393 24.8696 23.6522 

260023 ............................................................................. 1.3563 0.8885 21.2077 24.3192 25.4291 23.5894 

260024 ............................................................................. 1.1337 0.8145 18.4829 19.4952 19.2179 19.0576 

260025 ............................................................................. 1.3611 0.8885 22.4645 22.2451 24.0348 22.9414 

260027 ............................................................................. 1.6424 0.9321 25.3348 26.3590 29.3205 26.9768 

260032 ............................................................................. 1.8499 0.8885 23.9478 25.6763 25.8890 25.1792 

260034 ............................................................................. 0.9779 0.9321 24.1143 25.0573 27.1644 25.5181 

mmaher on DSK3CLS3C1PROD with $$_JOB

24885 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

260035 ............................................................................. *** * 17.8741 * * 17.8741 

260036 ............................................................................. *** * 22.1913 * * 22.1913 

260040 ............................................................................. 1.6639 0.9196 23.3566 24.3938 28.5815 25.2261 

260047 ............................................................................. 1.4482 0.8706 24.4185 25.4978 26.6318 25.5311 

260048 ............................................................................. 1.1759 0.9321 24.3906 27.6117 28.2868 26.7437 

260050 ............................................................................. 1.1594 0.8831 23.6849 25.0506 26.2320 25.0309 

260052 ............................................................................. 1.3110 0.8885 24.5165 26.0052 27.6348 26.0327 

260053 ............................................................................. 1.0761 * 21.6607 * * 21.6607 

260057 ............................................................................. 1.0699 0.9321 19.3335 20.9639 21.5895 20.6144 

260059 ............................................................................. 1.1568 0.8272 19.7243 22.6922 22.3875 21.6445 

260061 ............................................................................. 1.1351 0.8145 21.5264 22.4766 22.8581 22.2790 

260062 ............................................................................. 1.2507 0.9321 26.4539 28.1661 28.4951 27.7044 

260064 ............................................................................. 1.3834 0.8545 19.0543 22.2395 23.5352 21.5798 

260065 ............................................................................. 1.7778 0.9196 23.0015 27.1014 29.3548 26.5318 

260067 ............................................................................. 0.9311 * 17.6256 * * 17.6256 

260068 ............................................................................. 1.7969 0.8545 24.9504 26.0295 27.3717 26.1290 

260070 ............................................................................. 0.9563 0.8145 18.4779 24.6331 21.9646 21.9639 

260073 ............................................................................. *** * 21.6214 * * 21.6214 

260074 ............................................................................. 1.2375 0.8545 24.8655 25.6218 28.0454 26.1516 

260077 ............................................................................. 1.6221 0.8885 25.5782 26.7466 27.7359 26.6839 

260078 ............................................................................. 1.2835 0.8145 19.0802 20.1983 21.1532 20.1475 

260080 ............................................................................. 0.9195 0.8145 14.7774 17.9107 18.6028 17.0061 

260081 ............................................................................. 1.5691 0.8885 26.3969 28.1182 29.1725 27.9063 

260085 ............................................................................. 1.5670 0.9321 25.6302 26.6718 28.0298 26.7543 

260086 ............................................................................. 0.9570 * 19.1702 * * 19.1702 

260091 ............................................................................. 1.5269 0.8885 27.2407 28.0537 28.5213 27.9452 

260094 ............................................................................. 1.7017 0.8943 23.2544 24.1473 23.8642 23.7598 

260095 ............................................................................. 1.3903 0.9321 25.5668 24.2698 27.3917 25.6438 

260096 ............................................................................. 1.4990 0.9321 27.5592 29.7312 30.7246 29.3745 

260097 ............................................................................. 1.2006 0.8440 21.3957 25.0624 25.5604 24.1093 

260102 ............................................................................. 0.9518 0.9321 24.2368 27.2145 26.7618 26.1063 

260104 ............................................................................. 1.5655 0.8885 26.2867 28.6247 28.0218 27.6808 

260105 ............................................................................. 1.8539 0.8885 28.8849 29.8848 29.4761 29.4215 

260107 ............................................................................. 1.2949 0.9321 26.7781 25.8177 27.8030 26.7722 

260108 ............................................................................. 1.8342 0.8885 24.9880 26.6374 27.0748 26.2654 

260110 ............................................................................. 1.6392 0.8885 23.7978 24.7656 * 24.2985 

260113 ............................................................................. 1.1068 0.8355 20.9644 21.2072 21.8850 21.3616 

260115 ............................................................................. 1.1392 0.8885 21.9858 23.1396 24.6379 23.3009 

260116 ............................................................................. 1.0986 0.8145 18.5076 21.3503 20.7451 20.1801 

260119 ............................................................................. 1.3299 0.8507 24.9937 27.9769 31.5417 28.0654 

260122 ............................................................................. *** * 20.8015 * * 20.8015 

260127 ............................................................................. 0.9486 * 21.8533 * * 21.8533 

260137 ............................................................................. 1.7247 0.9318 22.7431 24.3273 28.2386 25.0868 

260138 ............................................................................. 1.9895 0.9321 28.5610 30.4410 30.7179 29.9246 

260141 ............................................................................. 1.8510 0.8545 22.4886 24.1555 25.5660 24.0282 

260142 ............................................................................. 1.0871 0.8145 20.3993 21.5923 21.7584 21.2691 

260147 ............................................................................. 0.9229 0.8145 18.5153 21.4235 22.1878 20.7802 

260159 ............................................................................. *** * 23.7427 22.6276 23.9520 23.4461 

260160 ............................................................................. 1.0728 0.8145 21.0544 23.8257 25.5072 23.4620 

260162 ............................................................................. 1.3823 0.8885 25.1423 27.0236 28.4645 26.9318 

260163 ............................................................................. 1.1437 0.8145 20.1949 21.6408 21.5551 21.0992 

260164 ............................................................................. 1.3771 * 19.7068 * * 19.7068 

260166 ............................................................................. 1.2260 0.9321 27.0237 29.1225 28.4735 28.1987 

260175 ............................................................................. 1.0782 0.9321 22.6171 25.1817 24.6035 24.1897 

260176 ............................................................................. 1.7016 0.8885 27.4244 29.3034 31.1025 29.3195 

260177 ............................................................................. 1.2061 0.9321 26.1178 27.0185 28.7735 27.3063 

260178 ............................................................................. 1.8406 0.8545 22.2251 25.4782 27.1192 25.2033 

260179 ............................................................................. 1.5483 0.8885 26.1419 26.6069 28.1578 26.9703 

260180 ............................................................................. 1.5417 0.8885 26.7461 28.2931 29.3792 28.1552 

260183 ............................................................................. 1.6671 0.8885 26.0418 27.5577 29.2666 27.6346 

260186 ............................................................................. 1.5449 0.8706 25.3148 26.9797 28.8584 27.0989 

mmaher on DSK3CLS3C1PROD with $$_JOB

24886 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

260190 ............................................................................. 1.1940 0.9321 26.4505 27.9137 30.5095 28.3280 

260191 ............................................................................. 1.3655 0.8885 23.3856 24.6973 26.3196 24.8420 

260193 ............................................................................. 1.1900 0.9321 26.2979 26.8922 28.1060 27.0944 

260195 ............................................................................. 1.2147 0.8145 22.3959 22.6870 24.0387 23.0815 

260198 ............................................................................. 0.9613 0.8885 27.5996 28.0021 27.2554 27.6065 

260200 ............................................................................. 1.2655 0.8885 24.8624 28.2453 27.4813 26.8911 

260207 ............................................................................. 1.1543 0.9196 19.7294 22.6109 22.9594 22.0277 

260209 ............................................................................. 1.1051 0.8706 23.2430 25.0098 25.0733 24.4643 

260210 ............................................................................. 1.2690 0.8885 25.3781 26.8745 30.6046 27.6608 

260211 ............................................................................. 1.5777 0.9321 33.9109 40.9821 35.9066 37.0319 

260213 ............................................................................. *** * * * 34.8944 34.8944 

260214 ............................................................................. 1.2355 0.9321 * * * * 

260215 ............................................................................. 0.8925 * * * * * 

260216 ............................................................................. 1.1874 0.9321 * * * * 

260217 ............................................................................. 1.9096 0.8145 * * * * 

270002 ............................................................................. 1.1595 0.8337 22.7322 24.0534 25.2902 24.0315 

270003 ............................................................................. 1.3079 0.8765 26.4843 28.8700 29.2082 28.2134 

270004 ............................................................................. 1.6792 0.8877 23.5454 26.1319 26.7037 25.4969 

270011 ............................................................................. 1.0335 0.8337 22.1394 22.7061 24.4678 23.0847 

270012 ............................................................................. 1.5539 0.8765 25.2873 25.2914 26.5782 25.7174 

270014 ............................................................................. 1.9641 0.8737 26.2025 25.8231 27.4790 26.5061 

270017 ............................................................................. 1.3145 0.8737 27.5483 26.5404 27.4092 27.1700 

270021 ............................................................................. *** * 21.7056 * * 21.7056 

270023 ............................................................................. 1.5491 0.8737 26.7576 25.5682 26.2592 26.1753 

270032 ............................................................................. 1.0285 0.8337 19.6212 20.3469 20.4332 20.1360 

270036 ............................................................................. *** * 20.4241 * * 20.4241 

270049 ............................................................................. 1.7523 0.8877 26.3996 27.1634 28.6651 27.4207 

270051 ............................................................................. 1.5590 0.8337 26.6619 26.5621 24.8924 25.9335 

270057 ............................................................................. 1.2521 0.8337 24.2980 25.5811 27.1840 25.7302 

270060 ............................................................................. *** * 17.7564 * * 17.7564 

270074 ............................................................................. 0.9141 1.4406 * * * * 

270081 ............................................................................. 0.9750 0.8573 17.4862 19.5612 20.0422 18.9880 

270086 ............................................................................. 1.0637 0.8765 * 21.0808 20.7990 20.9439 

270087 ............................................................................. 1.2165 0.8337 * 25.9772 24.8182 25.3750 

280003 ............................................................................. 1.7455 0.9836 29.3921 30.6124 29.8995 29.9681 

280009 ............................................................................. 1.8639 0.9603 26.7678 27.0705 29.3561 27.7370 

280013 ............................................................................. 1.7316 0.9419 26.1908 27.0250 27.9514 27.0724 

280020 ............................................................................. 1.7365 0.9836 26.5068 27.3284 32.3886 28.7653 

280021 ............................................................................. 1.1556 * 22.0489 * * 22.0489 

280023 ............................................................................. 1.3658 0.9603 22.3230 26.7980 29.5116 26.0300 

280030 ............................................................................. 1.8923 0.9419 30.7481 29.5102 30.6995 30.3315 

280032 ............................................................................. 1.2987 0.9603 23.6462 24.3995 24.7535 24.2695 

280040 ............................................................................. 1.6382 0.9419 26.9827 28.7207 29.5254 28.4311 

280054 ............................................................................. 1.1439 * 23.5665 * * 23.5665 

280057 ............................................................................. 0.8567 * 20.4830 * * 20.4830 

280060 ............................................................................. 1.6740 0.9419 26.2139 27.7496 30.3288 28.0764 

280061 ............................................................................. 1.3931 0.9049 24.9482 26.0208 26.4808 25.8452 

280065 ............................................................................. 1.2398 0.9747 26.0135 28.0581 27.9710 27.3272 

280077 ............................................................................. 1.3381 0.8905 25.5624 27.0860 28.2199 26.9868 

280081 ............................................................................. 1.7001 0.9419 26.0541 28.7464 31.1636 28.6498 

280105 ............................................................................. 1.2700 0.9419 26.7555 27.8599 24.0173 26.1446 

280108 ............................................................................. 1.0629 * 23.2503 * * 23.2503 

280111 ............................................................................. 1.1871 0.8848 23.4770 24.5617 27.4621 25.3069 

280117 ............................................................................. 1.1227 * 24.1521 * * 24.1521 

280119 ............................................................................. 0.8644 1.4406 * * * * 

280123 ............................................................................. 0.9968 0.8966 * 15.4047 22.2049 17.7468 

280125 ............................................................................. 1.5933 0.8848 21.7657 22.1345 23.2889 22.4198 

280127 ............................................................................. 1.7915 0.9836 * 29.3684 25.6815 27.2620 

280128 ............................................................................. 2.9058 0.9836 * 28.5422 28.8725 28.7209 

280129 ............................................................................. 1.9022 0.9419 * * 27.8784 27.8784 

280130 ............................................................................. 1.3728 0.9419 * * 30.5784 30.5784 

mmaher on DSK3CLS3C1PROD with $$_JOB

24887 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

290001 ............................................................................. 1.8544 1.1062 31.1981 36.3129 35.5076 34.2980 

290002 ............................................................................. 0.9059 0.9688 18.3469 17.3876 24.0115 19.4175 

290003 ............................................................................. 1.8294 1.1431 28.1625 30.3373 32.8160 30.4044 

290005 ............................................................................. 1.4257 1.1431 27.6697 28.3366 31.4494 28.9962 

290006 ............................................................................. 1.1856 1.0851 27.9501 31.7301 31.9783 30.5921 

290007 ............................................................................. 1.6373 1.1431 37.5559 38.1938 39.6409 38.4737 

290008 ............................................................................. 1.2052 0.9688 27.9714 27.3019 30.8413 28.7097 

290009 ............................................................................. 1.7177 1.1062 29.8019 36.2724 32.3330 32.7004 

290010 ............................................................................. *** * 23.9655 * * 23.9655 

290012 ............................................................................. 1.3586 1.1431 31.0843 32.3966 35.7987 33.1284 

290016 ............................................................................. *** * 26.1925 * * 26.1925 

290019 ............................................................................. 1.4100 1.0851 28.6158 29.3650 30.5954 29.5666 

290020 ............................................................................. 0.9879 0.9688 21.6993 23.2103 27.7976 23.8850 

290021 ............................................................................. 1.7397 1.1431 33.2116 32.7894 36.5004 34.2290 

290022 ............................................................................. 1.6627 1.1431 29.4422 29.9717 33.3048 30.8956 

290027 ............................................................................. 0.8977 0.9688 15.1448 23.9959 23.9599 21.2093 

290032 ............................................................................. 1.4275 1.1062 31.7105 31.6711 34.3860 32.5896 

290039 ............................................................................. 1.5604 1.1431 31.2941 32.1423 34.9629 32.8645 

290041 ............................................................................. 1.3801 1.1431 33.9877 34.2436 37.4249 35.3803 

290042 ............................................................................. *** * * * 22.4809 22.4809 

290044 ............................................................................. *** * * 37.1662 * 37.1662 

290045 ............................................................................. 1.5925 1.1431 30.9612 33.1512 34.4159 32.9841 

290046 ............................................................................. 1.3247 1.1431 * * 38.6235 38.6235 

290047 ............................................................................. 1.4996 1.1431 * * 33.4701 33.4701 

290049 ............................................................................. 1.3670 0.9688 * * 26.1159 26.1159 

290051 ............................................................................. 1.6067 0.9688 * * * * 

290052 ............................................................................. 0.8797 0.9688 * * * * 

300001 ............................................................................. 1.5438 1.1266 27.5032 29.2260 29.8127 28.8790 

300003 ............................................................................. 2.1029 1.1266 33.3560 34.7900 37.0864 35.1213 

300005 ............................................................................. 1.4046 1.1266 25.6699 27.8000 27.8412 27.1335 

300006 ............................................................................. *** * 23.3200 * * 23.3200 

300010 ............................................................................. *** * 27.5028 * * 27.5028 

300011 ............................................................................. 1.2842 1.1266 28.4044 30.9403 31.8926 30.4452 

300012 ............................................................................. 1.3771 1.1266 30.5198 30.4972 31.2638 30.7723 

300014 ............................................................................. 1.1567 1.1266 27.5151 29.7667 29.1829 28.8585 

300017 ............................................................................. 1.3103 1.1266 29.6957 29.9560 31.6688 30.4410 

300018 ............................................................................. 1.4114 1.1266 29.7209 29.4270 31.7886 30.3782 

300019 ............................................................................. 1.2727 1.1266 25.9656 27.5672 28.2267 27.2944 

300020 ............................................................................. 1.1629 1.1266 28.6723 30.8491 31.0585 30.2190 

300023 ............................................................................. 1.3399 1.1266 28.6309 31.0040 31.2712 30.3856 

300029 ............................................................................. 1.7610 1.1266 29.0806 29.8117 31.4416 30.1530 

300034 ............................................................................. 1.9071 1.1266 29.7484 30.7676 31.6879 30.7462 

310001 ............................................................................. 1.7811 1.3215 35.3612 41.7460 39.3376 38.8070 

310002 ............................................................................. 1.8123 1.2993 37.3461 37.9183 37.9222 37.7187 

310003 ............................................................................. 1.1430 1.3215 32.8935 36.2346 39.0744 36.1389 

310005 ............................................................................. 1.3201 1.1681 29.0084 32.1319 33.6294 31.6189 

310006 ............................................................................. 1.2212 1.3215 27.4545 28.4771 28.7318 28.2233 

310008 ............................................................................. 1.3025 1.3215 31.2579 32.6788 33.3151 32.4229 

310009 ............................................................................. 1.3174 1.2993 32.7384 33.6940 33.6147 33.3544 

310010 ............................................................................. 1.2786 1.0879 28.5852 33.9552 33.6979 32.1224 

310011 ............................................................................. 1.2517 1.0749 30.8612 31.2907 33.3167 31.8219 

310012 ............................................................................. 1.6584 1.3215 34.6882 38.3590 39.8553 37.6612 

310013 ............................................................................. 1.3584 1.2993 30.6248 31.0447 35.6324 32.2990 

310014 ............................................................................. 1.9437 1.0778 29.7204 30.0793 32.9002 30.9524 

310015 ............................................................................. 1.9917 1.2993 36.4776 36.8818 39.2914 37.5855 

310016 ............................................................................. 1.3455 1.3215 33.9862 35.6155 38.2693 36.0382 

310017 ............................................................................. 1.3323 1.2993 30.9233 32.2434 35.7519 32.9534 

310018 ............................................................................. 1.1951 1.2993 30.3381 30.3234 32.9700 31.1742 

310019 ............................................................................. 1.5537 1.3215 29.6592 30.3518 30.6364 30.2332 

310020 ............................................................................. 1.5411 1.3215 30.6722 33.5516 38.4379 35.7904 

310021 ............................................................................. 1.6686 1.1578 31.3410 32.1929 31.6553 31.7275 

mmaher on DSK3CLS3C1PROD with $$_JOB

24888 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

310022 ............................................................................. 1.2932 1.0522 28.2024 30.4043 31.1924 29.9525 

310024 ............................................................................. 1.2738 1.1681 30.9171 33.3415 33.8601 32.7346 

310025 ............................................................................. 1.3587 1.3215 31.1274 34.3687 32.2621 32.6290 

310026 ............................................................................. 1.1830 1.3215 27.5171 29.1588 30.1373 28.9603 

310027 ............................................................................. 1.3922 1.1681 28.8314 29.7793 31.5949 30.0511 

310028 ............................................................................. 1.1686 1.1681 31.3849 32.2977 33.9891 32.5798 

310029 ............................................................................. 1.9312 1.0522 30.7707 32.9246 33.6690 32.4532 

310031 ............................................................................. 3.0093 1.1131 33.9685 37.0668 38.5892 36.5339 

310032 ............................................................................. 1.3412 1.0752 27.5232 30.7865 33.0210 30.4618 

310034 ............................................................................. 1.3882 1.1131 29.9162 31.7012 32.7508 31.4426 

310037 ............................................................................. 1.3836 1.3215 35.0329 38.5415 38.2849 37.2929 

310038 ............................................................................. 1.9989 1.2993 33.4822 35.9190 36.3324 35.3010 

310039 ............................................................................. 1.2659 1.2993 28.8292 31.4278 33.2087 31.1027 

310040 ............................................................................. 1.3296 1.3215 34.1113 33.8535 37.7941 35.2736 

310041 ............................................................................. 1.3039 1.1131 32.8085 32.8390 33.9785 33.1810 

310042 ............................................................................. *** * 30.7357 34.4986 * 32.5359 

310044 ............................................................................. 1.3429 1.0879 31.3205 31.9678 33.7598 32.3234 

310045 ............................................................................. 1.6626 1.3215 34.1060 36.7862 38.4412 36.4048 

310047 ............................................................................. 1.3101 1.2095 32.7880 34.1520 37.6016 34.9123 

310048 ............................................................................. 1.3620 1.1578 30.2025 32.9681 33.9471 32.4207 

310049 ............................................................................. *** * 27.8565 * * 27.8565 

310050 ............................................................................. 1.2631 1.2993 27.3033 29.1732 32.3677 29.5223 

310051 ............................................................................. 1.4207 1.1681 33.7168 35.0121 38.1175 35.6230 

310052 ............................................................................. 1.3148 1.1131 30.8036 32.5778 33.5833 32.3042 

310054 ............................................................................. 1.3494 1.2993 34.1860 34.4431 36.9103 35.1809 

310057 ............................................................................. 1.3560 1.0652 29.5221 31.1268 31.8882 30.8455 

310058 ............................................................................. 1.1001 1.3215 28.0815 27.1555 30.4060 28.5493 

310060 ............................................................................. 1.2254 1.0024 25.1575 27.3415 27.8235 26.8641 

310061 ............................................................................. 1.2038 1.0652 28.2129 31.6648 39.0527 32.6386 

310063 ............................................................................. 1.3573 1.1681 31.4884 31.9247 33.8500 32.3995 

310064 ............................................................................. 1.5574 1.2095 33.4440 35.7607 38.6296 36.0384 

310069 ............................................................................. 1.2293 1.0752 28.1681 31.7642 34.4614 31.6133 

310070 ............................................................................. 1.4396 1.2993 33.2310 34.3225 36.3246 34.6566 

310073 ............................................................................. 1.9339 1.1131 32.0328 32.6733 34.2852 33.0130 

310074 ............................................................................. 1.4038 1.3215 29.4834 40.3494 39.6126 36.4273 

310075 ............................................................................. 1.3460 1.1131 31.6869 31.5226 32.5325 31.9056 

310076 ............................................................................. 1.6950 1.2993 36.4280 38.0643 37.5145 37.3322 

310077 ............................................................................. *** * 32.6644 34.6085 * 33.6290 

310078 ............................................................................. *** * 29.8014 30.5761 * 30.1919 

310081 ............................................................................. 1.2439 1.0778 26.6136 30.1561 31.0670 29.3003 

310083 ............................................................................. 1.2968 1.2993 28.2392 30.3580 31.9125 30.1899 

310084 ............................................................................. 1.2502 1.1131 32.9001 33.5941 32.6073 33.0241 

310086 ............................................................................. 1.2173 1.0522 29.3058 29.5566 29.8937 29.5898 

310088 ............................................................................. 1.1945 1.2095 26.4966 29.9929 30.3513 28.9184 

310090 ............................................................................. 1.2500 1.1681 30.8941 32.8191 33.4603 32.3294 

310091 ............................................................................. 1.1866 1.0752 27.7204 29.3969 31.9736 29.6731 

310092 ............................................................................. 1.4214 1.0879 29.4998 29.7958 32.7029 30.6404 

310093 ............................................................................. 1.2379 1.2993 28.0401 29.1288 30.2858 29.1452 

310096 ............................................................................. 2.0679 1.2993 34.4275 34.1524 35.0725 34.5578 

310105 ............................................................................. 1.2685 1.3215 31.9769 30.1069 32.5642 31.5185 

310108 ............................................................................. 1.3924 1.2993 30.1002 33.0172 34.2946 32.4532 

310110 ............................................................................. 1.3064 1.0879 31.2164 33.2246 33.4787 32.6988 

310111 ............................................................................. 1.2383 1.1131 30.7475 31.8393 34.8278 32.5301 

310112 ............................................................................. 1.3378 1.1131 30.4192 31.2372 32.2812 31.3132 

310113 ............................................................................. 1.2461 1.1131 29.6079 31.0436 33.6769 31.5139 

310115 ............................................................................. 1.3278 1.0024 29.6020 29.5320 32.8144 30.7156 

310116 ............................................................................. 1.2564 1.3215 25.6976 29.2748 29.8219 28.1707 

310118 ............................................................................. 1.2957 1.3215 28.8797 31.1803 31.2285 30.4796 

310119 ............................................................................. 1.9246 1.2993 37.7876 43.1238 41.5679 40.9083 

310120 ............................................................................. 1.1067 1.1681 31.4111 29.2535 33.3847 31.2917 

310122 ............................................................................. *** * * * 41.9008 41.9008 

mmaher on DSK3CLS3C1PROD with $$_JOB

24889 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

310123 ............................................................................. *** * * * 37.1088 37.1088 

310124 ............................................................................. *** * * * 41.8807 41.8807 

310125 ............................................................................. *** * * * 36.2250 36.2250 

310126 ............................................................................. 1.5770 1.1681 * * * * 

310127 ............................................................................. 2.1663 1.0652 * * * * 

320001 ............................................................................. 1.6846 0.9740 26.9434 29.6182 30.0055 28.9118 

320002 ............................................................................. 1.4659 1.0689 30.5158 32.0477 33.1322 31.9531 

320003 ............................................................................. 1.1337 1.0376 28.1402 27.6222 31.4451 29.2080 

320004 ............................................................................. 1.3346 0.8965 24.9481 24.7803 26.2118 25.3020 

320005 ............................................................................. 1.3975 0.9740 23.8264 24.7543 28.7944 25.7110 

320006 ............................................................................. 1.3191 0.9740 24.2812 26.9080 28.0944 26.5127 

320009 ............................................................................. 1.5658 0.9740 22.8293 32.0116 27.1448 26.7952 

320011 ............................................................................. 1.1525 0.9302 24.2279 25.6693 27.9505 25.9804 

320013 ............................................................................. 1.1100 1.0376 28.9276 22.8283 30.3766 26.8594 

320014 ............................................................................. 1.0803 0.8965 24.5310 27.2806 28.7043 26.9250 

320016 ............................................................................. 1.1846 0.8965 23.5040 25.0835 27.1469 25.3042 

320017 ............................................................................. 1.1945 0.9740 25.0286 31.6357 33.3482 30.1538 

320018 ............................................................................. 1.4713 0.8990 23.2360 26.5109 25.9235 25.0329 

320019 ............................................................................. 1.5781 0.9740 31.5192 27.8067 35.0213 30.9859 

320021 ............................................................................. 1.6048 0.9740 27.2357 26.9918 28.8474 27.7575 

320022 ............................................................................. 1.1613 0.8965 23.7160 23.9595 25.3696 24.3630 

320030 ............................................................................. 1.0965 0.8965 22.1971 21.0378 24.4482 22.6073 

320033 ............................................................................. 1.1954 1.0376 27.6393 31.7114 30.1473 29.8085 

320037 ............................................................................. 1.2522 0.9740 23.3999 24.9657 25.2866 24.5732 

320038 ............................................................................. 1.2773 0.8965 20.1533 21.7022 32.7170 25.2881 

320046 ............................................................................. *** * 24.3534 * * 24.3534 

320057 ............................................................................. 0.8707 1.4406 * * * * 

320058 ............................................................................. 0.7716 1.4406 * * * * 

320059 ............................................................................. 0.8741 1.4406 * * * * 

320060 ............................................................................. 0.9480 1.4406 * * * * 

320061 ............................................................................. 0.8805 1.4406 * * * * 

320062 ............................................................................. 0.8907 1.4406 * * * * 

320063 ............................................................................. 1.3149 0.9527 24.4696 25.0031 26.0095 25.1843 

320065 ............................................................................. 1.3098 0.9527 26.6603 27.3163 25.7921 26.5970 

320067 ............................................................................. 0.8747 0.8965 23.7745 24.9865 24.6963 24.5130 

320069 ............................................................................. 1.1001 0.8965 20.9167 22.4128 23.9847 22.4801 

320070 ............................................................................. 0.9497 1.4406 * * * * 

320074 ............................................................................. 1.1777 0.9740 22.2175 31.1333 28.4393 27.5521 

320079 ............................................................................. 1.0738 0.9740 25.2105 26.1188 27.6850 26.3851 

320083 ............................................................................. 2.5853 0.9740 28.2114 26.6921 31.4628 28.8401 

320084 ............................................................................. 0.9586 0.8965 17.2511 17.5788 22.7674 19.1162 

320085 ............................................................................. 1.7001 0.8990 24.8752 27.9944 27.4093 26.8652 

330001 ............................................................................. *** * 33.4718 * * 33.4718 

330002 ............................................................................. 1.4716 1.3215 31.1924 30.9600 32.1948 31.4363 

330003 ............................................................................. 1.3901 0.8672 22.9945 24.4326 25.2199 24.2253 

330004 ............................................................................. 1.2791 1.0644 26.0445 28.0594 29.9032 27.9539 

330005 ............................................................................. 1.5858 0.9586 29.0124 30.3200 31.5013 30.2919 

330006 ............................................................................. 1.2547 1.3215 31.5370 33.6284 34.1959 33.1177 

330008 ............................................................................. 1.1969 0.9586 21.8198 23.4429 25.1985 23.4724 

330009 ............................................................................. 1.2178 1.3215 35.4986 36.2820 34.8184 35.5246 

330010 ............................................................................. 0.9609 0.8482 19.6920 20.7476 19.2838 19.8627 

330011 ............................................................................. 1.3855 0.9072 21.8008 25.1308 27.4732 24.7762 

330013 ............................................................................. 1.8823 0.8672 24.5162 26.4578 26.8359 25.9711 

330014 ............................................................................. 1.3016 1.3215 38.8123 42.1759 45.7594 42.1079 

330016 ............................................................................. *** * 28.4391 22.0493 23.0754 24.0041 

330019 ............................................................................. 1.2360 1.3215 34.8266 38.5368 39.7366 37.6971 

330023 ............................................................................. 1.5534 1.2380 31.6208 35.9428 35.4371 34.4826 

330024 ............................................................................. 1.8516 1.3215 37.8398 42.7691 43.2449 41.1310 

330025 ............................................................................. 1.0757 0.9586 20.2776 21.2565 23.2412 21.5971 

330027 ............................................................................. 1.3299 1.2993 39.0717 42.8000 45.1871 42.3247 

330028 ............................................................................. 1.4253 1.3215 34.2709 36.6498 36.2872 35.6905 

mmaher on DSK3CLS3C1PROD with $$_JOB

24890 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

330029 ............................................................................. 0.4640 0.9586 19.1589 23.2039 24.0652 21.4784 

330030 ............................................................................. 1.2459 0.8899 22.9937 24.6175 24.7514 24.0792 

330033 ............................................................................. 1.1944 0.8645 22.5680 24.5510 24.8008 23.9488 

330036 ............................................................................. 1.1736 1.3215 28.9409 29.1884 30.3728 29.5020 

330037 ............................................................................. 1.1939 0.8899 20.6904 22.3689 21.9242 21.6478 

330041 ............................................................................. 1.3232 1.3215 36.0286 37.4883 36.9921 36.8224 

330043 ............................................................................. 1.3836 1.2791 34.7480 39.1643 37.6666 37.1976 

330044 ............................................................................. 1.3066 0.8440 24.1907 26.5669 28.2003 26.3311 

330045 ............................................................................. 1.3331 1.2791 36.1893 38.1269 40.0305 38.1670 

330046 ............................................................................. 1.3803 1.3215 44.8494 50.3152 47.4949 47.5038 

330047 ............................................................................. 1.1860 0.8482 24.0678 24.3932 24.9779 24.4959 

330049 ............................................................................. 1.5206 1.2380 29.2904 29.8350 34.8972 31.4643 

330053 ............................................................................. 1.0498 0.8899 18.5289 20.6272 21.8755 20.3411 

330055 ............................................................................. 1.5727 1.3215 38.4839 41.5934 42.1979 40.8295 

330056 ............................................................................. 1.4393 1.3215 37.8444 36.0136 38.8876 37.5779 

330057 ............................................................................. 1.7325 0.8672 24.4680 26.4989 27.7098 26.2555 

330058 ............................................................................. 1.2589 0.8899 21.3727 22.2524 21.7018 21.7824 

330059 ............................................................................. 1.5266 1.3215 39.7387 41.7343 44.9131 42.1510 

330061 ............................................................................. 1.1887 1.3215 33.2848 36.0587 37.8810 35.7856 

330062 ............................................................................. 2.5188 * 21.0464 * * 21.0464 

330064 ............................................................................. 1.1807 1.3215 36.4276 38.0437 38.2307 37.5268 

330065 ............................................................................. 1.0348 0.9586 23.9128 25.3043 24.3986 24.5180 

330066 ............................................................................. 1.2793 0.8672 24.7941 29.1780 25.8149 26.6311 

330067 ............................................................................. 1.4313 1.2380 26.4243 27.8900 29.2544 27.8289 

330072 ............................................................................. 1.3663 1.3215 36.4336 37.8505 39.6955 37.9159 

330073 ............................................................................. 1.0847 0.8899 20.1490 22.5592 23.0765 21.9326 

330074 ............................................................................. 1.2115 0.8899 21.4274 22.6629 23.5142 22.5510 

330075 ............................................................................. 1.1310 0.9912 22.4188 23.1592 23.4332 23.0114 

330078 ............................................................................. 1.4633 0.9586 23.3981 25.8073 27.2852 25.5265 

330079 ............................................................................. 1.3908 0.9431 22.5237 24.6054 24.9934 24.0663 

330080 ............................................................................. 1.1615 1.3215 39.1724 39.1417 38.9393 39.0845 

330084 ............................................................................. 1.0885 0.8440 21.5455 22.5573 25.6859 23.2864 

330085 ............................................................................. 1.1343 0.9577 23.9568 25.3285 26.6208 25.3039 

330086 ............................................................................. 1.3317 1.3215 29.1784 32.7675 35.4708 32.6068 

330088 ............................................................................. 1.0150 1.2791 31.3973 34.0789 35.3841 33.6057 

330090 ............................................................................. 1.4726 0.8440 23.6174 25.5351 26.8715 25.3561 

330091 ............................................................................. 1.3639 0.9586 23.8063 25.9378 27.0011 25.6211 

330094 ............................................................................. 1.2532 0.9231 23.0001 25.7116 26.9119 25.1924 

330095 ............................................................................. *** * 31.9873 * * 31.9873 

330096 ............................................................................. 1.2270 0.8440 22.0337 22.7189 23.4149 22.7206 

330097 ............................................................................. 1.0476 * 20.3189 * * 20.3189 

330100 ............................................................................. 1.0853 1.3215 34.4621 38.3333 39.6209 37.5339 

330101 ............................................................................. 1.9268 1.3215 38.7503 40.1929 43.7932 40.9960 

330102 ............................................................................. 1.3805 0.9586 24.8184 25.3879 26.6873 25.6615 

330103 ............................................................................. 1.1459 0.8440 21.1452 22.8242 24.5566 22.8013 

330104 ............................................................................. 1.3468 1.3215 32.8818 33.7537 34.3166 33.6767 

330106 ............................................................................. 1.7224 1.2993 41.4561 43.8210 45.9263 43.7752 

330107 ............................................................................. 1.2622 1.2791 31.3888 34.9047 35.7373 34.0849 

330108 ............................................................................. 1.1634 0.8440 22.2607 23.2919 23.9344 23.1799 

330111 ............................................................................. 1.0675 0.9586 20.9387 20.3473 40.4318 24.2734 

330115 ............................................................................. 1.1809 0.9912 23.3043 25.2373 23.0235 23.8663 

330119 ............................................................................. 1.7982 1.3215 39.1114 39.0528 42.2871 40.1393 

330125 ............................................................................. 1.7876 0.8899 26.7119 27.2920 28.0831 27.3803 

330126 ............................................................................. 1.3169 1.2993 31.6370 35.2257 36.5676 35.2858 

330127 ............................................................................. 1.3510 1.3215 44.6103 45.3680 45.2974 45.0865 

330128 ............................................................................. 1.2215 1.3215 37.7166 39.5197 41.7780 39.6521 

330132 ............................................................................. 1.1465 0.8561 17.4946 21.0479 21.7624 20.0513 

330133 ............................................................................. 1.3487 1.3215 36.6962 39.3837 38.5211 38.1371 

330135 ............................................................................. 1.1424 1.0853 29.0837 27.9132 32.0511 29.6957 

330136 ............................................................................. 1.5153 0.9577 24.2010 25.8531 26.6667 25.5991 

330140 ............................................................................. 1.8341 0.9912 25.7573 27.6183 29.3429 27.5920 

mmaher on DSK3CLS3C1PROD with $$_JOB

24891 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

330141 ............................................................................. 1.3225 1.2791 34.8902 39.4701 38.2473 37.6083 

330144 ............................................................................. 1.0373 0.8440 20.9935 22.9561 23.3863 22.4512 

330151 ............................................................................. 1.1211 0.8440 19.1841 21.7665 19.7949 20.1954 

330152 ............................................................................. 1.2983 1.3215 36.5136 37.6721 38.2040 37.4693 

330153 ............................................................................. 1.7286 0.8672 24.5219 26.4386 28.4427 26.4924 

330154 ............................................................................. 1.7054 * * * * * 

330157 ............................................................................. 1.3498 0.9577 25.2312 26.5686 27.1422 26.3135 

330158 ............................................................................. 1.5257 1.3215 32.2990 38.2033 41.6972 37.3734 

330159 ............................................................................. 1.3649 0.9912 28.9094 28.2774 31.7829 29.5878 

330160 ............................................................................. 1.5299 1.3215 34.1960 36.6208 39.4136 36.7564 

330162 ............................................................................. 1.2873 1.3215 32.1783 34.9460 37.6198 34.8798 

330163 ............................................................................. 1.1299 0.9586 24.0200 27.1933 28.3889 26.5653 

330164 ............................................................................. 1.4611 0.8899 28.8481 27.7217 27.4988 28.0125 

330166 ............................................................................. 1.0839 0.8440 19.4360 20.4680 20.7114 20.1915 

330167 ............................................................................. 1.7102 1.2993 34.4748 36.7653 39.1206 36.7231 

330169 ............................................................................. 1.3871 1.3215 39.3361 45.3774 46.4890 43.5617 

330171 ............................................................................. *** * 30.0122 30.4005 35.1552 31.6496 

330175 ............................................................................. 1.1110 0.8681 22.2067 23.8509 23.3990 23.1608 

330177 ............................................................................. 0.9871 0.8440 19.6100 20.6338 22.9802 21.0952 

330180 ............................................................................. 1.2281 0.8672 22.1920 24.3761 25.4142 23.9988 

330181 ............................................................................. 1.2689 1.2993 38.5351 41.4104 42.2619 40.7706 

330182 ............................................................................. 2.3122 1.2993 39.6038 40.9014 40.8712 40.4724 

330184 ............................................................................. 1.4040 1.3215 34.4044 35.8102 39.0405 36.4609 

330185 ............................................................................. 1.2787 1.2791 32.3466 36.3155 37.9564 35.6879 

330188 ............................................................................. 1.2378 0.9586 23.9210 25.1153 27.5982 25.5241 

330189 ............................................................................. 1.3891 0.8672 21.6229 22.3484 22.4386 22.1392 

330191 ............................................................................. 1.2684 0.8672 24.0232 25.5656 26.4297 25.3758 

330193 ............................................................................. 1.3149 1.3215 37.1807 39.9327 38.9508 38.7084 

330194 ............................................................................. 1.7330 1.3215 43.9910 45.5639 46.8833 45.5303 

330195 ............................................................................. 1.7148 1.3215 40.0206 39.7802 41.7863 40.5425 

330196 ............................................................................. 1.2484 1.3215 33.2171 36.7178 38.2483 36.0767 

330197 ............................................................................. 1.0598 0.8440 23.4290 26.8921 25.9860 25.4379 

330198 ............................................................................. 1.3670 1.2993 30.5485 33.4930 34.8948 33.0511 

330199 ............................................................................. 1.1951 1.3215 35.0059 38.6407 40.3929 37.9482 

330201 ............................................................................. 1.5880 1.3215 39.3682 37.2064 42.6689 39.7174 

330202 ............................................................................. 1.2474 1.3215 38.0129 37.4150 37.4138 37.6069 

330203 ............................................................................. 1.4679 0.9912 26.5882 32.1207 34.0475 30.8848 

330204 ............................................................................. 1.3409 1.3215 37.6849 39.6393 41.9936 39.7972 

330205 ............................................................................. 1.1766 1.0853 32.1618 31.9510 33.9404 32.7289 

330208 ............................................................................. 1.1551 1.3215 29.6282 32.1256 33.5256 31.7765 

330209 ............................................................................. *** * 29.7988 30.2038 * 30.0002 

330211 ............................................................................. 1.1593 0.8440 22.9966 24.4470 25.8735 24.4782 

330212 ............................................................................. *** * 27.2232 * * 27.2232 

330213 ............................................................................. 1.1110 0.8440 22.5191 24.4049 27.4887 24.8464 

330214 ............................................................................. 1.9082 1.3215 37.8500 41.8719 41.2768 40.2400 

330215 ............................................................................. 1.3064 0.8774 22.6744 23.7361 23.9564 23.4614 

330218 ............................................................................. 1.0749 0.9912 24.1106 26.9638 26.9959 26.0466 

330219 ............................................................................. 1.7271 0.9586 29.3644 29.8889 32.5646 30.5813 

330221 ............................................................................. 1.3239 1.3215 36.5539 39.2080 40.0488 38.6287 

330222 ............................................................................. 1.2884 0.8672 23.9746 25.8507 27.7182 25.9131 

330223 ............................................................................. 1.0004 0.8440 19.4229 23.3669 26.1256 22.8479 

330224 ............................................................................. 1.3202 1.0644 25.7850 27.9231 29.0864 27.6364 

330225 ............................................................................. 1.2316 1.2993 29.2719 32.3585 35.7735 32.4753 

330226 ............................................................................. 1.3388 0.8899 21.8977 24.5646 24.8456 23.8231 

330229 ............................................................................. 1.1912 0.8440 20.6095 21.9356 23.0562 21.8540 

330230 ............................................................................. 1.0097 1.3215 33.3175 37.1298 38.6523 36.3361 

330231 ............................................................................. 1.0931 1.3215 36.9619 40.6697 44.9376 40.8957 

330232 ............................................................................. 1.1619 0.8672 24.4531 26.3313 27.4623 26.1064 

330233 ............................................................................. 1.4121 1.3215 45.5132 47.3497 52.7025 48.3771 

330234 ............................................................................. 2.3848 1.3215 40.6314 48.2306 49.3194 45.8234 

330235 ............................................................................. 1.1939 0.9577 23.3866 27.7031 29.4294 26.7553 

mmaher on DSK3CLS3C1PROD with $$_JOB

24892 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

330236 ............................................................................. 1.5608 1.3215 35.6347 40.2386 42.8923 39.6820 

330238 ............................................................................. 1.2614 0.8899 20.8639 21.7435 21.7652 21.4610 

330239 ............................................................................. 1.2560 0.8440 21.5397 22.3854 23.6653 22.5395 

330240 ............................................................................. 1.2133 1.3215 39.9450 43.5753 40.4972 41.3029 

330241 ............................................................................. 1.8038 0.9912 29.0882 30.2304 32.6139 30.7098 

330242 ............................................................................. 1.3307 1.3215 33.6926 37.4870 36.8969 35.9769 

330245 ............................................................................. 1.8750 0.8440 22.8003 26.1811 27.4329 25.5153 

330246 ............................................................................. 1.3359 1.2791 34.6329 37.1611 35.7391 35.8256 

330247 ............................................................................. 0.8986 1.3215 32.2300 35.4980 39.0193 35.4567 

330249 ............................................................................. 1.3518 0.9912 22.9834 25.3246 23.8548 24.0420 

330250 ............................................................................. 1.3308 0.9589 25.1664 27.1606 29.0058 27.1464 

330259 ............................................................................. 1.4194 1.2993 31.9152 35.1514 36.5831 34.5776 

330261 ............................................................................. 1.2665 1.3215 30.7942 33.7834 40.2554 34.7041 

330263 ............................................................................. 1.0289 0.8440 22.4675 23.8738 24.1312 23.5399 

330264 ............................................................................. 1.2912 1.0853 30.0139 30.4701 30.1809 30.2033 

330265 ............................................................................. 1.1849 0.8899 20.4635 21.6477 23.9070 21.9772 

330267 ............................................................................. 1.3602 1.3215 31.5478 32.8541 34.9869 33.1372 

330268 ............................................................................. 0.9192 0.8440 20.9720 25.3567 23.8791 23.3606 

330270 ............................................................................. 2.0325 1.3215 42.2111 57.3596 55.2076 51.3946 

330273 ............................................................................. 1.3982 1.3215 30.4720 37.0157 34.5032 34.0363 

330276 ............................................................................. 1.0979 0.8440 22.2353 24.3300 26.0917 24.2198 

330277 ............................................................................. 1.1791 0.9715 25.3582 26.4535 30.9561 27.3784 

330279 ............................................................................. 1.5215 0.9586 25.2130 27.4539 29.4540 27.4527 

330285 ............................................................................. 1.9980 0.8899 27.9018 30.1928 31.1219 29.7572 

330286 ............................................................................. 1.3653 1.2791 33.3552 35.5895 36.8535 35.2974 

330290 ............................................................................. 1.7316 1.3215 36.9981 39.4690 40.3862 38.9177 

330304 ............................................................................. 1.3060 1.3215 34.5761 36.2845 37.3516 36.1507 

330306 ............................................................................. 1.4126 1.3215 35.6640 36.3552 38.7631 36.9884 

330307 ............................................................................. 1.3336 0.9715 27.5699 29.2529 29.5522 28.8425 

330314 ............................................................................. *** * 25.5597 26.2719 28.1362 26.6009 

330316 ............................................................................. 1.2421 1.3215 34.8623 34.8567 37.1744 35.6156 

330331 ............................................................................. 1.2559 1.2993 36.1630 39.8402 41.2652 39.1610 

330332 ............................................................................. 1.2705 1.2993 33.3050 35.1646 37.0082 35.2111 

330333 ............................................................................. *** * 26.1917 * * 26.1917 

330338 ............................................................................. *** * 31.3761 37.7497 * 34.6182 

330339 ............................................................................. 0.7038 0.8672 22.6569 23.5786 24.3064 23.5064 

330340 ............................................................................. 1.2556 1.2791 33.9358 37.9000 36.0162 35.9189 

330350 ............................................................................. 1.4768 1.3215 36.6250 41.1339 43.9324 40.6020 

330353 ............................................................................. 1.2410 1.3215 37.6549 45.9692 45.0917 43.0066 

330354 ............................................................................. 2.1053 * * * * * 

330357 ............................................................................. 1.2623 1.3215 35.5975 38.2286 40.3814 37.9050 

330372 ............................................................................. 1.2696 1.2993 32.6721 36.1840 35.1250 34.7426 

330385 ............................................................................. 1.1071 1.3215 46.3221 48.6175 49.0841 47.9726 

330386 ............................................................................. 1.2194 1.1578 27.9943 29.9366 33.3181 30.4738 

330389 ............................................................................. 1.7372 1.3215 34.7669 37.1862 38.6409 36.8607 

330390 ............................................................................. 1.2371 1.3215 36.0573 36.3842 35.5521 35.9765 

330393 ............................................................................. 1.7369 1.2791 34.8095 38.0619 39.2461 37.4154 

330394 ............................................................................. 1.6366 0.9072 25.2229 27.3388 28.4575 27.0150 

330395 ............................................................................. 1.4366 1.3215 37.3096 36.3921 37.5757 37.0853 

330396 ............................................................................. 1.5239 1.3215 35.0297 37.4998 39.4882 37.3251 

330397 ............................................................................. 1.4326 1.3215 38.4741 37.5682 41.4413 39.1429 

330399 ............................................................................. 1.0763 1.3215 32.3688 34.7394 37.1175 34.7258 

330401 ............................................................................. 1.3610 1.2791 40.6249 37.8559 40.4446 39.6483 

330403 ............................................................................. 0.9812 0.8899 23.1886 25.5163 25.2928 24.6329 

330404 ............................................................................. 0.8616 1.3215 * * * * 

330405 ............................................................................. 0.8688 1.3215 * * * * 

330406 ............................................................................. 0.8701 0.8672 * * * * 

340001 ............................................................................. 1.5147 0.9512 25.0041 28.3988 29.5669 27.7156 

340002 ............................................................................. 1.8220 0.9209 27.3349 28.4860 29.6875 28.5183 

340003 ............................................................................. 1.1852 0.8608 23.3066 24.1602 26.0869 24.5118 

340004 ............................................................................. 1.4192 0.9083 25.4474 26.6404 27.5270 26.5361 

mmaher on DSK3CLS3C1PROD with $$_JOB

24893 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

340005 ............................................................................. 0.9877 * 22.3814 * * 22.3814 

340008 ............................................................................. 1.1889 0.9348 26.6314 26.7443 27.7190 27.0539 

340010 ............................................................................. 1.3717 0.9373 24.5666 27.2105 28.7525 26.8565 

340011 ............................................................................. 1.1370 0.8608 19.9484 19.7441 22.0042 20.5589 

340012 ............................................................................. 1.2498 0.8608 22.7189 23.2288 24.7564 23.5968 

340013 ............................................................................. 1.2487 0.9348 23.0261 23.9492 26.3599 24.4158 

340014 ............................................................................. 1.5497 0.9083 25.1872 27.4888 27.8361 26.8911 

340015 ............................................................................. 1.3640 0.9348 26.2276 28.0585 28.3916 27.5637 

340016 ............................................................................. 1.2883 0.8608 23.0359 25.6454 27.3478 25.3411 

340017 ............................................................................. 1.3186 0.9209 23.8229 25.7780 27.4678 25.6896 

340018 ............................................................................. *** * 23.7243 * * 23.7243 

340020 ............................................................................. 1.2004 0.8751 23.7995 26.4465 27.5449 25.9051 

340021 ............................................................................. 1.3001 0.9348 26.0995 29.4864 29.3819 28.3674 

340023 ............................................................................. 1.3623 0.9386 24.4896 26.4225 26.3102 25.7592 

340024 ............................................................................. 1.1037 0.8779 22.2522 23.6638 26.3988 24.1337 

340025 ............................................................................. 1.3303 0.9209 21.2276 23.5881 24.0074 22.9989 

340027 ............................................................................. 1.1601 0.9272 23.6326 25.5973 26.3812 25.2702 

340028 ............................................................................. 1.5219 0.9926 26.3298 28.0323 30.7692 28.3795 

340030 ............................................................................. 2.0869 0.9814 29.0122 29.6630 30.7705 29.8384 

340032 ............................................................................. 1.4485 0.9512 26.7475 26.5958 28.7619 27.4144 

340035 ............................................................................. 1.0891 0.8608 23.5476 23.9669 24.6257 24.0393 

340036 ............................................................................. 1.3731 0.9373 25.2077 27.2691 27.3834 26.6507 

340037 ............................................................................. 1.1089 0.8770 21.6411 25.6262 29.0640 25.6376 

340038 ............................................................................. 1.2278 0.8861 14.0713 22.4829 24.2103 19.1095 

340039 ............................................................................. 1.2800 0.9348 27.1275 27.4457 27.8213 27.4756 

340040 ............................................................................. 1.9806 0.9272 26.3325 27.6626 28.7422 27.6117 

340041 ............................................................................. 1.1961 0.8977 23.6600 24.3595 26.8306 25.0114 

340042 ............................................................................. 1.2712 0.8608 23.0236 25.0110 25.6323 24.5577 

340045 ............................................................................. *** * 23.1918 * * 23.1918 

340047 ............................................................................. 1.8383 0.9083 25.0605 27.4022 28.4974 27.0298 

340049 ............................................................................. 1.8540 0.9814 30.4827 30.6791 29.6812 30.2355 

340050 ............................................................................. 1.1120 0.9600 24.2533 26.0365 27.5249 25.9399 

340051 ............................................................................. 1.2212 0.8819 23.4091 23.9612 24.4546 23.9484 

340053 ............................................................................. 1.4963 0.9512 27.7261 27.8577 28.9350 28.1745 

340055 ............................................................................. 1.2461 0.8977 24.1057 26.0647 26.5750 25.5722 

340060 ............................................................................. 1.1427 0.9111 22.8657 22.9097 25.1769 23.6611 

340061 ............................................................................. 1.8071 0.9814 27.5594 27.0089 29.8565 28.1789 

340064 ............................................................................. 1.0727 0.8608 22.9143 23.4233 23.9696 23.4392 

340068 ............................................................................. 1.2508 0.9172 21.8830 22.6814 23.6737 22.7405 

340069 ............................................................................. 1.8779 0.9603 27.4473 29.3439 29.2259 28.6869 

340070 ............................................................................. 1.2886 0.9111 24.9033 25.3226 26.6539 25.6456 

340071 ............................................................................. 1.0909 0.9373 25.4537 26.3921 27.9724 26.6149 

340072 ............................................................................. 1.2076 0.8608 23.1163 25.2493 24.1322 24.1635 

340073 ............................................................................. 1.6001 0.9603 30.2061 30.9849 32.2694 31.1640 

340075 ............................................................................. 1.2345 0.8977 26.0226 25.1551 25.1432 25.4400 

340084 ............................................................................. 1.1990 0.9512 21.2580 21.1363 23.1513 21.8365 

340085 ............................................................................. 1.1471 0.8858 23.9793 26.5164 27.9544 26.0796 

340087 ............................................................................. 1.2862 0.8608 22.0070 22.4287 25.4716 23.2830 

340090 ............................................................................. 1.3672 0.9373 23.4541 26.4031 26.7407 25.6220 

340091 ............................................................................. 1.5781 0.9083 25.8266 27.1285 28.8018 27.2994 

340096 ............................................................................. 1.2035 0.8858 25.2169 24.9036 26.5426 25.5725 

340097 ............................................................................. 1.2771 0.8608 24.2127 26.2228 29.7729 26.6118 

340098 ............................................................................. 1.4524 0.9512 27.3308 28.2493 29.6697 28.4313 

340099 ............................................................................. 1.3064 0.8608 20.3683 21.8564 23.9712 22.0909 

340104 ............................................................................. 0.9032 0.8770 15.7521 16.1204 17.6322 16.5484 

340106 ............................................................................. 1.1107 0.8608 22.4894 26.0892 26.1296 24.8414 

340107 ............................................................................. 1.2094 0.9017 22.9698 24.1762 26.6468 24.6193 

340109 ............................................................................. 1.2629 0.8785 23.4419 25.4464 26.6306 25.1776 

340113 ............................................................................. 1.9347 0.9512 28.2568 28.5587 30.3822 29.0843 

340114 ............................................................................. 1.5707 0.9603 26.6813 28.3222 28.1306 27.7302 

340115 ............................................................................. 1.6239 0.9603 25.0212 26.7592 27.2771 26.3716 

mmaher on DSK3CLS3C1PROD with $$_JOB

24894 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

340116 ............................................................................. 1.7637 0.8977 25.3213 27.5881 29.3675 27.4184 

340119 ............................................................................. 1.3184 0.9512 24.2287 25.6226 29.4442 26.4327 

340120 ............................................................................. 1.0120 0.8608 23.0915 25.9134 25.5502 24.8610 

340121 ............................................................................. 1.1179 0.9338 21.7576 23.1343 23.8832 22.9461 

340123 ............................................................................. 1.3434 0.9111 26.1083 26.0637 28.5642 26.9157 

340124 ............................................................................. 1.0382 0.9373 20.8018 22.2988 23.5464 22.2123 

340126 ............................................................................. 1.2877 0.9373 25.0189 26.9866 28.2229 26.7660 

340127 ............................................................................. 1.1542 0.9603 25.7831 26.4746 28.2146 26.8344 

340129 ............................................................................. 1.2616 0.9348 25.4902 25.7976 26.7596 26.0411 

340130 ............................................................................. 1.3513 0.9512 25.2941 26.1717 28.1587 26.5937 

340131 ............................................................................. 1.5011 0.9272 27.9358 27.4750 28.8528 28.1009 

340132 ............................................................................. 1.1993 0.8608 21.3521 23.5856 24.3442 23.1134 

340133 ............................................................................. 1.0170 0.8850 22.5558 23.4678 24.8551 23.5976 

340137 ............................................................................. *** * 21.0642 22.1741 28.9661 23.0832 

340138 ............................................................................. 0.8420 0.9603 21.3670 * * 21.3670 

340141 ............................................................................. 1.6591 0.9338 27.3355 29.3878 29.3158 28.6960 

340142 ............................................................................. 1.1639 0.8608 22.9907 26.6886 27.7501 25.8989 

340143 ............................................................................. 1.5072 0.8977 25.3633 28.0082 27.9782 27.1350 

340144 ............................................................................. 1.2446 0.9348 27.2686 26.1865 27.0139 26.8084 

340145 ............................................................................. 1.1838 0.9348 23.7131 25.8459 26.7457 25.4570 

340147 ............................................................................. 1.3000 0.9373 25.4534 26.9162 28.2605 26.9066 

340148 ............................................................................. 1.4008 0.9083 23.5880 25.3660 25.8316 24.9275 

340151 ............................................................................. 1.1664 0.8661 22.0052 22.7736 23.2142 22.6702 

340153 ............................................................................. 1.8779 0.9512 26.4896 27.6509 28.5972 27.6009 

340155 ............................................................................. 1.4283 0.9814 30.4940 30.3443 31.6013 30.8281 

340156 ............................................................................. 0.8549 1.4406 * * * * 

340158 ............................................................................. 1.1124 0.9338 26.4849 27.7816 27.9252 27.3725 

340159 ............................................................................. 1.2301 0.9814 23.2991 24.2588 24.8366 24.1490 

340160 ............................................................................. 1.3374 0.8608 20.7525 21.7923 23.4619 22.0119 

340166 ............................................................................. 1.2904 0.9512 26.0558 27.1132 28.5388 27.2672 

340168 ............................................................................. 0.3793 0.9338 17.3249 * * 17.3249 

340171 ............................................................................. 1.1735 0.9512 28.2734 27.8539 27.4705 27.8496 

340173 ............................................................................. 1.2951 0.9603 27.5072 28.3502 30.2808 28.7935 

340177 ............................................................................. 1.0970 * 24.7471 26.7155 * 25.7127 

340178 ............................................................................. *** * 28.7218 * * 28.7218 

340179 ............................................................................. *** * * 34.1895 * 34.1895 

340182 ............................................................................. *** * * 27.8071 * 27.8071 

340183 ............................................................................. 1.0771 0.9512 * * * * 

350002 ............................................................................. 1.8102 0.7329 22.0283 22.4307 23.7161 22.7683 

350003 ............................................................................. 1.1838 0.7329 21.8061 23.9639 24.9963 23.6034 

350006 ............................................................................. 1.5606 0.7329 19.4985 21.2726 22.4602 21.0489 

350009 ............................................................................. 1.1335 0.8189 23.0873 23.8681 24.5724 23.8525 

350010 ............................................................................. 0.9681 0.7313 19.1964 20.1290 20.4189 19.9339 

350011 ............................................................................. 1.9833 0.8189 23.1947 23.8400 24.1118 23.7255 

350014 ............................................................................. 0.9073 0.7313 17.7565 19.1684 17.5803 18.1595 

350015 ............................................................................. 1.6832 0.7329 20.1161 20.9046 21.3324 20.8688 

350017 ............................................................................. 1.2724 0.7313 21.0243 22.4359 21.6164 21.6690 

350019 ............................................................................. 1.6835 0.7729 22.1960 23.2018 23.9585 23.1800 

350030 ............................................................................. 0.9605 0.7313 18.9978 20.2722 22.5960 20.6212 

350061 ............................................................................. 1.4521 * 22.0515 * * 22.0515 

350063 ............................................................................. 0.8930 1.4406 * * * * 

350070 ............................................................................. 1.8146 0.8189 25.2836 25.2365 26.2446 25.5900 

360001 ............................................................................. 1.4375 0.9654 23.9101 25.8669 28.8621 26.1633 

360002 ............................................................................. 1.2626 0.8843 24.5789 24.5155 25.4859 24.8654 

360003 ............................................................................. 1.7692 0.9654 27.5029 28.9672 30.7793 29.0933 

360006 ............................................................................. 1.9028 1.0048 28.1698 30.1363 30.9800 29.7938 

360008 ............................................................................. 1.3248 0.8706 24.5714 26.2632 27.5658 26.1301 

360009 ............................................................................. 1.6042 0.9312 23.1012 25.0007 27.0599 25.0987 

360010 ............................................................................. 1.2239 0.8810 23.1178 23.7825 24.7338 23.9116 

360011 ............................................................................. 1.2624 0.9840 25.5340 27.6036 31.5555 28.1828 

360012 ............................................................................. 1.3983 1.0048 27.5470 30.1416 31.0504 29.6648 

mmaher on DSK3CLS3C1PROD with $$_JOB

24895 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

360013 ............................................................................. 1.0938 0.9312 26.8130 27.0893 29.8398 27.9263 

360014 ............................................................................. 1.1288 0.9840 25.3861 27.1017 27.0725 26.5476 

360016 ............................................................................. 1.4363 0.9654 26.1283 27.8031 29.6279 27.8538 

360017 ............................................................................. 1.7059 1.0048 27.2910 29.8525 31.7064 29.6400 

360019 ............................................................................. 1.2999 0.9238 25.5926 26.9178 27.2984 26.6159 

360020 ............................................................................. 1.6208 0.9238 24.4343 23.6400 25.6319 24.5731 

360024 ............................................................................. *** * 23.5793 * * 23.5793 

360025 ............................................................................. 1.4533 0.9276 25.5633 27.4533 27.1537 26.7665 

360026 ............................................................................. 1.3236 0.9283 23.5898 25.5379 25.2930 24.8033 

360027 ............................................................................. 1.6124 0.9238 25.4894 27.4454 28.2908 27.0616 

360029 ............................................................................. 1.0866 0.9276 22.7785 24.3216 26.4202 24.5304 

360032 ............................................................................. 1.2094 0.8701 23.2638 25.0034 25.9909 24.7561 

360035 ............................................................................. 1.7332 1.0048 27.5220 30.0172 31.3158 29.6736 

360036 ............................................................................. 1.2090 0.9238 27.6094 27.8343 29.3509 28.2916 

360037 ............................................................................. 1.4254 0.9365 24.3982 29.0046 30.0437 27.6733 

360038 ............................................................................. 1.5417 0.9654 22.8009 25.4274 31.0557 26.2991 

360039 ............................................................................. 1.4955 0.9840 24.0218 23.9783 24.7864 24.2787 

360040 ............................................................................. 1.1428 0.9093 24.0942 24.8569 25.5333 24.8327 

360041 ............................................................................. 1.4963 0.9365 24.1080 26.1522 26.6728 25.6861 

360044 ............................................................................. 1.1371 0.8824 21.8411 21.5619 24.3827 22.5765 

360046 ............................................................................. 1.2025 0.9654 25.0775 25.4673 26.2408 25.5991 

360047 ............................................................................. 1.0860 * 21.7248 * * 21.7248 

360048 ............................................................................. 1.7551 0.9276 28.8107 29.3415 29.4798 29.2208 

360049 ............................................................................. *** * 25.8367 26.2222 * 26.0185 

360051 ............................................................................. 1.6982 0.9283 25.7556 26.8501 28.1154 26.9160 

360052 ............................................................................. 1.6085 0.9283 24.5405 26.2066 26.8786 25.8857 

360054 ............................................................................. 1.3922 0.8706 23.0376 22.9359 24.8241 23.5843 

360055 ............................................................................. 1.4135 0.8996 26.3112 27.3941 30.0124 27.8965 

360056 ............................................................................. 1.6196 0.9654 23.1024 26.5318 30.3674 26.6370 

360058 ............................................................................. 1.0570 0.8701 23.4429 23.8119 24.5004 23.9275 

360059 ............................................................................. 1.5019 0.9365 25.3516 29.3624 30.6157 28.4896 

360062 ............................................................................. 1.4828 1.0048 28.6518 31.7422 33.1325 31.3394 

360064 ............................................................................. 1.5894 0.8996 22.2393 25.2336 27.7775 24.9757 

360065 ............................................................................. 1.2185 0.9276 26.3036 28.0405 29.7142 28.0320 

360066 ............................................................................. 1.5174 0.9312 27.3362 27.1436 29.7605 28.0751 

360068 ............................................................................. 1.8821 0.9276 25.8414 26.2065 26.6926 26.2580 

360069 ............................................................................. 1.2464 * 24.2444 * * 24.2444 

360070 ............................................................................. 1.6601 0.8921 24.8863 27.2389 27.8858 26.6566 

360071 ............................................................................. 1.1154 0.8736 22.0786 23.4619 26.4057 23.9592 

360072 ............................................................................. 1.5235 1.0048 24.4332 25.9589 27.2266 25.9252 

360074 ............................................................................. 1.3006 0.9276 24.9055 25.8959 27.5322 26.1110 

360075 ............................................................................. 1.1470 0.9365 26.8453 26.8925 26.1643 26.5899 

360076 ............................................................................. 1.4896 0.9654 25.9369 28.1013 29.0117 27.7066 

360077 ............................................................................. 1.5217 0.9365 25.6505 28.4449 28.2382 27.4520 

360078 ............................................................................. 1.2784 0.9238 26.1313 25.7885 27.4681 26.4451 

360079 ............................................................................. 1.7865 0.9654 26.0935 27.2437 30.1207 27.8332 

360080 ............................................................................. 1.1298 0.8701 20.8309 21.4526 22.7007 21.7293 

360081 ............................................................................. 1.3482 0.9276 27.5695 29.8366 29.5312 28.9628 

360082 ............................................................................. 1.3502 0.9365 27.1197 29.2561 28.7914 28.4294 

360084 ............................................................................. 1.6070 0.8854 25.8415 27.3917 28.5391 27.2562 

360085 ............................................................................. 2.0277 1.0048 29.0081 31.5800 33.1242 31.3481 

360086 ............................................................................. 1.6599 0.9283 22.1859 25.4218 27.1112 24.8912 

360087 ............................................................................. 1.3509 0.9365 25.4040 29.6579 28.4514 27.8631 

360089 ............................................................................. 1.1462 0.8701 22.7951 25.3465 25.5599 24.5871 

360090 ............................................................................. 1.5838 0.9276 26.7717 29.0199 30.7505 28.8607 

360091 ............................................................................. 1.3280 0.9365 27.5067 25.8657 27.6802 27.0162 

360092 ............................................................................. 1.2657 1.0048 25.6618 25.4954 25.4045 25.5161 

360094 ............................................................................. *** * 26.6348 * * 26.6348 

360095 ............................................................................. 1.4017 0.9276 26.1275 26.4635 29.3772 27.2940 

360096 ............................................................................. 1.0892 0.8775 24.6317 25.9275 26.8627 25.8201 

360098 ............................................................................. 1.3635 0.9365 24.8447 25.5973 26.6025 25.7083 

mmaher on DSK3CLS3C1PROD with $$_JOB

24896 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

360100 ............................................................................. 1.2005 0.8921 23.0561 25.4523 23.6159 24.0347 

360101 ............................................................................. 1.3623 0.9365 26.6209 27.6030 29.7806 28.0278 

360106 ............................................................................. *** * 24.1588 * * 24.1588 

360107 ............................................................................. 1.1250 0.9276 25.9697 24.6095 26.0530 25.5447 

360109 ............................................................................. 1.0690 0.8701 25.4184 26.3131 30.1363 27.2357 

360112 ............................................................................. 1.9961 0.9276 28.6784 30.5715 31.1515 30.1229 

360113 ............................................................................. 1.3136 0.9654 25.6493 26.6556 30.2863 27.4972 

360115 ............................................................................. 1.2841 0.9365 24.0052 25.9841 26.1795 25.4590 

360116 ............................................................................. 1.1939 0.9654 18.0655 25.1717 26.4955 23.3907 

360118 ............................................................................. 1.5237 0.9214 27.7289 27.3884 28.5629 27.8928 

360121 ............................................................................. 1.3620 0.9276 24.5593 27.4442 28.3823 26.7820 

360123 ............................................................................. 1.4133 0.9365 22.6523 27.1920 28.0320 25.8332 

360125 ............................................................................. 1.1982 0.8701 22.1096 24.1388 25.9042 23.9896 

360128 ............................................................................. *** * 21.0067 * * 21.0067 

360130 ............................................................................. 1.4718 0.9365 22.9762 25.6570 26.3962 25.2266 

360131 ............................................................................. 1.3051 0.8921 24.0496 25.3719 26.6628 25.3527 

360132 ............................................................................. 1.3639 0.9654 25.9453 27.7724 29.4046 27.6748 

360133 ............................................................................. 1.6035 0.9283 24.6208 29.8684 31.7499 28.7264 

360134 ............................................................................. 1.7956 0.9654 29.2974 27.7339 28.5138 28.4864 

360137 ............................................................................. 1.7463 0.9365 26.9522 26.1250 27.6882 26.9252 

360141 ............................................................................. 1.6594 0.8996 27.7085 29.7937 31.1769 29.5398 

360142 ............................................................................. 1.0704 * 22.1610 * * 22.1610 

360143 ............................................................................. 1.2891 0.9365 24.6306 28.3057 27.3743 26.8209 

360144 ............................................................................. 1.3643 0.9365 25.7079 28.2473 28.9166 27.6777 

360145 ............................................................................. 1.6714 0.9365 25.8268 27.1908 28.1802 27.1029 

360147 ............................................................................. 1.2484 0.8701 24.1953 25.5854 27.5529 25.7869 

360148 ............................................................................. 1.0883 0.8701 26.1947 26.0837 26.3390 26.2100 

360150 ............................................................................. 1.2297 0.9238 24.7667 25.1217 31.2684 26.9639 

360151 ............................................................................. 1.6221 0.8921 24.8629 25.3780 26.5001 25.5913 

360152 ............................................................................. 1.5017 1.0048 27.9147 29.9425 31.5364 29.7871 

360153 ............................................................................. 0.9767 0.8701 19.0226 19.8499 20.2124 19.7383 

360155 ............................................................................. 1.4479 0.9365 25.3909 26.9127 28.9551 27.1136 

360156 ............................................................................. 1.1512 0.8796 24.0509 24.3281 25.0839 24.5014 

360159 ............................................................................. 1.2592 0.9840 33.1613 29.1529 28.6161 30.0443 

360161 ............................................................................. 1.3686 0.8996 24.3792 25.4433 27.0861 25.6054 

360163 ............................................................................. 1.9114 0.9654 26.9728 28.9742 30.0503 28.6581 

360170 ............................................................................. 1.3066 1.0048 24.3620 28.5474 30.2417 27.8461 

360172 ............................................................................. 1.3796 0.9365 26.3501 27.5669 28.8276 27.5898 

360174 ............................................................................. 1.2817 0.9283 24.9990 26.8586 28.3284 26.7426 

360175 ............................................................................. 1.2427 0.9840 26.5949 28.1531 28.3038 27.6954 

360177 ............................................................................. 1.1565 * 24.4712 * * 24.4712 

360179 ............................................................................. 1.5926 0.9654 28.8645 30.0311 29.8291 29.5971 

360180 ............................................................................. 2.2538 0.9365 26.1514 29.6633 31.4318 29.1118 

360185 ............................................................................. 1.1979 0.8775 23.7173 25.6800 26.1053 25.1940 

360187 ............................................................................. 1.5392 0.9283 24.8173 24.9353 25.7593 25.1880 

360189 ............................................................................. 1.1090 1.0048 24.2136 26.3756 27.5194 26.0228 

360192 ............................................................................. 1.2914 0.9365 26.7577 26.4616 27.5979 26.9455 

360195 ............................................................................. 1.0872 0.9365 26.1281 25.0922 27.6148 26.2465 

360197 ............................................................................. 1.1400 0.9840 27.0896 28.7580 28.9190 28.2666 

360203 ............................................................................. 1.2433 0.8701 22.1414 24.4433 25.3724 24.0021 

360210 ............................................................................. 1.1676 1.0048 27.8415 28.2976 29.1231 28.4261 

360211 ............................................................................. 1.5603 0.8701 22.5449 25.7053 26.5443 24.7611 

360212 ............................................................................. 1.3255 0.9365 25.2756 25.6080 27.2263 26.0408 

360218 ............................................................................. 1.1995 1.0048 27.4288 29.8662 30.0072 29.0783 

360230 ............................................................................. 1.5565 0.9365 27.0223 28.8018 30.0644 28.6832 

360234 ............................................................................. 1.3350 0.9654 24.3625 25.9360 31.0655 27.0902 

360236 ............................................................................. 1.2597 0.9654 35.8143 25.6728 29.5312 29.3312 

360239 ............................................................................. 1.3159 0.9283 25.2474 27.2939 30.7698 27.7358 

360241 ............................................................................. *** * 24.7001 23.0662 25.7293 24.4913 

360242 ............................................................................. 1.8997 * * * * * 

360245 ............................................................................. 0.5512 0.9238 19.1884 20.6504 20.3411 20.0849 

mmaher on DSK3CLS3C1PROD with $$_JOB

24897 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

360247 ............................................................................. 0.3793 1.0048 19.8891 19.3677 * 19.6148 

360253 ............................................................................. 2.4484 0.9654 30.4276 33.2371 34.3298 32.7134 

360259 ............................................................................. 1.3020 0.9276 25.1338 25.9878 27.2896 26.1978 

360260 ............................................................................. *** * 27.3903 * * 27.3903 

360261 ............................................................................. 1.3730 0.8845 22.5431 22.3614 25.6328 23.5171 

360262 ............................................................................. 1.3188 0.9276 27.1680 28.6995 30.1562 28.7641 

360263 ............................................................................. 1.8192 0.9312 20.8884 25.1652 25.4813 23.9900 

360264 ............................................................................. *** * * 36.0754 * 36.0754 

360265 ............................................................................. *** * * 36.6265 * 36.6265 

360266 ............................................................................. 2.1280 1.0048 * * 31.7532 31.7532 

360267 ............................................................................. *** * * * 34.0914 34.0914 

360268 ............................................................................. *** * * * 34.0503 34.0503 

360269 ............................................................................. 1.7180 0.9654 * * 24.8569 24.8569 

360270 ............................................................................. 1.1022 0.8701 * * * * 

360271 ............................................................................. 1.4810 0.9654 * * * * 

360273 ............................................................................. 1.6114 0.8701 * * * * 

370001 ............................................................................. 1.6364 0.8504 27.7245 26.0194 26.9066 26.8618 

370002 ............................................................................. 1.2199 0.7702 20.1479 22.0476 23.6850 21.9862 

370004 ............................................................................. 1.1269 0.9040 25.3919 26.7434 26.8511 26.3097 

370006 ............................................................................. 1.2605 0.8504 20.1063 22.4802 23.9928 22.1048 

370007 ............................................................................. 1.0754 0.7702 17.6547 19.4036 20.3673 19.1460 

370008 ............................................................................. 1.4647 0.8764 24.2978 25.3352 26.6546 25.4718 

370011 ............................................................................. 0.9837 0.8764 19.7821 21.9649 22.3379 21.3301 

370013 ............................................................................. 1.5640 0.8764 24.9294 26.5364 27.2662 26.2290 

370014 ............................................................................. 1.0060 0.8535 25.3576 25.9393 26.4459 25.9300 

370015 ............................................................................. 1.0124 0.8504 23.6694 24.7547 25.5786 24.6931 

370016 ............................................................................. 1.6367 0.8764 25.4062 26.7938 29.8253 27.2541 

370018 ............................................................................. 1.5049 0.8504 23.5336 25.3573 24.6848 24.5166 

370019 ............................................................................. 1.2516 0.7702 21.4474 22.0221 25.2799 22.9578 

370020 ............................................................................. 1.3456 0.7702 18.5046 20.8723 22.7512 20.7432 

370022 ............................................................................. 1.2128 0.8071 19.6495 24.6099 22.2254 22.0686 

370023 ............................................................................. 1.3507 0.7792 21.5762 23.5170 23.9997 23.0468 

370025 ............................................................................. 1.2923 0.8504 23.5659 23.9873 24.5531 24.0379 

370026 ............................................................................. 1.4292 0.8764 23.0848 25.8428 25.3460 24.7668 

370028 ............................................................................. 1.8835 0.8764 26.6153 27.8621 28.5594 27.6903 

370029 ............................................................................. 1.1365 0.7702 23.9956 26.8508 28.5284 26.4589 

370030 ............................................................................. 1.0204 0.7702 23.3037 24.1483 25.8183 24.4349 

370032 ............................................................................. 1.4524 0.8764 23.4843 24.8626 26.3171 24.8715 

370034 ............................................................................. 1.2252 0.7702 18.2341 19.5099 20.4074 19.4048 

370036 ............................................................................. 1.1122 0.7702 17.7575 19.2318 19.8132 18.9467 

370037 ............................................................................. 1.6252 0.8764 23.9685 24.9553 25.5152 24.8480 

370039 ............................................................................. 1.0449 0.8504 21.8220 23.0254 23.5733 22.8098 

370040 ............................................................................. 0.9665 0.8056 22.4048 22.8356 26.7367 23.9154 

370041 ............................................................................. 0.8802 0.8504 22.3496 22.6731 22.9777 22.6684 

370047 ............................................................................. 1.3864 0.8764 20.4657 24.1991 24.4738 23.0657 

370048 ............................................................................. 1.0417 0.7702 19.2464 21.4543 22.0594 20.9179 

370049 ............................................................................. 1.3124 0.8764 23.2171 23.8844 22.8742 23.3160 

370051 ............................................................................. 1.0579 0.7702 17.2618 19.8329 19.3164 18.8224 

370054 ............................................................................. 1.2325 0.7702 21.5044 22.4652 25.2122 22.9823 

370056 ............................................................................. 1.8614 0.8406 22.0312 24.3986 25.5420 23.9740 

370057 ............................................................................. 0.9753 0.8504 19.7284 19.8683 22.1308 20.5333 

370060 ............................................................................. 0.9969 0.8504 18.7592 19.9025 23.3793 20.5008 

370064 ............................................................................. 0.8912 * 14.2053 * * 14.2053 

370065 ............................................................................. 1.0064 0.7799 20.0227 21.2343 23.5785 21.6442 

370072 ............................................................................. 0.8029 0.7962 9.9615 11.7942 13.0903 11.6655

370078 ............................................................................. 1.5669 0.8504 25.4068 27.8611 26.6945 26.6513 

370080 ............................................................................. 0.8703 0.7702 18.0665 19.9595 22.3662 20.0726 

370083 ............................................................................. 0.8972 0.7753 16.8836 19.2568 20.9831 18.9413 

370084 ............................................................................. 0.9999 0.7702 16.6513 19.6230 20.7278 19.1519 

370089 ............................................................................. 1.3096 0.7702 20.4699 20.6153 22.1503 21.0632 

370091 ............................................................................. 1.5724 0.8504 23.3357 24.1438 25.8676 24.4372 

mmaher on DSK3CLS3C1PROD with $$_JOB

24898 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

370093 ............................................................................. 1.6188 0.8764 26.9774 26.0459 27.4328 26.8140 

370094 ............................................................................. 1.4242 0.8764 23.1191 24.5555 26.5223 24.7218 

370097 ............................................................................. 1.3209 0.8406 22.3267 26.3168 26.7940 25.2222 

370099 ............................................................................. 1.0704 0.7702 20.5075 24.9971 26.7160 23.9172 

370100 ............................................................................. 0.9275 0.7803 14.7711 17.9732 19.3931 17.4549 

370103 ............................................................................. 1.0056 0.7702 17.8018 18.8933 19.4227 18.7231 

370105 ............................................................................. 1.9411 0.8764 23.8978 26.7973 26.6370 25.8992 

370106 ............................................................................. 1.4000 0.8764 26.5867 27.8979 28.5947 27.7396 

370112 ............................................................................. 0.9491 0.8056 15.4471 16.0592 16.7860 16.1368 

370113 ............................................................................. 1.1449 0.8719 25.3565 26.9720 26.4599 26.2279 

370114 ............................................................................. 1.5828 0.8504 21.7880 23.0006 25.9816 23.5714 

370123 ............................................................................. *** * 25.4733 * * 25.4733 

370125 ............................................................................. *** * 17.1361 * * 17.1361 

370138 ............................................................................. 1.0409 0.7702 18.3113 20.2528 22.1656 20.1240 

370139 ............................................................................. 0.9462 0.7702 18.5226 19.4287 20.5120 19.5050 

370148 ............................................................................. 1.5477 0.8764 25.2348 27.0904 28.1920 26.9001 

370149 ............................................................................. 1.2424 0.8764 22.3537 23.3493 23.3403 23.0323 

370153 ............................................................................. 1.1462 0.7702 19.8349 23.2778 24.1577 22.4430 

370156 ............................................................................. 0.9979 0.7824 19.4743 25.2562 23.0030 22.5278 

370158 ............................................................................. 0.9453 0.8764 18.5578 20.7641 21.5187 20.2564 

370166 ............................................................................. 0.8427 0.8504 23.1682 25.1107 24.7202 24.3416 

370169 ............................................................................. 0.8651 0.7866 15.8002 16.8252 16.6722 16.4248 

370170 ............................................................................. 0.9077 1.4406 * * * * 

370171 ............................................................................. 0.8795 1.4406 * * * * 

370172 ............................................................................. 0.8593 1.4666 * * * * 

370173 ............................................................................. 0.9221 1.4406 * * * * 

370174 ............................................................................. 0.7942 1.4406 * * * * 

370176 ............................................................................. 1.2142 0.8504 25.0509 24.7655 24.9681 24.9283 

370177 ............................................................................. *** * 14.7193 * * 14.7193 

370178 ............................................................................. 0.8842 0.7702 14.6070 16.0179 16.0702 15.5699 

370179 ............................................................................. 0.8038 * 23.5794 * * 23.5794 

370180 ............................................................................. 1.0055 1.4406 * * * * 

370183 ............................................................................. 0.9349 0.8504 21.8147 24.7103 23.8398 23.4249 

370190 ............................................................................. 1.4248 0.8504 33.1137 29.1568 34.8952 32.5860 

370192 ............................................................................. 1.9859 0.8764 31.4930 27.6367 19.0636 24.5970 

370196 ............................................................................. *** * 22.6824 22.3498 20.8286 21.9381 

370199 ............................................................................. 0.7713 0.8764 26.0450 23.3989 23.7422 24.3360 

370200 ............................................................................. 1.0426 0.7702 17.6317 20.5175 21.7857 19.8245 

370201 ............................................................................. 1.6779 0.8764 23.3550 23.8090 24.2461 23.8017 

370202 ............................................................................. 1.4321 0.8504 25.1181 26.1132 25.7745 25.6728 

370203 ............................................................................. 2.0656 0.8764 23.5190 22.8869 25.7761 24.0066 

370206 ............................................................................. 1.5795 0.8764 26.0912 26.0353 27.5742 26.5857 

370210 ............................................................................. 2.1553 0.8504 21.2682 23.3786 27.2693 23.9762 

370211 ............................................................................. 1.0823 0.8764 26.5345 27.8737 28.6515 27.7373 

370212 ............................................................................. 1.7647 0.8764 21.0758 19.1720 20.3497 20.1566 

370213 ............................................................................. *** * 29.3777 * * 29.3777 

370214 ............................................................................. 0.9301 0.7824 * 20.6217 21.0658 20.8579 

370215 ............................................................................. 2.4404 0.8764 32.3589 31.5652 32.4081 32.1113 

370216 ............................................................................. 2.0143 0.8504 * 27.2429 25.8238 26.4842 

370217 ............................................................................. *** * * 26.8677 * 26.8677 

370218 ............................................................................. 2.3290 0.8504 * * 30.3422 30.3422 

370220 ............................................................................. 2.0085 0.8764 * * * * 

370222 ............................................................................. 1.8273 0.8764 * * * * 

370223 ............................................................................. 0.8874 0.8764 * * * * 

370224 ............................................................................. 1.0183 0.8764 * * * * 

380001 ............................................................................. 1.3085 1.1233 30.0103 29.5842 32.0772 30.5857 

380002 ............................................................................. 1.2471 0.9950 27.1861 30.3385 31.5214 29.7041 

380004 ............................................................................. 1.7236 1.1233 30.5172 32.6901 34.5430 32.6119 

380005 ............................................................................. 1.4094 1.0304 30.2210 30.9087 33.2838 31.5051 

380007 ............................................................................. 2.0573 1.1233 33.9969 33.9601 35.1698 34.3879 

380008 ............................................................................. *** * 25.8356 * * 25.8356 

mmaher on DSK3CLS3C1PROD with $$_JOB

24899 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

380009 ............................................................................. 2.0468 1.1233 31.7042 32.4016 34.5626 32.8910 

380010 ............................................................................. *** * 30.2957 34.4208 * 32.1520 

380014 ............................................................................. 1.9254 1.0708 29.9648 33.6078 33.1920 32.2199 

380017 ............................................................................. 1.8307 1.1233 32.2447 34.2605 35.3727 33.9499 

380018 ............................................................................. 1.9127 1.0304 28.0701 30.9923 31.8162 30.3574 

380020 ............................................................................. 1.4175 1.1008 28.3563 29.6053 34.6178 30.5328 

380021 ............................................................................. 1.4799 1.1233 29.3295 29.2164 32.6143 30.3295 

380022 ............................................................................. 1.3427 1.0322 29.2642 30.1742 29.6225 29.6961 

380023 ............................................................................. 1.1613 * 26.5439 * * 26.5439 

380025 ............................................................................. 1.2130 1.1233 33.2105 35.5084 36.4904 35.1203 

380027 ............................................................................. 1.2891 1.0713 25.5161 26.4982 28.0232 26.6747 

380029 ............................................................................. 1.2598 1.0404 26.9967 28.7994 29.4458 28.4963 

380033 ............................................................................. 1.7477 1.1008 30.8767 33.4828 34.0066 32.8324 

380037 ............................................................................. 1.3213 1.1233 30.5818 32.4033 32.7927 31.9695 

380038 ............................................................................. 1.3172 1.1233 34.2303 34.5971 35.1114 34.6434 

380039 ............................................................................. *** * 32.3959 38.0989 * 34.9720 

380040 ............................................................................. 1.4149 0.9950 32.0103 31.2286 32.9082 32.0782 

380047 ............................................................................. 1.8758 1.0592 29.8627 31.0584 32.8186 31.2890 

380050 ............................................................................. 1.4603 1.0151 25.6190 27.1814 29.7312 27.5470 

380051 ............................................................................. 1.6397 1.0404 29.7219 30.8891 32.8537 31.1839 

380052 ............................................................................. 1.2960 0.9950 24.9476 25.6085 28.6112 26.2863 

380056 ............................................................................. 1.1337 1.0404 25.1475 27.7253 29.1649 27.4834 

380060 ............................................................................. 1.4638 1.1233 30.7041 32.0101 33.8855 32.2257 

380061 ............................................................................. 1.6749 1.1233 29.8217 32.3699 34.5222 32.2741 

380071 ............................................................................. 1.3167 1.1233 30.2304 31.7761 31.0905 31.0383 

380075 ............................................................................. 1.3427 1.0304 29.0368 33.8962 31.6899 31.4887 

380081 ............................................................................. 0.6765 0.9950 21.8850 26.8149 28.9626 25.5794 

380082 ............................................................................. 1.2728 1.1233 32.3002 35.6708 35.7815 34.6173 

380089 ............................................................................. 1.3127 1.1233 33.4214 34.6015 35.4845 34.5150 

380090 ............................................................................. 1.3031 1.0713 34.4536 33.0990 35.5491 34.3699 

380091 ............................................................................. 1.3581 1.1233 33.8950 39.9703 40.5058 38.1381 

380100 ............................................................................. 1.6492 1.1233 * * * * 

390001 ............................................................................. 1.5910 0.8366 22.5309 23.6075 24.3387 23.5011 

390002 ............................................................................. 1.2796 0.8388 22.4388 24.7867 25.0846 24.1306 

390003 ............................................................................. 1.1972 0.8366 21.6477 23.3672 24.6385 23.2157 

390004 ............................................................................. 1.5727 0.9240 24.3249 24.4068 25.3218 24.7131 

390006 ............................................................................. 1.9184 0.9130 25.1216 26.8581 28.7849 27.0024 

390008 ............................................................................. 1.1369 0.8421 22.2680 22.8042 22.6293 22.5687 

390009 ............................................................................. 1.8139 0.8507 25.5482 26.7462 26.7227 26.3592 

390010 ............................................................................. 1.1864 0.8388 23.5390 24.5785 24.8175 24.2866 

390011 ............................................................................. *** * 21.9279 21.4856 20.2276 21.2239 

390012 ............................................................................. 1.2254 1.0906 28.5076 30.7542 32.3118 30.5163 

390013 ............................................................................. 1.3340 0.9130 24.0044 25.0037 26.2309 25.0972 

390016 ............................................................................. 1.2391 0.8701 21.9549 23.2095 24.3473 23.2182 

390019 ............................................................................. 1.1019 1.0024 23.4636 24.0538 25.7506 24.3568 

390022 ............................................................................. *** * 29.0710 30.3565 29.6304 29.6954 

390023 ............................................................................. 1.2530 1.0906 31.7149 35.4452 34.7747 34.0474 

390024 ............................................................................. 1.0208 1.0906 35.3960 33.5186 39.7191 35.9814 

390025 ............................................................................. 0.4785 1.0906 17.2977 19.1362 20.3840 18.9796 

390026 ............................................................................. 1.2151 1.0906 29.5157 31.8512 31.8294 31.0655 

390027 ............................................................................. 1.7286 1.0906 35.8381 35.5692 39.2148 36.9324 

390028 ............................................................................. 1.6335 0.8388 25.7246 27.1869 27.1447 26.6793 

390030 ............................................................................. 1.1566 1.0024 22.1581 23.6063 24.6318 23.4864 

390031 ............................................................................. 1.2252 0.9419 22.6828 26.2654 27.2007 25.3401 

390032 ............................................................................. 1.2843 0.8388 22.7205 23.9466 24.5233 23.7226 

390035 ............................................................................. 1.1523 1.0906 26.2647 28.4564 29.5405 28.1286 

390036 ............................................................................. 1.4372 0.8388 24.6032 21.6358 24.4924 23.5132 

390037 ............................................................................. 1.4045 0.8388 24.7820 25.4290 25.2295 25.1463 

390039 ............................................................................. 1.1412 0.8366 20.3787 22.0208 23.2288 21.8618 

390041 ............................................................................. 1.2811 0.8388 21.5925 22.9814 24.2252 22.9571 

390042 ............................................................................. 1.3531 0.8388 25.6328 28.3633 28.0982 27.3600 

mmaher on DSK3CLS3C1PROD with $$_JOB

24900 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

390043 ............................................................................. 1.2012 0.8366 22.2549 23.2378 24.2078 23.2254 

390044 ............................................................................. 1.6708 1.0778 27.1505 28.7758 29.4037 28.4744 

390045 ............................................................................. 1.5821 0.8366 23.0712 23.9343 24.6486 23.8977 

390046 ............................................................................. 1.6479 0.9589 27.2630 29.6574 29.9620 28.9961 

390048 ............................................................................. 1.0778 0.9130 24.9759 28.5342 28.3118 27.3366 

390049 ............................................................................. 1.5920 1.0024 27.1366 29.6121 30.7411 29.2421 

390050 ............................................................................. 2.0718 0.8388 26.6931 27.2599 27.3478 27.1027 

390052 ............................................................................. 1.1793 0.8410 23.3474 24.9510 25.1446 24.4778 

390054 ............................................................................. *** * 22.8087 24.4435 27.4795 24.7386 

390055 ............................................................................. *** * 25.6945 * * 25.6945 

390056 ............................................................................. 1.0633 0.8366 19.5537 23.5077 23.5637 22.1096 

390057 ............................................................................. 1.3240 1.0906 27.9583 29.7982 30.8283 29.5698 

390058 ............................................................................. 1.3199 0.9240 27.4799 26.9546 27.7268 27.3837 

390061 ............................................................................. 1.4182 0.9589 28.4538 29.1318 30.0565 29.1849 

390062 ............................................................................. 1.1297 0.8366 21.4051 21.2999 21.0708 21.2582 

390063 ............................................................................. 1.8004 0.8507 24.7614 26.4998 26.8353 26.0645 

390065 ............................................................................. 1.2577 1.0108 25.2188 27.6249 29.5649 27.4343 

390066 ............................................................................. 1.4268 0.9130 24.2087 25.9645 25.4393 25.2120 

390067 ............................................................................. 1.8076 0.9240 26.3287 29.7234 30.6094 28.8535 

390068 ............................................................................. 1.3351 0.9589 25.8291 26.7358 29.0944 27.1392 

390070 ............................................................................. 1.4180 1.0906 30.9500 33.3185 34.4930 32.9334 

390071 ............................................................................. 1.0299 0.8366 21.8367 24.6462 24.8460 23.7235 

390072 ............................................................................. 1.0763 0.8366 24.9389 25.3029 26.2548 25.5020 

390073 ............................................................................. 1.7429 0.8366 26.3698 25.7822 26.4077 26.2014 

390074 ............................................................................. *** * 22.8545 23.6500 25.4092 23.9492 

390075 ............................................................................. *** * 24.6359 * * 24.6359 

390076 ............................................................................. 1.4123 1.0906 27.9004 31.8500 32.7649 30.8669 

390079 ............................................................................. 1.8385 0.8779 23.3053 22.5607 24.4435 23.4342 

390080 ............................................................................. 1.3296 1.0906 27.2616 28.7063 29.2639 28.4487 

390081 ............................................................................. 1.2598 1.0752 30.3840 31.7569 33.6236 31.9438 

390084 ............................................................................. 1.0968 0.8366 19.8606 23.2039 24.3329 22.4562 

390086 ............................................................................. 1.6536 0.8366 22.5317 23.5141 25.0983 23.7475 

390090 ............................................................................. 1.9853 0.8388 25.2014 27.3528 27.0118 26.5228 

390091 ............................................................................. 1.1455 0.8775 21.5586 21.7010 23.3559 22.1984 

390093 ............................................................................. 1.1582 0.8388 21.4401 22.6082 22.6016 22.2273 

390095 ............................................................................. 1.1970 0.8366 23.6240 22.6150 24.6271 23.6286 

390096 ............................................................................. 1.5973 1.0778 27.0763 28.8258 28.6039 28.1713 

390097 ............................................................................. 1.2470 1.0906 25.6660 26.1741 27.9853 26.5901 

390100 ............................................................................. 1.7090 0.9589 27.7208 30.0132 30.0428 29.3272 

390101 ............................................................................. 1.2975 0.9307 21.9418 23.1497 24.8352 23.3524 

390102 ............................................................................. 1.4439 0.8388 24.8898 24.8369 24.4585 24.7139 

390103 ............................................................................. 0.8439 0.8388 20.6775 20.5741 20.4440 20.5654 

390104 ............................................................................. 1.0870 0.8366 19.6428 19.2326 19.6622 19.5081 

390107 ............................................................................. 1.5261 0.8388 24.1386 24.1159 24.6567 24.3173 

390108 ............................................................................. 1.2329 1.0906 27.2661 27.8171 28.5901 27.9019 

390109 ............................................................................. 1.1589 * 19.9156 * * 19.9156 

390110 ............................................................................. 1.6020 0.8388 23.9808 27.7311 25.3386 25.6176 

390111 ............................................................................. 2.1643 1.0906 32.6510 34.2990 34.8737 33.9658 

390112 ............................................................................. 1.2290 0.8366 19.2126 20.2380 21.5428 20.3235 

390113 ............................................................................. 1.2888 0.8775 22.2591 23.3686 24.2583 23.3082 

390114 ............................................................................. 1.5631 0.8388 24.0473 26.9620 27.9174 26.3014 

390115 ............................................................................. 1.4526 1.0906 27.7333 29.6905 30.8033 29.4301 

390116 ............................................................................. 1.2416 1.0906 30.2722 32.2513 33.2549 31.9771 

390117 ............................................................................. 1.1678 0.8366 20.3946 20.7821 21.5035 20.9015 

390118 ............................................................................. 1.1725 0.8366 21.5001 20.5614 21.8906 21.3374 

390119 ............................................................................. 1.3029 0.8366 22.2746 23.0928 24.3227 23.2316 

390121 ............................................................................. *** * 23.1408 25.4826 * 24.2748 

390122 ............................................................................. 1.0760 0.8415 22.5786 23.1866 23.3220 23.0325 

390123 ............................................................................. 1.1933 1.0906 28.6269 32.4528 34.0037 31.6497 

390125 ............................................................................. 1.2622 0.8366 20.9456 22.4033 22.8792 22.0898 

390127 ............................................................................. 1.3278 1.0906 30.9374 31.9091 33.6955 32.1928 

mmaher on DSK3CLS3C1PROD with $$_JOB

24901 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

390128 ............................................................................. 1.2537 0.8388 23.1539 24.1628 24.1382 23.8227 

390130 ............................................................................. 1.2868 0.8366 24.0685 23.0592 23.2426 23.4688 

390131 ............................................................................. 1.3320 0.8388 22.6306 23.0577 23.5768 23.1072 

390132 ............................................................................. 1.4492 1.0906 27.7250 29.6396 31.1131 29.5021 

390133 ............................................................................. 1.7198 1.0778 28.7162 31.1083 32.9942 31.0177 

390135 ............................................................................. *** * 24.4738 * * 24.4738 

390136 ............................................................................. *** * 22.1415 23.9813 * 23.0891 

390137 ............................................................................. 1.4877 0.8366 23.4877 24.2878 26.1444 24.6484 

390138 ............................................................................. 1.1925 0.9130 24.2769 25.3410 27.4226 25.7127 

390139 ............................................................................. 1.3707 1.0906 30.4246 34.1447 34.0800 32.9175 

390142 ............................................................................. 1.5236 1.0906 32.5786 33.8224 34.5755 33.7216 

390145 ............................................................................. 1.5372 0.8388 23.8041 24.6672 25.6972 24.7296 

390146 ............................................................................. 1.2178 0.8385 25.2460 22.6752 25.1795 24.3869 

390147 ............................................................................. 1.3587 0.8388 25.0971 26.8522 28.6585 26.8141 

390150 ............................................................................. 1.1283 0.8388 24.1855 22.8228 22.7669 23.2856 

390151 ............................................................................. 1.3568 1.0990 27.1539 29.9254 31.4053 29.5922 

390153 ............................................................................. 1.3449 1.0906 30.0585 32.8234 33.2401 32.1631 

390154 ............................................................................. 1.2257 0.8366 20.6982 22.8391 23.3554 22.2878 

390156 ............................................................................. 1.3797 1.0752 31.2571 32.2688 32.8981 32.1217 

390157 ............................................................................. 1.2706 0.8388 22.7493 21.5923 22.1101 22.1488 

390160 ............................................................................. 1.2523 0.8388 21.4877 24.0208 22.9688 22.8164 

390162 ............................................................................. 1.4945 1.1578 30.0900 35.5057 34.5792 33.2581 

390163 ............................................................................. 1.2309 0.8388 22.1741 23.2055 22.8331 22.7280 

390164 ............................................................................. 2.1785 0.8388 26.4971 26.3087 27.1941 26.6933 

390166 ............................................................................. 1.1701 0.8388 24.9810 20.9272 23.3249 23.1376 

390168 ............................................................................. 1.5196 0.8388 24.5820 26.1365 26.9801 25.9244 

390169 ............................................................................. 1.4291 0.8366 27.2242 26.5514 26.2631 26.6871 

390173 ............................................................................. 1.1808 0.8366 22.8220 23.9927 25.6446 24.1667 

390174 ............................................................................. 1.7023 1.0906 32.6265 34.2069 35.2897 34.0693 

390176 ............................................................................. 1.0556 0.8388 * 23.9779 24.1240 24.0542 

390178 ............................................................................. 1.3607 0.8996 20.7270 22.6006 23.1440 22.1434 

390179 ............................................................................. 1.4433 1.0906 27.2222 28.0688 30.1208 28.5190 

390180 ............................................................................. 1.4073 1.0752 32.4375 34.9832 35.5103 34.3001 

390181 ............................................................................. 1.1003 0.8366 24.4573 25.9871 26.6009 25.6297 

390183 ............................................................................. 1.1425 0.8366 25.6554 27.0122 27.8354 26.8138 

390184 ............................................................................. 1.1043 0.8388 22.5519 22.7451 23.9729 23.0650 

390185 ............................................................................. 1.2679 0.8366 23.0202 25.4256 27.1111 25.2264 

390189 ............................................................................. 1.1536 0.8366 22.3722 22.6796 23.6210 22.9386 

390191 ............................................................................. 1.1480 * 20.8761 * * 20.8761 

390192 ............................................................................. 0.9891 0.8366 21.2619 20.5459 23.6172 21.8230 

390193 ............................................................................. *** * 20.1024 * * 20.1024 

390194 ............................................................................. 1.1200 1.0024 25.4235 27.5890 26.3138 26.4431 

390195 ............................................................................. 1.6265 1.0906 31.0019 34.2980 34.5552 33.3460 

390196 ............................................................................. 1.6615 * * * * * 

390197 ............................................................................. 1.3824 1.0024 25.7739 26.8270 27.2431 26.6095 

390198 ............................................................................. 1.0937 0.8507 18.7222 20.5979 20.4340 19.9083 

390199 ............................................................................. 1.1706 0.8366 21.3157 22.3224 23.0031 22.2033 

390200 ............................................................................. *** * 23.7471 * * 23.7471 

390201 ............................................................................. 1.3000 0.8366 26.3658 27.0054 27.3536 26.9243 

390203 ............................................................................. 1.6186 1.0906 28.9054 29.4930 29.1367 29.1780 

390204 ............................................................................. 1.2999 1.0906 28.6829 29.5251 30.3378 29.5558 

390211 ............................................................................. 1.2565 0.8996 23.1450 25.1689 26.5027 24.9525 

390215 ............................................................................. *** * 28.0403 * * 28.0403 

390217 ............................................................................. 1.2441 0.8388 24.3610 23.5879 24.1877 24.0510 

390219 ............................................................................. 1.3184 0.8388 25.1705 25.4886 26.1182 25.5759 

390220 ............................................................................. 1.1219 1.0906 41.6138 28.9128 30.7413 32.7167 

390222 ............................................................................. 1.2934 1.0752 28.7488 30.9464 31.7312 30.5055 

390223 ............................................................................. 2.0315 1.0906 27.6407 30.2523 34.3250 30.7316 

390224 ............................................................................. *** * 18.7624 * * 18.7624 

390225 ............................................................................. 1.2235 0.9589 24.9391 27.5803 27.2537 26.6140 

390226 ............................................................................. 1.7791 1.0906 28.5890 32.6658 32.6482 31.2951 

mmaher on DSK3CLS3C1PROD with $$_JOB

24902 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

390228 ............................................................................. 1.3964 0.8388 23.3078 23.9845 24.2239 23.8473 

390231 ............................................................................. 1.4024 1.0906 29.2653 30.9339 32.8332 30.9979 

390233 ............................................................................. 1.3811 0.9307 24.8690 25.6904 27.2575 25.9600 

390236 ............................................................................. 0.9656 0.8366 21.9169 22.1144 23.1290 22.3772 

390237 ............................................................................. 1.6150 0.8366 26.9533 27.4944 28.4317 27.5813 

390246 ............................................................................. 1.1274 0.8366 20.1581 25.1956 26.0175 23.4881 

390256 ............................................................................. 1.9049 0.9240 26.3619 28.0617 28.8967 27.8208 

390258 ............................................................................. 1.5061 1.0906 29.4626 30.4142 31.7149 30.6070 

390263 ............................................................................. 1.5329 1.0024 26.0170 28.5864 29.9800 28.2983 

390265 ............................................................................. 1.5078 0.8388 23.4836 24.0675 24.5237 24.0290 

390266 ............................................................................. 1.1594 0.8996 20.3918 20.8789 22.2224 21.1790 

390267 ............................................................................. 1.2788 0.8388 23.1051 24.2428 24.8302 24.0574 

390268 ............................................................................. 1.3895 0.8625 25.0021 25.6643 26.7336 25.8427 

390270 ............................................................................. 1.6237 0.8366 24.1496 24.9510 26.5010 25.2638 

390272 ............................................................................. 0.5351 1.0906 * * * * 

390278 ............................................................................. 0.5328 1.0906 23.6843 26.6664 28.6253 26.2989 

390279 ............................................................................. *** * 17.0012 * * 17.0012 

390285 ............................................................................. 1.4982 1.0906 35.0426 36.7163 37.6664 36.3989 

390286 ............................................................................. 1.1892 1.0906 28.1761 29.5281 31.3380 29.6274 

390287 ............................................................................. *** * 37.6569 39.3176 42.2395 39.3145 

390288 ............................................................................. *** * 29.7287 30.9701 * 30.3388 

390289 ............................................................................. *** * 28.8826 30.7583 * 29.8023 

390290 ............................................................................. 1.8483 1.0906 37.9040 38.3776 41.1403 39.1280 

390301 ............................................................................. *** * 30.9836 * * 30.9836 

390302 ............................................................................. 2.0384 1.0906 * * * * 

390303 ............................................................................. *** * * 27.5580 * 27.5580 

390304 ............................................................................. 1.2294 1.0906 * 30.4832 32.1625 31.3744 

390305 ............................................................................. *** * * * 29.3209 29.3209 

390306 ............................................................................. *** * * * 40.3778 40.3778 

390307 ............................................................................. 1.9734 0.8996 * * 24.5413 24.5413 

390308 ............................................................................. *** * * * 36.1732 36.1732 

390309 ............................................................................. *** * * * 37.8919 37.8919 

390310 ............................................................................. *** * * * 44.3970 44.3970 

390311 ............................................................................. 2.0736 1.0906 * * * * 

390312 ............................................................................. 1.1713 1.0906 * * * * 

390313 ............................................................................. 1.1482 0.9419 * * * * 

400001 ............................................................................. 1.2869 0.4517 13.1847 13.9386 14.9133 14.0366 

400002 ............................................................................. 1.8475 0.4161 16.7582 15.3833 12.9440 14.8789 

400003 ............................................................................. 1.3852 0.4161 12.8329 13.9258 15.6771 14.1320 

400004 ............................................................................. 1.2261 0.4517 14.3108 12.0923 12.5936 12.8944 

400005 ............................................................................. 1.1254 0.4517 10.7207 10.3505 11.1153 10.7266 

400006 ............................................................................. 1.1848 0.4517 9.2265 8.1841 8.4089 8.6005 

400007 ............................................................................. 1.2016 0.4517 9.2463 11.8203 12.0726 11.0856

400009 ............................................................................. 1.0096 0.2946 9.3116 9.3834 9.5111 9.4052 

400010 ............................................................................. 0.9284 0.3298 10.0962 9.8132 10.7991 10.2159

400011 ............................................................................. 1.0610 0.4517 8.5534 9.6641 8.5501 8.9390 

400012 ............................................................................. 1.4671 0.4517 8.3802 12.3362 10.1144 10.1137

400013 ............................................................................. 1.2470 0.4517 10.3347 11.1414 11.4213 10.9909 

400014 ............................................................................. 1.3721 0.3659 12.2169 10.5286 9.9385 10.8298

400015 ............................................................................. 1.3247 0.4517 15.6349 13.7043 22.1997 17.0460 

400016 ............................................................................. 1.3936 0.4517 14.7607 16.6472 16.1412 15.8512 

400017 ............................................................................. 0.9861 0.4517 10.2734 10.3123 9.9191 10.1746

400018 ............................................................................. 1.1698 0.4517 11.6165 11.9184 12.3935 11.9802 

400019 ............................................................................. 1.4381 0.4517 12.8029 12.8380 14.7123 13.3471 

400021 ............................................................................. 1.4346 0.4605 14.1534 14.4549 13.9215 14.1634 

400022 ............................................................................. 1.4165 0.4161 15.9246 14.9089 15.2620 15.3447 

400024 ............................................................................. 0.8885 0.3659 12.4648 10.8439 12.6216 11.9950 

400026 ............................................................................. 1.0798 0.2946 5.8200 9.9262 7.1176 7.2041 

400028 ............................................................................. 1.0991 0.4161 10.9808 11.3260 10.6709 10.9928 

400032 ............................................................................. 1.1384 0.4517 10.2652 10.3736 10.7136 10.4544 

400044 ............................................................................. 1.2888 0.4161 13.7509 14.6420 10.5388 12.6107 

mmaher on DSK3CLS3C1PROD with $$_JOB

24903 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

400048 ............................................................................. 1.1731 0.4517 10.4266 9.6416 9.6856 9.9021 

400061 ............................................................................. 2.0008 0.4517 18.9123 18.1303 18.0103 18.3237 

400079 ............................................................................. 1.2350 0.3298 12.7825 9.5296 10.2856 10.6551

400087 ............................................................................. 1.1993 0.4517 10.6849 11.0377 11.4156 11.0321 

400098 ............................................................................. 1.3670 0.4517 12.8230 13.8034 13.7875 13.3736 

400102 ............................................................................. 1.3166 0.4517 10.2677 10.5879 12.1755 10.9323 

400103 ............................................................................. 1.7536 0.3659 9.3859 10.6971 11.7480 10.5154

400104 ............................................................................. 1.1995 0.4517 9.3854 11.4322 12.8402 11.2160

400105 ............................................................................. 1.1555 0.4517 14.0219 15.6626 16.9039 15.5355 

400106 ............................................................................. 1.1079 0.4517 11.4507 13.4097 12.9264 12.5584 

400109 ............................................................................. 1.4454 0.4517 14.2111 14.4386 14.8196 14.4933 

400110 ............................................................................. 1.2255 0.3203 12.3449 11.1812 9.9275 11.1279

400111 ............................................................................. 1.1570 0.3298 14.5029 14.1718 10.0679 12.5939 

400112 ............................................................................. 1.2217 0.4517 19.3945 10.1512 13.4904 13.2997 

400113 ............................................................................. 1.2935 0.4161 9.6778 10.5305 10.9503 10.3752

400114 ............................................................................. 1.1422 0.4517 11.5478 10.1379 10.8905 10.8232 

400115 ............................................................................. 1.0297 0.4517 13.7392 12.0713 9.6200 11.5296

400117 ............................................................................. 1.1097 0.4517 12.7600 9.5929 11.2873 10.9990

400118 ............................................................................. 1.2474 0.4517 12.5743 12.8692 12.2614 12.5587 

400120 ............................................................................. 1.3545 0.4517 12.7955 13.4069 14.0810 13.4541 

400121 ............................................................................. 1.0490 0.4517 8.2197 9.7427 9.1824 9.0004 

400122 ............................................................................. 1.9135 0.4517 11.2324 8.9478 9.5819 10.3492 

400123 ............................................................................. 1.2192 0.3659 12.3041 12.8317 12.5605 12.5624 

400124 ............................................................................. 2.7654 0.4517 16.1812 17.2139 17.9135 17.1102 

400125 ............................................................................. 1.2125 0.4121 11.6386 11.9787 12.7755 12.1173 

400126 ............................................................................. 1.2050 0.4605 9.8008 14.1062 16.5721 12.5521

400127 ............................................................................. 1.7568 0.4517 * 17.8303 20.7788 19.5311 

400128 ............................................................................. 1.0765 0.4517 * * 12.3508 12.3508 

410001 ............................................................................. 1.3006 1.1256 28.0816 29.0877 30.0107 29.0623 

410004 ............................................................................. 1.2498 1.1256 27.4209 29.4953 33.5477 30.0869 

410005 ............................................................................. 1.2488 1.1256 30.1606 28.1141 31.7260 29.9813 

410006 ............................................................................. 1.3443 1.0654 29.4395 30.1855 32.8447 30.8317 

410007 ............................................................................. 1.6516 1.1256 31.8548 33.2896 32.0716 32.4071 

410008 ............................................................................. 1.2351 1.0654 29.6092 30.9505 32.5870 31.0405 

410009 ............................................................................. 1.2438 1.0654 29.4094 31.7300 32.8406 31.3626 

410010 ............................................................................. 1.1857 1.1256 32.8599 32.0704 32.7383 32.5468 

410011 ............................................................................. 1.3917 1.1256 30.3787 33.8781 30.2382 31.4189 

410012 ............................................................................. 1.6858 1.1256 32.6009 33.6072 37.0294 34.4552 

410013 ............................................................................. 1.2112 1.1794 35.4624 35.8075 41.0799 37.4473 

420002 ............................................................................. 1.5894 0.9512 28.2848 29.5592 30.5925 29.4848 

420004 ............................................................................. 1.9971 0.9144 27.2620 28.1455 28.9237 28.1331 

420005 ............................................................................. 1.1309 0.8791 23.1943 25.0420 26.3939 24.9179 

420006 ............................................................................. *** * 24.0811 26.3293 27.7699 26.0549 

420007 ............................................................................. 1.6214 0.9386 25.2650 26.8165 28.8268 26.9868 

420009 ............................................................................. 1.3837 0.9386 25.5079 27.0147 29.9490 27.4958 

420010 ............................................................................. 1.1456 0.8791 23.4562 25.1452 25.5677 24.7554 

420011 ............................................................................. 1.1700 0.9664 21.4029 22.1787 24.5883 22.7258 

420015 ............................................................................. 1.3589 0.9664 26.2154 24.1685 26.3714 25.5781 

420016 ............................................................................. 0.9742 0.8791 17.1229 21.6266 22.2776 20.2191 

420018 ............................................................................. 1.8381 0.8791 24.8024 25.6687 27.5522 26.0434 

420019 ............................................................................. 1.0975 0.8933 22.5312 22.5489 25.4922 23.3958 

420020 ............................................................................. 1.2772 0.9144 25.8883 28.4344 29.5695 27.8470 

420023 ............................................................................. 1.6934 0.9664 26.7263 27.4589 29.9819 28.0277 

420026 ............................................................................. 1.8820 0.8791 27.4814 27.8986 27.2418 27.5412 

420027 ............................................................................. 1.5860 0.9386 25.1692 26.4472 28.1687 26.6066 

420030 ............................................................................. 1.2464 0.9144 26.0079 27.8435 28.4401 27.4508 

420033 ............................................................................. 1.1208 0.9664 31.8759 30.4162 31.6349 31.2973 

420036 ............................................................................. 1.2394 0.9348 22.8294 23.8742 24.6494 23.7914 

420037 ............................................................................. 1.3000 0.9664 29.4156 29.8321 30.8503 30.0400 

420038 ............................................................................. 1.2507 0.9664 24.2259 24.6642 26.6292 25.1611 

420039 ............................................................................. 1.1499 0.9334 25.1148 28.2220 28.9841 27.4319 

mmaher on DSK3CLS3C1PROD with $$_JOB

24904 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

420043 ............................................................................. 1.1016 0.8923 23.0555 24.0971 25.7926 24.3478 

420048 ............................................................................. 1.2711 0.8791 24.1923 25.9610 26.8917 25.7298 

420049 ............................................................................. 1.2515 0.8791 23.9722 26.0953 25.6953 25.2614 

420051 ............................................................................. 1.6594 0.8791 24.8026 25.9056 26.6341 25.7969 

420053 ............................................................................. 1.1285 0.8791 22.2825 23.2246 24.4642 23.3619 

420054 ............................................................................. 1.1334 0.8791 24.8931 25.6779 25.6413 25.3982 

420055 ............................................................................. 1.0786 0.8791 21.9764 24.0965 25.1550 23.7646 

420056 ............................................................................. 1.3295 0.8791 21.6963 27.7250 25.5489 24.9908 

420057 ............................................................................. 1.1850 0.8791 23.4312 24.9313 25.4571 24.6270 

420062 ............................................................................. 1.0478 0.9348 25.9526 26.7467 25.9555 26.2258 

420064 ............................................................................. 1.1882 0.8791 23.3610 24.3540 24.5219 24.0703 

420065 ............................................................................. 1.4437 0.9144 24.5715 25.5483 26.8333 25.6653 

420066 ............................................................................. 1.0105 0.8791 23.9049 25.1062 26.7458 25.3096 

420067 ............................................................................. 1.3630 0.8987 25.0345 25.8561 26.5058 25.8193 

420068 ............................................................................. 1.3719 0.9144 23.4248 25.6857 27.5799 25.6023 

420069 ............................................................................. 1.1737 0.8791 20.5546 22.3445 23.7228 22.2320 

420070 ............................................................................. 1.2994 0.8875 23.4355 24.7899 27.5115 25.3139 

420071 ............................................................................. 1.4292 0.9386 24.9418 25.2862 27.6368 25.9945 

420072 ............................................................................. 1.0662 0.8791 18.6742 17.8019 21.6507 19.2795 

420073 ............................................................................. 1.3854 0.8791 24.5813 25.5204 26.1111 25.4567 

420078 ............................................................................. 1.9217 0.9664 28.9112 29.5135 30.6777 29.7053 

420079 ............................................................................. 1.4849 0.9144 25.4935 27.5439 28.6353 27.2411 

420080 ............................................................................. 1.4418 0.8987 28.4735 28.6060 31.5679 29.4702 

420082 ............................................................................. 1.5165 0.9600 29.8528 31.2671 33.6740 31.5607 

420083 ............................................................................. 1.4762 0.9386 27.1322 26.4932 28.9023 27.5471 

420085 ............................................................................. 1.5565 0.9172 26.8692 27.8386 29.2277 27.9683 

420086 ............................................................................. 1.4540 0.8791 25.8869 28.0485 27.9384 27.3327 

420087 ............................................................................. 1.8324 0.9144 24.3609 25.4697 27.3264 25.7075 

420089 ............................................................................. 1.3997 0.9144 26.0074 28.1855 29.5860 27.9479 

420091 ............................................................................. 1.4226 0.8791 26.9214 26.0592 26.8712 26.6184 

420093 ............................................................................. *** * 27.4767 28.0765 32.8212 29.1829 

420098 ............................................................................. 1.1883 0.8791 * 30.7532 29.4620 30.0328 

420099 ............................................................................. *** * * * 30.2160 30.2160 

420101 ............................................................................. 1.1332 0.8791 * * * * 

430005 ............................................................................. 1.3007 0.8343 22.3272 22.4111 23.8690 22.8727 

430008 ............................................................................. 1.1443 0.8880 23.3790 24.4277 26.0865 24.5248 

430012 ............................................................................. 1.3092 0.9395 24.0850 24.0326 25.2032 24.4263 

430013 ............................................................................. 1.1862 0.9395 25.1378 25.9828 27.6885 26.2696 

430014 ............................................................................. 1.4176 0.8343 26.4964 26.8752 27.9285 27.1026 

430015 ............................................................................. 1.2647 0.8343 22.7947 23.6296 26.5781 24.3440 

430016 ............................................................................. 1.6466 0.9558 27.8453 28.9376 32.8752 29.8586 

430027 ............................................................................. 1.7919 0.9558 26.2139 26.6044 27.5745 26.8174 

430031 ............................................................................. *** * 16.0346 * * 16.0346 

430047 ............................................................................. 1.0090 * 18.8982 * * 18.8982 

430048 ............................................................................. 1.2827 0.8343 23.0782 24.1969 25.1698 24.1626 

430060 ............................................................................. 0.8255 0.8343 * 13.2618 13.5646 13.4165 

430064 ............................................................................. 1.0259 0.8343 17.5376 18.3125 16.4884 17.3474 

430077 ............................................................................. 1.8114 0.8690 25.1763 25.8572 27.2106 26.0775 

430081 ............................................................................. 0.8795 1.4406 * * * * 

430082 ............................................................................. 0.8113 1.4406 * * * * 

430083 ............................................................................. 0.8773 1.4406 * * * * 

430084 ............................................................................. 0.9092 1.4406 * * * * 

430085 ............................................................................. 0.8887 1.4406 * * * * 

430089 ............................................................................. 1.8601 0.9220 22.5625 22.3335 23.2471 22.7179 

430090 ............................................................................. 1.4726 0.9558 25.8460 26.4862 29.0203 27.2004 

430091 ............................................................................. 2.1556 0.8690 24.3021 25.1105 24.7273 24.7229 

430092 ............................................................................. 1.8602 0.8343 20.9486 21.6478 21.9206 21.5139 

430093 ............................................................................. 0.8372 0.8690 29.5244 27.5326 26.0248 27.6517 

430094 ............................................................................. 1.6473 0.8398 18.9099 22.9091 23.2862 21.6352 

430095 ............................................................................. 2.4550 0.9558 28.1749 31.3409 32.2291 30.5974 

430096 ............................................................................. 1.8925 0.8343 21.6997 21.6713 24.6038 22.6697 

mmaher on DSK3CLS3C1PROD with $$_JOB

24905 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

440001 ............................................................................. 1.1421 0.7916 19.3100 21.2398 21.5725 20.7286 

440002 ............................................................................. 1.7517 0.8951 24.6664 25.7434 26.3607 25.6113 

440003 ............................................................................. 1.3294 0.9675 25.9209 28.4862 28.3551 27.6394 

440006 ............................................................................. 1.5106 0.9675 28.5951 29.7146 31.5513 29.9422 

440007 ............................................................................. 1.0215 0.8142 25.8236 19.9754 18.8253 20.7863 

440008 ............................................................................. 1.0651 0.8432 23.4301 23.2126 27.3717 24.8406 

440009 ............................................................................. 1.2224 0.7916 21.5970 23.9279 23.8117 23.1545 

440010 ............................................................................. 0.9454 0.7916 17.1803 19.3669 19.6194 18.7378 

440011 ............................................................................. 1.3473 0.8043 22.5068 23.6154 23.6692 23.2732 

440012 ............................................................................. 1.5819 0.7916 22.3029 24.0169 23.7854 23.3703 

440015 ............................................................................. 1.8656 0.8043 23.7422 25.0430 26.0583 24.9717 

440016 ............................................................................. 1.0064 0.8060 22.1645 23.0350 24.5792 23.2189 

440017 ............................................................................. 1.8252 0.7916 22.9364 25.0588 24.6678 24.2288 

440018 ............................................................................. 1.1288 0.7916 23.3445 23.2107 25.0764 23.9420 

440019 ............................................................................. 1.7505 0.8043 25.2553 25.3592 26.0762 25.5315 

440020 ............................................................................. 1.0946 0.8760 23.9475 24.0995 24.7759 24.2798 

440024 ............................................................................. 1.2187 0.8967 23.2717 23.9745 24.7683 24.0292 

440025 ............................................................................. 1.1305 0.8608 20.6798 22.5407 22.4856 21.9261 

440026 ............................................................................. 0.6838 0.9675 26.8986 28.0349 26.8138 27.2465 

440029 ............................................................................. 1.3902 0.9675 28.0779 30.1204 31.2276 29.8852 

440030 ............................................................................. 1.3259 0.7931 22.1217 23.7670 22.1894 22.7002 

440031 ............................................................................. 1.1820 0.7941 19.6684 20.8964 22.3877 20.9813 

440032 ............................................................................. 1.2192 0.7916 18.5277 19.7150 21.0368 19.7420 

440033 ............................................................................. 1.0331 0.7952 20.7917 21.1087 22.7949 21.5084 

440034 ............................................................................. 1.6264 0.8043 23.5403 24.6994 25.5041 24.6078 

440035 ............................................................................. 1.4158 0.9408 24.3752 25.9613 26.2444 25.5503 

440039 ............................................................................. 2.1833 0.9675 28.4678 29.8611 30.1798 29.5492 

440040 ............................................................................. 0.9032 0.7916 17.8509 20.8637 20.8737 19.8795 

440041 ............................................................................. 0.9123 * 17.9409 * * 17.9409 

440046 ............................................................................. 1.2556 0.9675 26.1341 27.9539 29.7354 27.9631 

440047 ............................................................................. 0.9027 0.8254 21.4280 21.7892 22.9125 22.0779 

440048 ............................................................................. 1.8381 0.9291 27.7560 29.4789 29.3276 28.8736 

440049 ............................................................................. 1.6379 0.9291 25.3043 26.4772 28.8751 26.9261 

440050 ............................................................................. 1.3564 0.7916 23.1363 24.4616 24.9749 24.2258 

440051 ............................................................................. 0.9547 0.7987 21.9108 23.9253 23.4849 23.1289 

440052 ............................................................................. 0.9974 0.7916 21.1133 22.8016 22.6093 22.1794 

440053 ............................................................................. 1.2683 0.9675 25.4345 27.1197 27.8161 26.7570 

440054 ............................................................................. 1.1306 0.7916 21.4400 23.5137 23.7916 22.9255 

440056 ............................................................................. 1.1615 0.8043 22.1067 22.7820 23.2296 22.7142 

440057 ............................................................................. 1.0901 0.7944 16.4451 16.6346 17.2159 16.7756 

440058 ............................................................................. 1.1778 0.7916 22.9263 24.3522 26.0692 24.4594 

440059 ............................................................................. 1.4611 0.7916 26.3551 28.3565 27.9440 27.5537 

440060 ............................................................................. 1.1303 0.8432 23.3014 24.1024 25.0943 24.2363 

440061 ............................................................................. 1.1231 0.7916 21.8274 23.9678 23.7344 23.1104 

440063 ............................................................................. 1.5848 0.7916 22.3256 24.2566 23.9625 23.5403 

440064 ............................................................................. 1.0103 0.8967 22.0955 23.7176 26.1228 23.9663 

440065 ............................................................................. 1.2648 0.9675 22.3247 24.6169 25.8517 24.2948 

440067 ............................................................................. 1.1058 0.7916 23.1089 24.4772 24.6523 24.0976 

440068 ............................................................................. 1.1547 0.8967 24.5972 24.8146 26.1066 25.1512 

440070 ............................................................................. 0.9790 0.8025 19.4372 20.0938 21.9133 20.5428 

440072 ............................................................................. 1.1053 0.8951 27.1442 23.9563 25.6126 25.4529 

440073 ............................................................................. 1.4655 0.9408 23.9198 26.3570 27.6130 25.9554 

440081 ............................................................................. 1.1997 0.7985 19.7878 20.7125 20.7679 20.4353 

440082 ............................................................................. 2.1152 0.9675 27.9724 30.6115 32.5266 30.3207 

440083 ............................................................................. 0.9664 0.7916 17.3329 25.6099 23.6295 22.2394 

440084 ............................................................................. 1.1855 0.7950 16.3738 18.6043 18.8661 17.9487 

440091 ............................................................................. 1.7522 0.8967 25.6797 26.5687 28.1980 26.8419 

440102 ............................................................................. 1.1442 0.7916 17.5261 20.7363 21.6734 19.9750 

440104 ............................................................................. 1.7686 0.8967 25.3739 26.5741 27.9739 26.6317 

440105 ............................................................................. 0.8903 0.7916 22.3438 22.9372 27.5434 24.0199 

440109 ............................................................................. 0.9695 0.7986 18.6720 20.8924 21.4586 20.4120 

mmaher on DSK3CLS3C1PROD with $$_JOB

24906 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

440110 ............................................................................. 1.1525 0.8043 21.3287 20.9179 22.5922 21.8673 

440111 ............................................................................. 1.2969 0.9675 28.5705 29.0975 28.8328 28.8339 

440114 ............................................................................. *** * 24.0146 * * 24.0146 

440115 ............................................................................. 1.0086 0.8254 21.7830 23.1409 23.7906 22.9173 

440120 ............................................................................. 1.5948 0.8043 25.5961 25.7161 24.7561 25.3527 

440125 ............................................................................. 1.6036 0.8043 22.4196 22.8097 23.6317 22.9327 

440130 ............................................................................. 1.1054 0.7916 23.4517 23.9955 25.1259 24.1967 

440131 ............................................................................. 1.2045 0.9291 24.9599 25.6666 26.9643 25.8558 

440132 ............................................................................. 1.2396 0.7916 21.5085 23.9410 24.0684 23.2162 

440133 ............................................................................. 1.7133 0.9675 26.2422 29.2829 30.7751 28.6805 

440135 ............................................................................. 0.9959 0.7916 26.6615 28.1925 27.7163 27.5263 

440137 ............................................................................. 1.0781 0.8679 20.6663 22.2538 22.9527 21.8983 

440141 ............................................................................. 0.9681 0.7916 21.3314 24.2406 24.9849 23.5732 

440144 ............................................................................. 1.3047 0.9408 23.3828 23.9241 25.2267 24.2122 

440145 ............................................................................. 1.0761 * 20.7875 * * 20.7875 

440147 ............................................................................. *** * 31.4012 33.1756 35.3815 33.3203 

440148 ............................................................................. 1.1126 0.9408 24.6412 23.9810 22.6179 23.6901 

440149 ............................................................................. *** * 20.4563 * * 20.4563 

440150 ............................................................................. 1.3903 0.9675 26.8308 28.1012 29.4367 28.1239 

440151 ............................................................................. 1.1741 0.9408 23.9808 27.1729 28.2182 26.4231 

440152 ............................................................................. 1.9279 0.9291 26.5513 27.1877 27.6451 27.1413 

440153 ............................................................................. 1.0815 0.7916 22.2846 23.6473 24.7378 23.4975 

440156 ............................................................................. 1.6521 0.8967 26.9689 27.7309 28.5630 27.7803 

440159 ............................................................................. 1.5137 0.9291 22.8645 26.9098 25.8246 25.2919 

440161 ............................................................................. 1.8708 0.9675 28.6971 28.7074 29.9892 29.1536 

440162 ............................................................................. *** * 21.1418 27.6837 24.8692 24.4630 

440166 ............................................................................. *** * 31.0779 35.3064 * 32.7296 

440168 ............................................................................. 0.9651 0.9291 22.8768 28.1215 29.4005 26.9610 

440173 ............................................................................. 1.4388 0.8043 22.8846 23.1167 24.0604 23.3811 

440174 ............................................................................. 0.8951 0.8226 22.0974 25.4829 26.2049 24.7272 

440175 ............................................................................. 1.0345 0.9408 22.7299 24.4848 24.7857 23.9708 

440176 ............................................................................. 1.2746 0.7916 23.6659 22.9631 24.1236 23.6112 

440180 ............................................................................. 1.2911 0.7952 23.3808 24.9841 22.3062 23.4471 

440181 ............................................................................. 0.9192 0.8277 22.7151 24.8857 26.0287 24.6007 

440182 ............................................................................. 0.9950 0.8060 22.3612 24.3302 25.0070 23.9818 

440183 ............................................................................. 1.5965 0.9291 27.1515 29.1982 30.6570 28.9837 

440184 ............................................................................. 0.9643 0.7916 22.3475 24.5786 23.3803 23.4120 

440185 ............................................................................. 1.1499 0.8967 23.9052 25.3817 26.7453 25.4013 

440186 ............................................................................. 0.9668 0.9675 25.7445 27.3733 28.9113 27.3826 

440187 ............................................................................. 1.0856 0.7916 21.3252 24.0723 25.8192 23.7538 

440189 ............................................................................. 1.3576 0.8590 27.5435 28.2621 28.8947 28.1761 

440192 ............................................................................. 1.0840 0.9408 25.7495 27.3917 29.6238 27.6362 

440193 ............................................................................. 1.3501 0.9675 24.4299 24.3622 25.2113 24.6709 

440194 ............................................................................. 1.3057 0.9675 26.6527 29.4706 30.8500 29.0988 

440197 ............................................................................. 1.3661 0.9675 27.1534 29.4275 30.3318 28.9141 

440200 ............................................................................. 0.9726 0.9675 17.7491 21.1860 23.8598 20.9517 

440203 ............................................................................. *** * 19.3864 23.7451 17.9024 20.1678 

440217 ............................................................................. 1.3238 0.9291 28.5968 28.8641 29.9206 29.1168 

440218 ............................................................................. 2.1944 0.9675 24.6465 23.7257 18.7271 22.2602 

440222 ............................................................................. 1.0509 0.9291 29.7292 28.4664 29.0064 29.0426 

440224 ............................................................................. 0.8974 0.9675 * * * * 

440225 ............................................................................. 0.7984 0.8043 * 24.8328 27.8866 26.2413 

440226 ............................................................................. 1.5497 0.8043 * 26.5831 28.3236 27.4254 

440227 ............................................................................. 1.3258 0.9675 * * 30.7783 30.7783 

440228 ............................................................................. 1.4433 0.9291 * * 28.3673 28.3673 

450002 ............................................................................. 1.4197 0.9144 25.7171 28.0936 28.8502 27.4825 

450005 ............................................................................. 1.0714 0.8587 23.5576 24.4933 24.5392 24.1596 

450007 ............................................................................. 1.3062 0.8916 20.7321 23.0026 23.9736 22.5788 

450008 ............................................................................. 1.2938 0.8308 22.9669 24.4701 24.5969 24.0254 

450010 ............................................................................. 1.6531 0.8488 23.7529 25.5503 26.5222 25.2850 

450011 ............................................................................. 1.6897 0.9177 24.8831 26.7418 28.5316 26.6971 

mmaher on DSK3CLS3C1PROD with $$_JOB

24907 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

450015 ............................................................................. 1.5327 0.9795 27.4012 29.9193 29.4897 28.9233 

450018 ............................................................................. 1.5156 1.0048 26.7999 30.2383 30.7798 29.2592 

450020 ............................................................................. 0.9414 * 18.3047 * * 18.3047 

450021 ............................................................................. 1.8775 0.9795 29.1350 29.5658 31.2631 29.9537 

450023 ............................................................................. 1.4776 0.8204 22.0558 25.4450 25.5456 24.3102 

450024 ............................................................................. 1.6726 0.9144 24.4195 26.9113 28.1995 26.5982 

450028 ............................................................................. 1.6122 0.9577 26.8250 29.1438 30.7386 28.7980 

450029 ............................................................................. 1.6195 0.8484 23.2995 25.0602 26.9317 25.0099 

450031 ............................................................................. 1.4016 0.9795 27.9626 29.0824 30.3520 29.1122 

450032 ............................................................................. 1.2877 0.8615 27.0748 21.5084 25.5763 24.5156 

450033 ............................................................................. 1.6325 0.9577 28.4781 29.2468 29.9792 29.1869 

450034 ............................................................................. 1.5788 0.8587 24.1589 26.5313 27.6906 26.1014 

450035 ............................................................................. 1.4933 1.0048 26.2838 28.0668 28.8961 27.7041 

450037 ............................................................................. 1.6443 0.8875 24.2684 26.6207 28.3379 26.4148 

450039 ............................................................................. 1.4633 0.9681 24.7347 26.7503 28.2052 26.5789 

450040 ............................................................................. 1.8073 0.8678 24.9590 25.4734 26.8399 25.7395 

450042 ............................................................................. 1.7896 0.8598 24.1181 26.6382 26.5414 25.7894 

450044 ............................................................................. 1.7520 0.9795 29.4308 31.0381 29.4295 29.9719 

450046 ............................................................................. 1.6190 0.8460 23.4907 24.8947 25.5895 24.6756 

450047 ............................................................................. 0.8462 0.9577 19.8221 21.8824 23.8397 21.9016 

450050 ............................................................................. 0.8661 * 23.3044 * * 23.3044 

450051 ............................................................................. 1.9226 0.9795 28.0411 28.8829 29.9034 28.9706 

450052 ............................................................................. 0.9462 0.8204 19.7774 22.6448 22.9956 21.3913 

450053 ............................................................................. 0.9303 * 21.9082 * * 21.9082 

450054 ............................................................................. 1.7987 0.8308 24.2782 27.5399 26.5580 26.0520 

450055 ............................................................................. 1.0496 0.8204 22.1979 22.9245 23.6359 22.9294 

450056 ............................................................................. 1.7616 0.9518 27.0530 28.3092 31.5925 28.7714 

450058 ............................................................................. 1.5924 0.8916 25.9653 26.6926 26.9903 26.5543 

450059 ............................................................................. 1.3101 0.9518 26.6535 26.8325 27.3949 26.9660 

450064 ............................................................................. 1.4743 0.9681 23.8748 26.8355 28.2780 26.2937 

450068 ............................................................................. 2.1568 1.0048 27.9633 29.5876 30.5075 29.3731 

450072 ............................................................................. 1.2060 1.0048 24.0166 25.8619 27.0747 25.6777 

450073 ............................................................................. 0.8869 0.8204 21.7337 26.9446 26.0900 24.8080 

450076 ............................................................................. 1.6718 * * * * * 

450078 ............................................................................. 0.9157 0.8204 15.8968 21.4716 20.0665 18.9487 

450079 ............................................................................. 1.6354 0.9795 28.1096 30.2420 30.8882 29.6870 

450080 ............................................................................. 1.2459 0.8875 22.9836 27.9191 26.2251 25.5990 

450082 ............................................................................. 1.1501 0.8204 22.0442 23.9025 24.1995 23.3896 

450083 ............................................................................. 1.8302 0.9190 25.8214 27.4955 32.6432 28.5954 

450085 ............................................................................. 1.0618 0.8204 22.0840 24.3637 25.6398 24.0602 

450087 ............................................................................. 1.4149 0.9681 29.1587 30.0095 31.2651 30.1449 

450090 ............................................................................. 1.2358 0.8855 19.4245 21.3837 21.8819 20.8844 

450092 ............................................................................. 1.1888 0.8204 23.2071 24.9917 26.0863 24.7978 

450094 ............................................................................. *** * 25.2434 * * 25.2434 

450096 ............................................................................. *** * 24.1618 26.5103 28.1877 26.1057 

450097 ............................................................................. 1.4833 1.0048 26.4965 29.0142 29.8695 28.4563 

450098 ............................................................................. 0.9764 * 22.6626 * * 22.6626 

450099 ............................................................................. 1.2850 0.9141 26.6796 31.3495 31.8214 29.8896 

450101 ............................................................................. 1.6845 0.8598 23.6905 25.4409 26.7429 25.2714 

450102 ............................................................................. 1.7567 0.9190 24.5503 25.6318 26.4138 25.5264 

450104 ............................................................................. 1.1914 0.8916 23.8469 24.6169 28.8008 25.7423 

450107 ............................................................................. 1.5656 0.9144 25.9326 27.6064 27.8167 27.1281 

450108 ............................................................................. 1.2022 0.8916 19.4935 21.6557 19.3203 20.1279 

450113 ............................................................................. *** * 54.6663 * * 54.6663 

450119 ............................................................................. 1.3063 0.9140 25.7008 27.8027 31.0620 28.0085 

450121 ............................................................................. *** * 25.7051 29.1296 27.7456 27.5362 

450123 ............................................................................. 1.2264 0.8587 21.2154 24.9674 26.2404 24.0842 

450124 ............................................................................. 1.8765 0.9518 27.4198 28.2571 30.9581 28.8840 

450126 ............................................................................. 1.3815 1.0048 28.3032 29.3768 29.6165 29.1427 

450128 ............................................................................. 1.2607 0.9140 23.3633 25.1122 26.3380 24.9423 

450130 ............................................................................. 1.1616 0.8916 21.5226 24.3295 24.3816 23.4123 

mmaher on DSK3CLS3C1PROD with $$_JOB

24908 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

450131 ............................................................................. *** * 23.7098 25.9494 * 24.6979 

450132 ............................................................................. 1.5741 0.9959 28.6954 30.1620 31.9964 30.2610 

450133 ............................................................................. 1.5650 1.0016 26.8344 28.4647 31.0158 28.7726 

450135 ............................................................................. 1.7036 0.9681 26.0755 27.8983 30.1366 28.0785 

450137 ............................................................................. 1.7292 0.9681 30.4254 31.4950 31.9628 31.3189 

450143 ............................................................................. 0.9894 0.9518 21.8705 23.4592 23.6800 23.0239 

450144 ............................................................................. 1.0806 0.8762 21.3289 26.2881 29.4336 25.2664 

450147 ............................................................................. 1.5058 0.8204 23.9771 24.3562 24.7217 24.3816 

450148 ............................................................................. 1.2596 0.9681 25.3498 27.0894 29.6769 27.2881 

450151 ............................................................................. *** * 22.2915 23.9558 26.1922 24.2420 

450152 ............................................................................. 1.2210 0.8308 22.7463 23.3428 23.1056 23.0676 

450154 ............................................................................. 1.3960 0.8204 21.2021 21.7237 22.9324 21.9516 

450155 ............................................................................. 1.1128 0.8204 18.0588 21.7604 24.8023 21.2754 

450162 ............................................................................. 1.3172 0.8678 30.9903 33.3285 32.9269 32.4564 

450163 ............................................................................. 1.0672 0.8257 23.1400 24.1267 24.7829 24.0364 

450165 ............................................................................. 1.1659 0.8916 24.3242 28.6490 29.1799 27.3444 

450176 ............................................................................. 1.3543 0.9140 20.9297 23.1284 24.4427 22.7685 

450177 ............................................................................. 1.1710 0.8204 21.3322 23.7624 24.4026 23.1595 

450178 ............................................................................. 0.9841 0.9527 24.7301 27.8405 27.1083 26.5644 

450184 ............................................................................. 1.5603 1.0048 26.7821 28.5399 29.7402 28.3456 

450187 ............................................................................. 1.1820 1.0048 25.6787 28.3243 27.7355 27.2563 

450188 ............................................................................. 0.9378 0.8204 20.4070 23.0595 23.2229 22.2784 

450191 ............................................................................. 1.1685 0.9518 26.0298 26.5863 28.3929 27.0034 

450192 ............................................................................. 1.1362 0.8475 22.5880 24.1186 26.5577 24.4507 

450193 ............................................................................. 2.0914 1.0048 32.2964 34.4545 36.4769 34.4405 

450194 ............................................................................. 1.3698 0.8417 24.8972 22.9605 24.3528 24.0549 

450196 ............................................................................. 1.4362 0.9681 24.7557 24.0161 23.4570 24.1008 

450200 ............................................................................. 1.5832 0.8204 23.5344 23.5012 25.6410 24.1113 

450201 ............................................................................. 0.9691 0.8204 20.9810 23.2510 23.2742 22.5445 

450203 ............................................................................. 1.1773 0.9646 24.1675 26.5237 27.8762 26.2137 

450209 ............................................................................. 1.9557 0.9141 26.0958 27.5668 30.4681 27.9965 

450210 ............................................................................. 0.9541 0.8354 19.9832 21.8722 22.5708 21.5253 

450211 ............................................................................. 1.3229 0.8875 23.8230 28.4581 28.3715 26.9028 

450213 ............................................................................. 1.9199 0.8916 23.9676 25.9169 26.8539 25.6070 

450214 ............................................................................. 1.2475 1.0048 25.9598 27.4357 28.1262 27.1815 

450219 ............................................................................. 0.9710 0.8204 21.7934 21.9207 23.9627 22.5466 

450221 ............................................................................. 1.1296 0.8204 20.3186 19.3793 21.3691 20.3727 

450222 ............................................................................. 1.6669 1.0048 27.4426 30.0314 30.3786 29.2826 

450224 ............................................................................. 1.3681 0.9190 24.1956 26.8302 28.4367 26.4253 

450229 ............................................................................. 1.6513 0.8244 21.4459 24.4450 25.1327 23.6486 

450231 ............................................................................. 1.6695 0.9141 25.2852 27.1674 26.9773 26.4819 

450234 ............................................................................. 1.0260 0.8204 18.4451 20.6889 20.4622 19.9270 

450235 ............................................................................. 1.0130 0.8204 21.5138 23.5212 21.8936 22.3093 

450236 ............................................................................. 1.0590 0.8593 22.0788 23.5426 22.9579 22.8801 

450237 ............................................................................. 1.6297 0.8916 24.8901 25.7939 30.5876 26.8886 

450239 ............................................................................. 0.9810 0.8308 21.1945 21.2586 19.1354 20.4357 

450241 ............................................................................. 1.0075 0.8204 18.7958 20.8732 21.3480 20.3076 

450243 ............................................................................. 0.9797 0.8204 15.4636 15.4510 17.2294 16.0640 

450253 ............................................................................. 0.9225 1.0048 20.6124 24.2435 24.1019 23.0154 

450270 ............................................................................. 1.1797 0.8475 14.4325 15.2190 19.8112 16.4138 

450271 ............................................................................. 1.2059 0.9646 21.7719 22.7035 24.1257 22.9106 

450272 ............................................................................. 1.2098 0.9518 25.7392 26.2576 27.0499 26.3724 

450276 ............................................................................. *** * 16.6319 * * 16.6319 

450280 ............................................................................. 1.4750 0.9795 28.7233 29.9730 31.6561 30.1306 

450283 ............................................................................. 1.0410 0.9681 20.9679 22.7938 24.1724 22.6240 

450289 ............................................................................. 1.4241 1.0048 28.5665 32.2645 33.6901 31.5939 

450292 ............................................................................. 1.2711 0.9795 25.0411 26.3242 26.8105 26.0606 

450293 ............................................................................. 0.8636 0.8204 21.3135 23.6413 24.0753 22.9676 

450296 ............................................................................. 1.1007 1.0048 27.9690 30.4324 31.5551 30.0325 

450299 ............................................................................. 1.6637 0.9177 26.4933 27.5797 28.4163 27.4987 

450306 ............................................................................. 0.9556 0.8244 15.9855 21.4558 22.9398 19.7033 

mmaher on DSK3CLS3C1PROD with $$_JOB

24909 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

450315 ............................................................................. 1.8055 0.9795 * 37.1721 * 37.1721 

450324 ............................................................................. 1.5715 0.9681 24.9128 25.1633 26.6082 25.5438 

450330 ............................................................................. 1.2148 1.0048 25.5820 26.0771 27.1088 26.2637 

450340 ............................................................................. 1.3764 0.8663 24.0637 25.0344 25.6777 24.9272 

450346 ............................................................................. 1.4306 0.8587 22.2468 23.6072 23.8975 23.2898 

450347 ............................................................................. 1.1980 1.0048 27.2203 28.7667 30.6500 28.8612 

450348 ............................................................................. 1.0409 0.8204 18.7675 21.6787 21.0437 20.5420 

450351 ............................................................................. 1.2643 0.9646 25.6859 26.5388 29.2557 27.1709 

450352 ............................................................................. 1.1040 0.9795 24.8012 26.2281 27.2978 26.1097 

450353 ............................................................................. *** * 24.4454 27.0248 28.2683 26.5977 

450358 ............................................................................. 1.9691 1.0048 30.4280 31.4926 32.5905 31.5502 

450362 ............................................................................. *** * 25.4372 * * 25.4372 

450369 ............................................................................. 1.0332 0.8204 18.4848 19.9148 22.9249 20.4404 

450370 ............................................................................. 1.1948 0.8445 20.0832 25.5834 26.3438 23.8025 

450372 ............................................................................. 1.3682 0.9795 28.3359 30.8886 30.9228 30.0232 

450373 ............................................................................. 0.8647 0.8204 22.2213 24.8286 27.0704 24.8199 

450374 ............................................................................. 0.9938 * 23.2283 * * 23.2283 

450378 ............................................................................. 1.4683 1.0048 30.7684 30.3883 32.2274 31.1285 

450379 ............................................................................. 1.3342 0.9795 30.6071 33.7521 35.3777 33.1813 

450381 ............................................................................. 0.9328 * 22.0482 * * 22.0482 

450388 ............................................................................. 1.6608 0.8916 25.8674 27.4328 27.9807 27.1010 

450389 ............................................................................. 1.1532 0.9681 23.8764 25.6732 26.9621 25.5400 

450393 ............................................................................. 0.5363 0.9681 18.4551 21.9347 * 19.7864 

450395 ............................................................................. 1.0563 1.0048 24.8656 27.5189 26.7686 26.4980 

450399 ............................................................................. 0.8955 0.8204 18.2074 20.3528 22.1687 20.1538 

450400 ............................................................................. 1.0787 0.8204 23.1739 23.6358 26.2840 24.2918 

450403 ............................................................................. 1.3144 0.9795 29.3063 29.0359 29.8626 29.4101 

450411 ............................................................................. 1.0097 0.8204 19.6086 20.9372 21.5711 20.7282 

450417 ............................................................................. 0.8612 * 20.0351 * * 20.0351 

450418 ............................................................................. *** * 26.8434 28.4362 * 27.5264 

450419 ............................................................................. 1.2715 0.9681 31.0405 31.9966 34.2413 32.4898 

450422 ............................................................................. 1.2225 0.9795 30.6659 34.4331 31.3421 32.1009 

450424 ............................................................................. 1.3427 1.0048 28.3149 28.2463 30.7204 29.0895 

450431 ............................................................................. 1.5890 0.9518 25.2477 26.3263 27.3917 26.3384 

450438 ............................................................................. 1.1315 1.0048 21.9350 27.8659 26.5110 25.2161 

450446 ............................................................................. 0.6348 1.0048 14.3132 17.0691 17.2849 16.0873 

450447 ............................................................................. 1.2629 0.9681 23.5047 25.4200 26.5230 25.1012 

450451 ............................................................................. 1.1286 0.8741 23.3043 24.6201 27.7093 25.1820 

450460 ............................................................................. 0.9637 0.8252 20.5811 22.4227 24.9806 22.7331 

450462 ............................................................................. 1.7172 0.9795 27.8923 29.6069 30.1441 29.2303 

450465 ............................................................................. 1.1120 1.0048 22.4183 26.2759 27.0808 25.3172 

450469 ............................................................................. 1.4925 0.9681 28.7890 26.3262 26.3408 27.1795 

450475 ............................................................................. 1.0926 0.8875 23.5596 23.0942 24.4820 23.6936 

450484 ............................................................................. 1.3680 0.8875 25.3527 26.7242 28.3900 26.8376 

450488 ............................................................................. 1.1517 0.8875 23.9144 22.3981 23.7940 23.3805 

450489 ............................................................................. 0.9935 0.8204 21.4771 23.4806 25.2611 23.4854 

450497 ............................................................................. 1.0139 0.8599 18.8344 22.0918 23.1798 21.3680 

450498 ............................................................................. 0.9453 0.8204 17.7822 18.6563 20.2424 18.8921 

450508 ............................................................................. 1.5948 0.8875 23.9572 28.4471 27.2884 26.5810 

450514 ............................................................................. *** * 22.6552 26.3704 26.9571 25.3918 

450518 ............................................................................. 1.4362 0.8587 24.1194 28.1755 28.0142 26.7922 

450530 ............................................................................. 1.2781 1.0048 28.7451 29.1349 29.9698 29.2956 

450537 ............................................................................. 1.4003 0.9795 27.5856 27.7757 28.7442 28.0479 

450539 ............................................................................. 1.1997 0.8275 21.0442 23.1829 24.2118 22.7454 

450547 ............................................................................. 0.9677 0.8399 21.6542 23.7820 34.3322 25.8915 

450558 ............................................................................. 1.8248 0.8244 26.1551 26.9407 28.0643 27.0629 

450563 ............................................................................. 1.5242 0.9681 28.7289 30.8332 32.0505 30.6110 

450565 ............................................................................. 1.2509 0.8685 23.8846 26.7942 28.1669 26.2638 

450571 ............................................................................. 1.6017 0.8663 22.7703 25.2108 27.4577 25.0804 

450573 ............................................................................. 1.1244 0.8319 20.1479 22.0797 22.1565 21.5134 

450578 ............................................................................. 0.9614 0.8204 20.2696 22.5167 25.0487 22.6269 

mmaher on DSK3CLS3C1PROD with $$_JOB

24910 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

450580 ............................................................................. 1.0846 0.8204 21.1574 22.3886 23.8964 22.4730 

450584 ............................................................................. 1.1129 0.8204 21.0808 20.5257 22.5149 21.3615 

450586 ............................................................................. 0.9359 0.8204 16.1003 18.9107 20.6563 18.6521 

450587 ............................................................................. 1.2013 0.8204 20.4512 23.1202 25.0153 22.8383 

450591 ............................................................................. 1.2535 1.0048 23.9992 25.7031 27.0806 25.5834 

450596 ............................................................................. 1.2190 0.9646 25.3317 27.4011 29.8448 27.4270 

450597 ............................................................................. 0.9772 0.8204 23.1711 24.7853 24.2555 24.0721 

450604 ............................................................................. 1.3487 0.8204 20.9514 24.4743 25.9097 23.8485 

450605 ............................................................................. 0.9394 0.8460 22.2205 20.9276 23.9323 22.2907 

450610 ............................................................................. 1.5913 1.0048 26.8710 27.7317 28.3923 27.6892 

450615 ............................................................................. 0.9880 0.8204 20.3028 21.8442 24.1786 22.0818 

450617 ............................................................................. 1.5099 1.0048 26.5026 28.0225 28.8304 27.8233 

450620 ............................................................................. 1.0016 0.8204 17.7138 18.6183 20.3650 18.9167 

450623 ............................................................................. 1.1755 * 28.3552 * * 28.3552 

450626 ............................................................................. *** * 26.8374 * * 26.8374 

450630 ............................................................................. 1.5447 1.0048 29.6796 29.1462 29.8420 29.5559 

450634 ............................................................................. 1.7057 0.9795 28.1705 28.7312 30.3207 29.0783 

450638 ............................................................................. 1.6763 1.0048 29.6184 30.6572 32.4988 30.8669 

450639 ............................................................................. 1.4439 0.9681 29.2669 30.4019 32.6237 30.7769 

450641 ............................................................................. 1.0317 0.8599 17.5845 19.4389 20.2439 19.0709 

450643 ............................................................................. 1.3269 0.8484 21.1205 22.7355 24.3088 22.7006 

450644 ............................................................................. 1.5884 1.0048 29.0186 29.7918 30.8220 29.9124 

450646 ............................................................................. 1.4235 0.9144 23.8908 25.6313 26.8036 25.4367 

450647 ............................................................................. 1.8302 0.9795 30.7334 30.6924 32.4230 31.2795 

450651 ............................................................................. 1.4808 0.9795 32.4822 30.4484 31.9155 31.5983 

450653 ............................................................................. 1.1658 0.8204 23.2603 25.2144 26.1733 24.8551 

450654 ............................................................................. 0.9021 0.8204 19.9992 21.5002 22.5409 21.4221 

450656 ............................................................................. 1.4166 0.8875 23.8280 25.5050 28.1462 25.7173 

450658 ............................................................................. 0.9853 0.8204 20.5398 22.2293 24.7846 22.5182 

450659 ............................................................................. 1.4617 1.0048 30.1727 31.5024 34.2303 31.8885 

450661 ............................................................................. 1.1887 0.9959 23.2989 30.2610 30.0728 27.8676 

450662 ............................................................................. 1.5737 0.9577 28.0913 29.0535 29.0508 28.7285 

450665 ............................................................................. *** * 18.6054 * * 18.6054 

450668 ............................................................................. 1.5281 0.9144 26.2375 28.8635 30.6109 28.5359 

450669 ............................................................................. 1.2115 0.9795 27.4507 27.9796 30.2655 28.6146 

450670 ............................................................................. 1.4063 1.0048 25.1575 25.9638 26.4296 25.8782 

450672 ............................................................................. 1.8206 0.9681 27.6359 30.1191 31.7990 29.9252 

450674 ............................................................................. 1.0675 1.0048 28.4416 28.7101 29.8969 29.0121 

450675 ............................................................................. 1.3872 0.9681 28.7765 28.9005 30.9547 29.5677 

450677 ............................................................................. 1.2672 0.9681 27.3728 25.9555 27.5747 26.9441 

450678 ............................................................................. 1.5041 0.9795 30.1500 31.1563 33.3407 31.5042 

450683 ............................................................................. 1.1582 0.9795 24.6609 27.4925 21.1727 24.2963 

450684 ............................................................................. 1.2927 1.0048 27.6789 29.3025 30.2122 29.1272 

450686 ............................................................................. 1.5920 0.8678 23.2367 24.2331 26.1607 24.5665 

450688 ............................................................................. 1.1942 0.9795 27.9057 26.8599 26.9879 27.2206 

450690 ............................................................................. 1.3072 0.9190 28.2531 26.5528 26.1729 27.0373 

450694 ............................................................................. 1.1612 0.8204 23.5789 23.9961 24.0008 23.8662 

450697 ............................................................................. 1.4207 0.8916 23.7155 24.8667 26.4094 25.0094 

450698 ............................................................................. 0.8996 0.8339 18.6494 20.0955 21.5692 20.0851 

450702 ............................................................................. 1.7092 0.8875 25.6147 26.8384 26.3694 26.2786 

450709 ............................................................................. 1.3571 1.0048 25.4855 26.8146 28.4214 26.8732 

450711 ............................................................................. 1.4822 0.9140 28.0104 26.7472 27.5782 27.4494 

450713 ............................................................................. 1.5798 0.9518 27.2801 28.8285 29.4951 28.5529 

450715 ............................................................................. 1.2415 0.9795 28.0365 17.3991 17.0201 19.5798 

450716 ............................................................................. 1.3493 1.0048 30.8440 32.3960 33.7175 32.3165 

450718 ............................................................................. 1.3798 0.9518 27.3408 27.3215 28.1558 27.6252 

450723 ............................................................................. 1.4651 0.9795 28.0812 28.5103 30.1696 28.9691 

450730 ............................................................................. 1.3611 0.9795 29.9430 31.3324 32.7866 31.3503 

450733 ............................................................................. *** * 26.4977 * * 26.4977 

450742 ............................................................................. 1.1915 0.9795 26.1189 27.2023 30.0561 27.8905 

450743 ............................................................................. 1.4606 0.9795 27.3213 28.3362 28.4726 28.0740 

mmaher on DSK3CLS3C1PROD with $$_JOB

24911 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

450746 ............................................................................. 0.9236 0.8204 12.4748 20.6343 22.7521 18.2376 

450747 ............................................................................. 1.2814 0.9190 22.2870 23.8314 25.8165 23.8624 

450749 ............................................................................. 0.9915 0.8204 17.8227 20.0487 22.1526 19.9050 

450751 ............................................................................. *** * 19.3267 18.7456 21.4208 19.9009 

450754 ............................................................................. 0.9278 0.8204 20.8968 22.1819 24.7752 22.6387 

450755 ............................................................................. 0.9399 0.8499 18.0092 19.8988 22.1950 20.0118 

450758 ............................................................................. *** * 25.6547 28.7342 28.2792 27.5628 

450760 ............................................................................. 1.0571 0.9144 24.6349 24.7489 25.1612 24.8383 

450761 ............................................................................. 0.8818 * 15.7483 * * 15.7483 

450763 ............................................................................. 1.0706 * 22.4905 * * 22.4905 

450766 ............................................................................. 1.9343 0.9795 30.0441 30.8004 30.2340 30.3516 

450770 ............................................................................. 1.2426 0.9518 20.3656 24.1647 23.7634 22.8145 

450771 ............................................................................. 1.6724 0.9795 31.3924 30.7105 32.0501 31.3870 

450774 ............................................................................. 1.6316 1.0048 24.9683 27.2080 25.7438 25.9776 

450775 ............................................................................. 1.2937 1.0048 24.4006 28.1428 29.7897 27.3080 

450779 ............................................................................. 1.2690 0.9681 26.9908 29.9674 31.8378 29.6435 

450780 ............................................................................. 2.0333 0.8916 23.9516 26.7611 27.0062 25.8978 

450788 ............................................................................. 1.5557 0.8460 25.4172 26.2840 28.3742 26.7014 

450795 ............................................................................. 1.1878 1.0048 23.7510 25.2007 32.9739 27.3766 

450796 ............................................................................. 1.7361 0.9141 27.9734 36.4073 37.8715 34.0484 

450797 ............................................................................. 1.9643 1.0048 20.5379 24.8950 24.8592 23.1190 

450801 ............................................................................. 1.4991 0.8204 23.0373 24.6328 25.3647 24.3609 

450803 ............................................................................. 1.1833 1.0048 30.6093 28.9235 30.3031 29.9076 

450804 ............................................................................. 1.9178 1.0048 26.0981 27.8775 29.1013 27.7076 

450808 ............................................................................. 1.3363 0.9518 23.8067 21.9793 23.0296 22.9175 

450809 ............................................................................. 1.5657 0.9518 26.3659 26.4223 27.3070 26.7163 

450811 ............................................................................. 1.8168 0.9140 25.8491 27.2584 31.1988 27.9792 

450813 ............................................................................. 1.1710 0.8916 25.5949 20.1710 22.9211 22.7699 

450820 ............................................................................. 1.3272 1.0048 30.5288 31.4666 33.9016 32.1404 

450822 ............................................................................. 1.2882 0.9795 31.1430 32.2968 32.2138 31.9065 

450824 ............................................................................. 2.4916 0.9518 26.7803 31.2375 33.3605 30.5401 

450825 ............................................................................. 1.3904 0.9140 20.2959 20.6457 25.1439 21.9852 

450827 ............................................................................. 1.3898 0.8488 20.9704 23.7554 24.1907 23.0383 

450828 ............................................................................. 1.3232 0.8204 22.3667 24.4740 24.8207 24.1285 

450829 ............................................................................. *** * 19.5014 20.6016 19.5826 19.9024 

450830 ............................................................................. 1.0196 0.9527 28.1617 28.5902 27.7967 28.1873 

450831 ............................................................................. 1.4011 1.0048 22.7885 23.3880 23.9437 23.3300 

450832 ............................................................................. 1.2713 1.0048 26.6628 26.5229 27.3292 26.8495 

450833 ............................................................................. 1.3228 0.9795 26.0044 27.0133 27.9622 27.0354 

450834 ............................................................................. 1.5862 0.9177 21.2204 20.9607 27.4845 22.7773 

450838 ............................................................................. 1.1487 0.8319 15.8026 19.5754 18.9504 18.1883 

450839 ............................................................................. 0.9901 0.8615 22.9711 25.8222 27.2151 25.2472 

450840 ............................................................................. 1.2907 0.9795 31.1914 30.1743 32.2544 31.2220 

450841 ............................................................................. 1.9217 0.9577 18.9468 20.9410 20.9412 20.3774 

450844 ............................................................................. 1.3103 1.0048 28.7296 30.7887 33.7961 31.3320 

450845 ............................................................................. 1.8427 0.9144 27.7461 29.4933 29.9243 29.0929 

450847 ............................................................................. 1.2704 1.0048 27.6854 28.5548 29.7336 28.6773 

450848 ............................................................................. 1.3004 1.0048 27.8100 29.5355 30.5537 29.3300 

450850 ............................................................................. 1.1195 1.0016 22.1335 21.9266 31.9567 24.7538 

450851 ............................................................................. 2.5569 0.9795 30.1213 32.6950 35.1080 32.6759 

450852 ............................................................................. *** * 30.0191 * * 30.0191 

450853 ............................................................................. 1.9527 0.9795 * 36.1169 37.1028 36.6720 

450854 ............................................................................. *** * * 27.1868 * 27.1868 

450855 ............................................................................. 1.5585 0.9577 * 30.8855 32.6866 31.8325 

450856 ............................................................................. 1.9086 0.8916 * 39.0865 37.7287 38.3752 

450857 ............................................................................. *** * * 30.4632 * 30.4632 

450860 ............................................................................. 1.9631 1.0048 * 24.0171 29.1020 26.9520 

450861 ............................................................................. *** * * 34.9290 * 34.9290 

450862 ............................................................................. 1.4583 1.0048 * 31.2224 31.8086 31.4626 

450863 ............................................................................. *** * * 24.8825 * 24.8825 

450864 ............................................................................. 2.0626 0.9190 * 23.3765 24.5033 24.0201 

mmaher on DSK3CLS3C1PROD with $$_JOB

24912 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

450865 ............................................................................. 1.0659 0.9518 * 29.1763 30.1175 29.6697 

450866 ............................................................................. *** * * 15.2959 * 15.2959 

450867 ............................................................................. 1.1897 0.9518 * 28.2289 29.8401 29.0248 

450868 ............................................................................. 1.8341 0.9959 * 27.9579 25.3483 26.8245 

450869 ............................................................................. 2.0520 0.9140 * 22.6253 26.1586 24.9890 

450870 ............................................................................. *** * * 37.4364 * 37.4364 

450871 ............................................................................. 1.8013 0.9518 * * 28.6667 28.6667 

450872 ............................................................................. 1.3856 0.9681 * * 27.2839 27.2839 

450873 ............................................................................. *** * * * 14.8808 14.8808 

450874 ............................................................................. 1.5449 0.9795 * * 34.6069 34.6069 

450875 ............................................................................. 1.6403 0.9141 * * 23.2771 23.2771 

450876 ............................................................................. 2.0787 0.8678 * * 28.4327 28.4327 

450877 ............................................................................. 1.5503 0.9144 * * 26.1823 26.1823 

450878 ............................................................................. 2.5581 0.8916 * * 31.4363 31.4363 

450879 ............................................................................. 1.2943 0.8484 * * 35.5585 35.5585 

450880 ............................................................................. 1.6579 0.9681 * * 35.9522 35.9522 

450881 ............................................................................. *** * * * 24.5455 24.5455 

450882 ............................................................................. *** * * * 27.8226 27.8226 

450883 ............................................................................. 2.5235 0.9795 * * 35.2632 35.2632 

450884 ............................................................................. 0.9913 0.8925 * * 27.8171 27.8171 

450885 ............................................................................. 1.4982 0.9795 * * 34.1144 34.1144 

450886 ............................................................................. 1.9390 0.9670 * * * * 

450888 ............................................................................. 1.4581 0.9670 * * * * 

450889 ............................................................................. 1.5257 0.9795 * * * * 

450890 ............................................................................. 2.0977 0.9795 * * * * 

450891 ............................................................................. 1.3643 0.9795 * * * * 

450893 ............................................................................. 1.2518 0.9795 * * * * 

450894 ............................................................................. 1.7048 0.9795 * * * * 

450895 ............................................................................. *** * * * 18.4129 18.4129 

460001 ............................................................................. 1.8847 0.9488 27.0757 28.7150 30.0024 28.5948 

460003 ............................................................................. 1.5181 0.9482 26.1372 31.4135 32.3411 29.8766 

460004 ............................................................................. 1.7332 0.9482 26.4498 28.2040 29.6502 28.1059 

460005 ............................................................................. 1.4390 0.9482 23.5633 25.0239 26.0927 24.8850 

460006 ............................................................................. 1.3709 0.9482 25.4787 27.1392 28.3673 27.0130 

460007 ............................................................................. 1.3738 0.9546 25.6686 27.1308 28.0016 26.9924 

460008 ............................................................................. 1.4054 0.9482 26.5672 29.5907 31.5474 29.1767 

460009 ............................................................................. 1.9494 0.9482 26.2833 27.2885 28.3813 27.3950 

460010 ............................................................................. 2.0931 0.9482 27.4648 29.0063 30.4873 29.0186 

460011 ............................................................................. 1.3207 0.9388 23.4023 24.4402 24.9677 24.2736 

460013 ............................................................................. 1.4115 0.9488 25.2448 27.7381 29.2708 27.3700 

460014 ............................................................................. 1.1337 0.9482 24.1412 28.2647 29.5924 27.3264 

460015 ............................................................................. 1.3650 0.9219 25.6576 27.2506 29.1301 27.3608 

460017 ............................................................................. 1.3070 0.8631 23.0388 24.3030 26.1574 24.4631 

460018 ............................................................................. 0.9383 0.8267 20.3756 22.0517 22.7973 21.8331 

460019 ............................................................................. 1.1647 0.8267 19.9901 24.3756 23.2172 22.4666 

460020 ............................................................................. 1.0141 0.8267 19.5669 18.5159 29.5332 21.7927 

460021 ............................................................................. 1.6947 1.1205 26.3420 28.0291 29.5906 28.1994 

460023 ............................................................................. 1.1933 0.9488 25.3094 26.9512 28.6509 26.9991 

460026 ............................................................................. 1.0465 0.9388 24.1547 26.9295 27.9463 26.3205 

460030 ............................................................................. 1.1799 0.8267 23.4679 23.5942 24.3597 23.8093 

460033 ............................................................................. 0.9138 0.8267 22.0249 25.3422 26.6541 24.7026 

460035 ............................................................................. 0.9491 0.8267 17.5723 20.6322 21.9077 20.1162 

460036 ............................................................................. 1.4454 * 27.2866 * * 27.2866 

460037 ............................................................................. 0.8447 * 21.1035 * * 21.1035 

460039 ............................................................................. 1.0810 0.9219 28.5657 29.5651 30.4903 29.5979 

460041 ............................................................................. 1.3613 0.9482 25.2744 26.4640 26.3798 26.0597 

460042 ............................................................................. 1.3920 0.9482 22.9949 24.9454 26.8365 24.8864 

460043 ............................................................................. 1.2796 0.9488 28.2089 28.2008 28.6673 28.3617 

460044 ............................................................................. 1.3114 0.9482 26.6795 27.4928 28.7017 27.6432 

460047 ............................................................................. 1.6716 0.9482 25.7920 28.2336 30.0498 27.9926 

460049 ............................................................................. 1.9965 0.9482 24.5165 26.6702 28.5026 26.6084 

mmaher on DSK3CLS3C1PROD with $$_JOB

24913 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

460051 ............................................................................. 1.2358 0.9482 25.5881 27.0160 27.8836 26.8632 

460052 ............................................................................. 1.6310 0.9488 25.3163 26.1629 27.1991 26.2809 

460054 ............................................................................. 1.5970 0.9219 25.8668 24.9926 25.7860 25.5261 

470001 ............................................................................. 1.2954 1.0782 27.7329 28.3017 29.7537 28.6008 

470003 ............................................................................. 1.9062 1.0401 26.4919 28.1137 30.1959 28.2585 

470005 ............................................................................. 1.3073 1.0401 29.8255 30.7872 33.1968 31.2956 

470006 ............................................................................. 1.2524 * 26.9651 * * 26.9651 

470010 ............................................................................. *** * 26.1273 * * 26.1273 

470011 ............................................................................. 1.1764 1.0401 28.3911 28.1330 29.6899 28.7438 

470012 ............................................................................. 1.1947 1.0401 24.3425 26.0225 27.0128 25.8090 

470018 ............................................................................. 1.1133 * 28.3419 * * 28.3419 

470024 ............................................................................. 1.2025 1.0401 25.2427 27.0394 26.6344 26.3232 

490001 ............................................................................. 1.0892 0.8095 21.9953 23.2174 24.0349 23.1144 

490002 ............................................................................. 1.0509 0.8095 19.5613 20.8609 21.7073 20.6687 

490003 ............................................................................. *** * 27.3456 * * 27.3456 

490004 ............................................................................. 1.3087 0.9353 25.4597 27.1676 27.8236 26.8453 

490005 ............................................................................. 1.6418 1.0679 28.5744 29.8215 30.5335 29.6408 

490007 ............................................................................. 2.1943 0.8785 26.2481 27.6572 29.3084 27.7570 

490009 ............................................................................. 2.0098 0.9555 29.0740 30.4722 29.9383 29.8425 

490011 ............................................................................. 1.5283 0.8785 24.5687 26.4766 27.4750 26.2046 

490012 ............................................................................. 1.0128 0.8095 19.2276 21.0605 22.9898 21.0346 

490013 ............................................................................. 1.3401 0.8490 22.4771 24.7521 25.5532 24.2689 

490017 ............................................................................. 1.5004 0.8785 24.6845 25.8216 27.5878 26.0263 

490018 ............................................................................. 1.3289 0.9353 24.5196 26.2510 27.3895 26.0937 

490019 ............................................................................. 1.1905 1.0679 25.9761 25.9885 25.8263 25.9276 

490020 ............................................................................. 1.2411 0.9238 24.8001 27.3142 29.4572 27.1534 

490021 ............................................................................. 1.4774 0.8490 24.6440 25.7938 26.5838 25.6856 

490022 ............................................................................. 1.4247 1.0679 28.0749 32.2676 30.1180 30.1134 

490023 ............................................................................. 1.3034 1.0679 29.7774 30.3416 30.9919 30.3865 

490024 ............................................................................. 1.7719 0.9441 23.0982 26.1125 30.6195 26.5180 

490027 ............................................................................. 1.0552 0.8095 18.9409 24.0288 22.9996 21.9117 

490031 ............................................................................. *** * 22.0579 * * 22.0579 

490032 ............................................................................. 1.9589 0.9238 25.1381 25.2654 28.5886 26.3873 

490033 ............................................................................. 1.1071 1.0679 30.0909 31.2922 31.8266 31.1174 

490037 ............................................................................. 1.2023 0.8095 21.3035 24.7711 25.2813 23.7322 

490038 ............................................................................. 1.2572 0.8095 22.3976 21.8509 22.6326 22.2914 

490040 ............................................................................. 1.4793 1.0679 32.8738 32.6564 34.1837 33.2336 

490041 ............................................................................. 1.5146 0.8785 24.5738 26.0897 27.1598 25.9088 

490042 ............................................................................. 1.2796 0.9190 21.8749 24.4650 25.3578 23.9261 

490043 ............................................................................. 1.2498 1.0679 30.8871 33.7096 35.8792 33.5666 

490044 ............................................................................. 1.4529 0.8785 20.8352 23.3527 23.3777 22.5138 

490045 ............................................................................. 1.2636 1.0679 28.8279 32.0937 30.3765 30.3674 

490046 ............................................................................. 1.5194 0.8785 25.6328 26.6517 27.9583 26.7669 

490047 ............................................................................. 1.2301 * 22.5423 * * 22.5423 

490048 ............................................................................. 1.4151 0.8490 25.0097 26.2828 26.7581 26.0497 

490050 ............................................................................. 1.4886 1.0679 30.5037 31.3885 32.3078 31.4093 

490052 ............................................................................. 1.6969 0.8785 22.8889 23.5973 25.0037 23.8192 

490053 ............................................................................. 1.2119 0.8095 21.8432 23.3315 23.7979 22.9784 

490057 ............................................................................. 1.6179 0.8785 26.1128 26.6898 27.5153 26.7785 

490059 ............................................................................. 1.6454 0.9238 28.7276 27.3611 30.8668 28.9526 

490060 ............................................................................. 1.0540 0.8095 22.4201 23.6113 24.3180 23.4563 

490063 ............................................................................. 1.8510 1.0679 30.3632 31.3619 31.6067 31.1276 

490066 ............................................................................. 1.3614 0.8785 24.7146 27.8250 29.6170 27.4591 

490067 ............................................................................. 1.2603 0.9238 22.9188 24.9021 25.9475 24.5479 

490069 ............................................................................. 1.6015 0.9238 26.8791 27.3181 29.1513 27.7948 

490071 ............................................................................. 1.3203 0.9238 28.4381 29.7186 31.6505 29.9219 

490073 ............................................................................. 2.0908 1.0679 31.7743 33.1829 36.6050 33.5942 

490075 ............................................................................. 1.4310 0.8486 23.8191 25.2022 26.3059 25.1154 

490077 ............................................................................. 1.4141 0.9555 26.0800 26.6806 28.1502 26.9962 

490079 ............................................................................. 1.2496 0.9083 23.4728 25.3103 25.2294 24.6362 

490084 ............................................................................. 1.1764 0.8240 24.5965 24.9007 25.7656 25.0947 

mmaher on DSK3CLS3C1PROD with $$_JOB

24914 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

490088 ............................................................................. 1.1004 0.8490 22.4186 24.1471 24.8101 23.7857 

490089 ............................................................................. 1.1026 0.9441 22.6461 24.9438 25.7992 24.4734 

490090 ............................................................................. 1.1074 0.8095 22.2907 25.1157 26.3608 24.4717 

490092 ............................................................................. 1.0927 0.9238 23.8655 23.3439 25.7387 24.2720 

490093 ............................................................................. 1.4711 0.8785 25.0751 25.6531 26.7886 25.8819 

490094 ............................................................................. 0.9852 0.9238 26.5726 28.2165 28.9146 27.8967 

490097 ............................................................................. 1.0622 0.9238 23.8005 26.5322 27.1435 25.8270 

490098 ............................................................................. 1.2549 0.8095 21.7231 23.2782 25.1610 23.3955 

490101 ............................................................................. 1.4013 1.0679 30.4285 31.2377 32.3688 31.3628 

490104 ............................................................................. 0.7733 0.9238 17.3295 * 17.0546 17.1727 

490105 ............................................................................. 0.7178 0.8095 24.7922 25.5329 26.3828 25.5156 

490106 ............................................................................. 0.9111 0.9353 23.0199 23.8334 25.7350 23.7423 

490107 ............................................................................. 1.3335 1.0679 29.7000 32.2672 33.5401 31.8912 

490108 ............................................................................. 1.0684 0.8490 22.4345 22.9076 23.3193 22.8875 

490109 ............................................................................. 0.8787 0.9238 21.9877 22.7854 24.2291 22.9552 

490110 ............................................................................. 1.3524 0.8422 22.5974 24.2887 24.9849 24.0081 

490111 ............................................................................. 1.1951 0.8095 22.0199 22.1476 22.8937 22.3629 

490112 ............................................................................. 1.7156 0.9238 26.6453 27.1932 29.0813 27.6671 

490113 ............................................................................. 1.3105 1.0679 29.5698 31.8177 32.4544 31.3269 

490114 ............................................................................. 1.1475 0.8095 20.9116 22.5255 22.1360 21.8649 

490115 ............................................................................. 1.1533 0.8095 21.4666 22.4058 23.7163 22.5107 

490116 ............................................................................. 1.1776 0.8095 22.9017 24.2258 24.3840 23.8562 

490117 ............................................................................. 1.1522 0.8095 18.0277 19.6398 18.1119 18.6014 

490118 ............................................................................. 1.6600 0.9238 27.4050 27.6749 29.0567 28.0590 

490119 ............................................................................. 1.3035 0.8785 25.2549 26.5756 27.8859 26.6077 

490120 ............................................................................. 1.3981 0.8785 24.4434 25.8795 26.0093 25.4236 

490122 ............................................................................. 1.5549 1.0679 31.0449 32.0743 33.3710 32.1670 

490123 ............................................................................. 1.1545 0.8095 23.9233 24.3490 24.2251 24.1637 

490126 ............................................................................. 1.1651 0.8095 22.2859 23.6690 24.0884 23.3590 

490127 ............................................................................. 1.1307 0.8095 20.4289 21.3735 23.4863 21.6178 

490130 ............................................................................. 1.2696 0.8785 22.8512 23.9982 25.3343 24.0812 

490133 ............................................................................. *** * 26.5684 * * 26.5684 

490134 ............................................................................. 0.7623 0.8095 * * 33.2227 33.2227 

490135 ............................................................................. 0.7016 0.9441 * * 25.9889 25.9889 

490136 ............................................................................. 1.4665 0.9238 * * * * 

490137 ............................................................................. 1.2895 0.8785 * * * * 

500001 ............................................................................. 1.6372 1.1351 29.3707 31.1605 33.0888 31.2052 

500002 ............................................................................. 1.4278 1.0565 25.3347 27.6400 29.1442 27.3385 

500003 ............................................................................. 1.3314 1.1202 29.6341 30.6939 32.1259 30.7329 

500005 ............................................................................. 1.7732 1.1351 32.0972 33.5117 34.8686 33.4895 

500007 ............................................................................. 1.3448 1.1202 28.0476 29.2869 30.5261 29.3452 

500008 ............................................................................. 1.8942 1.1351 31.8837 32.6052 33.5666 32.7102 

500011 ............................................................................. 1.3613 1.1351 30.6508 31.4514 32.6218 31.5867 

500012 ............................................................................. 1.7433 1.0565 30.6856 30.0509 33.8239 31.3893 

500014 ............................................................................. 1.6985 1.1351 33.7536 36.1380 36.5850 35.5229 

500015 ............................................................................. 1.4709 1.1351 32.0592 34.5877 35.6715 34.1465 

500016 ............................................................................. 1.6475 1.1202 31.4222 31.4905 32.9165 31.9509 

500019 ............................................................................. 1.2779 1.0705 28.6669 30.5594 31.6230 30.2717 

500021 ............................................................................. 1.2936 1.1202 30.1690 30.7927 32.4667 31.1930 

500024 ............................................................................. 1.7694 1.1060 30.7917 32.6171 36.1640 33.1799 

500025 ............................................................................. 1.8307 1.1351 34.7252 37.7952 40.6368 37.5370 

500026 ............................................................................. 1.3949 1.1351 33.2937 32.8369 34.5879 33.5879 

500027 ............................................................................. 1.5119 1.1351 34.2175 34.6164 39.2906 36.0226 

500030 ............................................................................. 1.6945 1.1264 32.7446 32.4426 34.9165 33.4025 

500031 ............................................................................. 1.2753 1.1325 31.2186 32.8833 33.2375 32.4927 

500033 ............................................................................. 1.3149 1.0565 29.4627 30.6292 31.9177 30.6609 

500036 ............................................................................. 1.3431 1.0565 27.0072 28.7096 30.5911 28.8233 

500037 ............................................................................. 1.0254 1.0565 26.9969 28.1056 31.2642 28.7442 

500039 ............................................................................. 1.4951 1.1202 29.8808 32.2245 33.5585 31.9341 

500041 ............................................................................. 1.4362 1.1233 26.7829 30.3627 34.1983 30.2983 

500044 ............................................................................. 1.9634 1.0565 30.3164 29.0214 31.0921 30.1178 

mmaher on DSK3CLS3C1PROD with $$_JOB

24915 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

500049 ............................................................................. 1.3525 1.0565 27.1819 27.7170 29.8189 28.3097 

500050 ............................................................................. 1.4984 1.1233 29.9791 32.6751 33.7695 32.1377 

500051 ............................................................................. 1.7936 1.1351 31.9406 32.5764 34.7579 33.0980 

500052 ............................................................................. 1.4374 1.1351 * * * * 

500053 ............................................................................. 1.2887 1.0565 28.4130 28.2901 30.2803 28.9863 

500054 ............................................................................. 1.9955 1.0565 30.8067 31.6595 32.4524 31.6451 

500058 ............................................................................. 1.6535 1.0565 30.4699 30.7487 30.7029 30.6482 

500060 ............................................................................. 1.3750 1.1351 34.1523 37.4869 38.7650 36.8212 

500064 ............................................................................. 1.7330 1.1351 31.5371 31.6112 32.3570 31.8420 

500072 ............................................................................. 1.2310 1.0826 33.4863 31.2000 32.5263 32.3947 

500077 ............................................................................. 1.4551 1.0565 29.4199 31.6153 33.2185 31.3933 

500079 ............................................................................. 1.3757 1.1202 29.6623 31.3280 32.5802 31.1943 

500084 ............................................................................. 1.3885 1.1351 29.3484 30.2411 32.7883 30.8053 

500088 ............................................................................. 1.3961 1.1351 33.4302 35.3770 36.7929 35.2125 

500108 ............................................................................. 1.6412 1.1202 29.4244 31.8483 34.3853 31.9453 

500119 ............................................................................. 1.3894 1.0565 30.9999 29.7028 31.2216 30.6353 

500122 ............................................................................. 1.3587 * 30.1396 * * 30.1396 

500124 ............................................................................. 1.4290 1.1351 31.5438 32.3505 34.4763 32.8201 

500129 ............................................................................. 1.5751 1.1202 30.7536 32.1102 34.4437 32.4983 

500134 ............................................................................. 0.4907 1.1351 26.8607 27.2428 28.1308 27.5250 

500138 ............................................................................. 0.8731 * * * * * 

500139 ............................................................................. 1.5216 1.1060 31.6591 33.9739 35.2459 33.5975 

500141 ............................................................................. 1.3178 1.1351 30.5456 31.3308 33.7520 31.9219 

500143 ............................................................................. 0.4729 1.1060 22.1419 23.6766 25.3064 23.6837 

500147 ............................................................................. 0.8772 * 24.5744 * * 24.5744 

500148 ............................................................................. 1.1794 1.0565 22.2161 26.4206 37.7820 30.2226 

500150 ............................................................................. 1.2175 1.1233 * * * * 

510001 ............................................................................. 1.9235 0.8388 23.4477 25.2973 25.8670 24.9189 

510002 ............................................................................. 1.2868 0.9190 25.9597 23.8921 23.7257 24.4599 

510006 ............................................................................. 1.3373 0.8244 23.5727 24.9627 24.8754 24.4761 

510007 ............................................................................. 1.7217 0.8845 25.2835 24.7264 26.7129 25.5735 

510008 ............................................................................. 1.3063 0.9259 24.6959 26.3554 27.5208 26.2143 

510012 ............................................................................. 0.9607 0.7568 18.2845 18.8984 20.8441 19.3184 

510013 ............................................................................. 1.1241 0.7568 20.8782 22.7882 22.8762 22.1595 

510018 ............................................................................. 1.0603 0.8294 20.5556 22.4597 22.8896 21.9850 

510022 ............................................................................. 1.8404 0.8397 24.2125 26.9511 26.8298 25.9931 

510023 ............................................................................. 1.2851 0.7893 20.4908 20.6435 21.0931 20.7442 

510024 ............................................................................. 1.8413 0.8388 24.0444 25.5634 26.6600 25.4522 

510026 ............................................................................. 0.9974 0.7568 16.6192 17.9908 19.0716 17.8791 

510028 ............................................................................. *** * 21.7135 * * 21.7135 

510029 ............................................................................. 1.3222 0.8397 22.4556 22.7104 24.0871 23.0837 

510030 ............................................................................. 1.0974 0.8244 21.5583 24.3936 23.7105 23.2332 

510031 ............................................................................. 1.4320 0.8397 21.7637 23.2624 24.0220 22.9918 

510033 ............................................................................. 1.7286 0.8238 23.0305 22.6189 24.0772 23.2692 

510038 ............................................................................. 1.0547 0.7568 17.2832 20.6565 20.9131 19.6268 

510039 ............................................................................. 1.2513 0.7568 19.5468 19.8751 20.4713 19.9553 

510046 ............................................................................. 1.3473 0.7744 21.2540 22.1712 22.7403 22.0415 

510047 ............................................................................. 1.1464 0.8388 24.0954 27.1214 27.6830 26.2412 

510048 ............................................................................. 1.1744 0.7568 17.5096 18.8576 22.7921 19.5218 

510050 ............................................................................. 1.6023 0.7568 19.9766 21.0772 21.8994 20.9834 

510053 ............................................................................. 1.1036 0.7568 20.8608 22.3318 21.5331 21.5796 

510055 ............................................................................. 1.5345 0.8845 30.7868 28.4615 29.4112 29.5183 

510058 ............................................................................. 1.3454 0.8238 22.6976 23.9015 25.1425 23.9213 

510059 ............................................................................. 0.7138 0.8397 21.9551 22.1435 20.8799 21.6736 

510062 ............................................................................. 1.1596 0.8294 23.3216 26.2296 26.5027 25.3360 

510067 ............................................................................. 1.1080 0.7568 21.2099 25.0437 25.2094 23.8467 

510068 ............................................................................. 1.1378 * 23.1011 * * 23.1011 

510070 ............................................................................. 1.2252 0.8294 23.2382 23.5639 23.9714 23.5982 

510071 ............................................................................. 1.3169 0.7744 23.1685 23.4508 23.2773 23.3001 

510072 ............................................................................. 1.1600 0.7568 20.1997 20.5146 19.4366 20.0240 

510077 ............................................................................. 1.0539 0.8706 23.6584 24.5010 25.9500 24.6968 

mmaher on DSK3CLS3C1PROD with $$_JOB

24916 

—————————— 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

510082 ............................................................................. 1.1114 0.7568 19.1878 19.9081 20.3265 19.7900 

510085 ............................................................................. 1.2935 0.8397 23.7174 26.3877 26.2593 25.5454 

510086 ............................................................................. 1.1756 0.7568 17.5933 19.8735 19.2574 18.9116 

510089 ............................................................................. *** * 27.7061 * * 27.7061 

510090 ............................................................................. 1.8498 0.8845 * * * * 

520002 ............................................................................. 1.3411 1.0011 24.9950 27.7705 29.0603 27.3244 

520004 ............................................................................. 1.3936 0.9704 25.4639 27.6530 28.9833 27.3808 

520008 ............................................................................. 1.5354 1.0296 29.8353 30.7553 33.8038 31.4979 

520009 ............................................................................. 1.7192 0.9635 26.1503 27.4044 28.8585 27.4835 

520011 ............................................................................. 1.3034 0.9635 25.2747 26.6268 27.2708 26.4030 

520013 ............................................................................. 1.4596 0.9635 26.6225 29.0018 30.1823 28.6557 

520017 ............................................................................. 1.1205 0.9635 24.6677 28.4699 29.3257 27.4741 

520019 ............................................................................. 1.3648 0.9635 26.7433 28.6971 29.8641 28.5157 

520021 ............................................................................. 1.3025 1.0455 26.6935 28.4182 29.1110 28.1498 

520027 ............................................................................. 1.3706 1.0296 27.6771 31.4284 32.4107 30.5705 

520028 ............................................................................. 1.3493 1.1002 25.4164 26.7260 28.0802 26.7497 

520030 ............................................................................. 1.7235 1.0011 27.0184 29.4678 30.5699 29.0605 

520033 ............................................................................. 1.2657 0.9635 25.0853 28.0662 29.0213 27.5155 

520034 ............................................................................. 1.2320 0.9635 23.9850 26.1094 26.8901 25.6373 

520035 ............................................................................. 1.3589 0.9718 24.7767 27.3276 28.1023 26.7456 

520037 ............................................................................. 1.8171 1.0011 29.7234 30.1799 32.2126 30.7297 

520038 ............................................................................. 1.2386 1.0296 26.6470 29.3134 29.6455 28.5972 

520040 ............................................................................. 1.2129 1.0296 27.2325 29.1262 31.2019 29.0313 

520041 ............................................................................. 1.0714 1.1181 22.7595 23.5495 25.3745 23.9555 

520044 ............................................................................. 1.3514 0.9718 26.0191 27.3685 28.2371 27.2569 

520045 ............................................................................. 1.6541 0.9635 26.0030 27.3336 29.3743 27.5624 

520048 ............................................................................. 1.5682 0.9635 25.1724 26.8080 29.1861 26.9820 

520049 ............................................................................. 2.1341 0.9635 25.9256 26.9851 28.0930 26.9956 

520051 ............................................................................. 1.5581 1.0296 28.4880 31.9949 31.3100 30.6580 

520057 ............................................................................. 1.1719 0.9819 25.3745 27.7528 29.1146 27.4372 

520059 ............................................................................. 1.3032 1.0287 28.0907 29.5801 30.4575 29.3881 

520060 ............................................................................. 1.3697 0.9635 23.8817 24.8638 26.3170 25.0791 

520062 ............................................................................. 1.2461 1.0296 28.2215 28.8510 32.8572 30.1180 

520063 ............................................................................. 1.1387 1.0296 27.4100 29.0993 30.3381 28.9449 

520064 ............................................................................. 1.5995 1.0296 28.6101 30.3225 31.5710 30.0467 

520066 ............................................................................. 1.4385 0.9813 27.1657 29.2088 31.0608 29.1271 

520068 ............................................................................. *** * 24.8184 * * 24.8184 

520070 ............................................................................. 1.7753 0.9635 24.8935 27.6771 28.0835 26.9326 

520071 ............................................................................. 1.1682 1.0296 27.6202 30.0262 30.6902 29.4705 

520075 ............................................................................. 1.5608 0.9635 27.1699 29.2920 30.1577 28.8340 

520076 ............................................................................. 1.2408 1.1002 26.1697 27.3335 27.4423 26.9220 

520078 ............................................................................. 1.5176 1.0296 27.5989 29.9837 31.6930 29.7364 

520083 ............................................................................. 1.7380 1.1181 28.8407 30.8826 32.7720 30.8982 

520087 ............................................................................. 1.7746 0.9704 27.3374 28.5810 30.5643 28.8727 

520088 ............................................................................. 1.4249 0.9892 26.9936 30.7450 30.6626 29.5642 

520089 ............................................................................. 1.5701 1.1181 30.0448 33.8793 33.4077 32.4828 

520091 ............................................................................. 1.2952 0.9635 24.6320 25.4593 27.3437 25.8208 

520094 ............................................................................. *** * 25.7567 * * 25.7567 

520095 ............................................................................. 1.2940 1.1002 26.7863 30.4216 32.0328 29.8101 

520096 ............................................................................. 1.3768 0.9824 24.5758 27.8896 29.5966 27.4533 

520097 ............................................................................. 1.3988 0.9635 26.3321 29.1479 30.0078 28.4894 

520098 ............................................................................. 2.0280 1.1181 30.6150 32.5785 36.5735 33.3161 

520100 ............................................................................. 1.2790 0.9813 26.2161 29.3243 29.6404 28.4022 

520102 ............................................................................. 1.1731 1.0296 26.8234 29.1680 30.7969 28.9921 

520103 ............................................................................. 1.5503 1.0296 27.9147 30.3165 32.6253 30.3606 

520107 ............................................................................. 1.2785 0.9721 28.3431 28.9878 29.4173 28.9353 

520109 ............................................................................. 1.0385 0.9635 23.3271 24.7228 25.0675 24.3755 

520113 ............................................................................. 1.3265 0.9635 27.4135 31.4708 33.3448 30.7246 

520116 ............................................................................. 1.2670 1.0296 26.9902 27.9688 30.2148 28.3943 

520132 ............................................................................. *** * 23.1941 25.0006 27.3413 25.0303 

520136 ............................................................................. 1.7254 1.0296 27.7703 30.6522 32.2056 30.1520 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24917 

TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL

WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS

2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued 

Provider No. Case-mix 

index 2

FY 2008 

wage index 

Average 

hourly wage 

FY 2006 

Average 

hourly wage 

FY 2007 

Average 

hourly wage 

FY 2008 1

Average 

hourly 

wage** 

(3 years) 

520138 ............................................................................. 1.8836 1.0296 28.4394 30.8016 31.6560 30.2955 

520139 ............................................................................. 1.2882 1.0296 26.5110 28.8870 30.4880 28.6146 

520140 ............................................................................. 0.3793 * 28.4433 31.0043 31.0603 30.2033 

520152 ............................................................................. 1.0909 * 24.9392 29.7308 * 27.4042 

520160 ............................................................................. 1.8643 0.9635 25.7588 27.9548 29.7288 27.8043 

520170 ............................................................................. 1.4772 1.0296 27.2221 30.4309 31.4684 29.7182 

520173 ............................................................................. 1.0835 0.9635 28.0995 29.2429 31.0590 29.4644 

520177 ............................................................................. 1.6145 1.0296 30.7317 31.4555 32.5695 31.6043 

520178 ............................................................................. 1.0240 * 20.2666 * * 20.2666 

520189 ............................................................................. 1.2031 1.0455 28.4720 28.0014 29.0284 28.4995 

520193 ............................................................................. 1.6998 0.9635 26.0885 27.8113 29.2005 27.7864 

520194 ............................................................................. 1.7148 1.0296 24.9408 30.1668 31.4969 28.9141 

520195 ............................................................................. 0.3556 1.0296 36.6973 36.3116 36.2864 36.4358 

520196 ............................................................................. 1.6798 0.9635 35.1043 36.9266 31.1197 34.0263 

520197 ............................................................................. *** * * * 30.1026 30.1026 

520198 ............................................................................. 1.4193 0.9635 * * 28.5962 28.5962 

520199 ............................................................................. 2.2788 1.0296 * * 36.5679 36.5679 

520200 ............................................................................. 0.9180 * * * * * 

520201 ............................................................................. 0.6866 * * * * * 

520202 ............................................................................. 1.4519 1.0011 * * * * 

530002 ............................................................................. 1.1242 0.9214 26.8356 28.3063 29.2066 28.1166 

530006 ............................................................................. 1.1836 0.9214 24.9318 27.2421 29.2091 27.0634 

530007 ............................................................................. *** * 20.4391 * * 20.4391 

530008 ............................................................................. 1.1673 0.9214 23.8589 24.0090 26.5170 24.7922 

530009 ............................................................................. 0.9239 0.9214 26.8316 24.6719 25.9366 25.7848 

530010 ............................................................................. 1.3065 0.9214 25.8482 25.9852 27.4111 26.4398 

530011 ............................................................................. 1.1127 0.9214 24.8245 27.8772 27.8600 26.9105 

530012 ............................................................................. 1.7049 0.9277 25.2526 26.9582 28.7554 26.9872 

530014 ............................................................................. 1.5650 0.9219 24.5947 26.7156 28.5771 26.7011 

530015 ............................................................................. 1.1585 0.9352 27.6876 29.8310 31.1119 29.5109 

530017 ............................................................................. 1.1052 0.9214 25.3362 29.8503 31.1044 28.7212 

530023 ............................................................................. *** * 21.3813 * * 21.3813 

530025 ............................................................................. 1.2406 0.9214 28.6938 24.4392 29.3697 27.4106 

530032 ............................................................................. 1.0164 0.9214 25.7728 23.9004 24.6562 24.7327 

1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. 

* Denotes wage data not available for the provider for that year. 

** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. 

*** Denotes MedPAR data not available for the provider for FY 2006. 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

10180 ....... Abilene, TX ............................................................................................................................................... 25.5538 24.1331 

10380 ....... Aguadilla-Isabela-San Sebasti[aacute]n, PR ............................................................................................ 10.2251 11.4341 

10420 ....... Akron, OH ................................................................................................................................................. 27.1423 25.9140 

10500 ....... Albany, GA ................................................................................................................................................ 26.5075 25.8661 

10580 ....... Albany-Schenectady-Troy, NY .................................................................................................................. 26.8799 25.7658 

10740 ....... Albuquerque, NM ...................................................................................................................................... 30.1918 28.6362 

10780 ....... Alexandria, LA ........................................................................................................................................... 24.6475 23.5445 

10900 ....... Allentown-Bethlehem-Easton, PA-NJ ....................................................................................................... 31.0725 29.5625 

11020 ....... Altoona, PA ............................................................................................................................................... 25.8968 25.4011 

11100 ....... Amarillo, TX .............................................................................................................................................. 28.3367 27.1348 

11180 ....... Ames, IA ................................................................................................................................................... 30.9401 28.8517 

11260 ....... Anchorage, AK .......................................................................................................................................... 36.4624 35.0341 

11300 ....... Anderson, IN ............................................................................................................................................. 27.8019 26.0238 

11340 ....... Anderson, SC ............................................................................................................................................ 28.1687 26.6066 

11460 ....... Ann Arbor, MI ............................................................................................................................................ 32.5597 31.5914 

11500 ....... Anniston-Oxford, AL .................................................................................................................................. 24.7339 23.2894 

11540 ....... Appleton, WI ............................................................................................................................................. 29.3844 27.6794 

mmaher on DSK3CLS3C1PROD with $$_JOB

24918 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

11700 ....... Asheville, NC ............................................................................................................................................ 28.5462 27.3747 

12020 ....... Athens-Clarke County, GA ....................................................................................................................... 32.6801 28.9702 

12060 ....... Atlanta-Sandy Springs-Marietta, GA ......................................................................................................... 30.5185 28.9861 

12100 ....... Atlantic City, NJ ........................................................................................................................................ 37.4892 34.9547 

12220 ....... Auburn-Opelika, AL ................................................................................................................................... 25.0667 23.9196 

12260 ....... Augusta-Richmond County, GA-SC ......................................................................................................... 29.7570 28.5673 

12420 ....... Austin-Round Rock, TX ............................................................................................................................ 29.5055 27.8771 

12540 ....... Bakersfield, CA ......................................................................................................................................... 35.1655 32.3553 

12580 ....... Baltimore-Towson, MD ............................................................................................................................. 31.3329 29.4975 

12620 ....... Bangor, ME ............................................................................................................................................... 30.5654 29.0449 

12700 ....... Barnstable Town, MA ............................................................................................................................... 39.1116 37.3016 

12940 ....... Baton Rouge, LA ...................................................................................................................................... 24.8394 24.3027 

12980 ....... Battle Creek, MI ........................................................................................................................................ 31.1266 28.7337 

13020 ....... Bay City, MI .............................................................................................................................................. 27.9569 27.3833 

13140 ....... Beaumont-Port Arthur, TX ........................................................................................................................ 26.6188 25.3168 

13380 ....... Bellingham, WA ........................................................................................................................................ 34.9165 33.4025 

13460 ....... Bend, OR .................................................................................................................................................. 32.8324 31.4061 

13644 ....... Bethesda-Gaithersburg-Frederick, MD ..................................................................................................... 32.4256 32.2302 

13740 ....... Billings, MT ............................................................................................................................................... 27.5180 26.3023 

13780 ....... Binghamton, NY ........................................................................................................................................ 28.1230 26.2431 

13820 ....... Birmingham-Hoover, AL ............................................................................................................................ 27.5033 26.3180 

13900 ....... Bismarck, ND ............................................................................................................................................ 22.5429 21.8622 

13980 ....... Blacksburg-Christiansburg-Radford, VA ................................................................................................... 25.0343 23.9362 

14020 ....... Bloomington, IN ........................................................................................................................................ 28.9114 26.4833 

14060 ....... Bloomington-Normal, IL ............................................................................................................................ 29.4126 27.2841 

14260 ....... Boise City-Nampa, ID ............................................................................................................................... 29.4529 27.5811 

14484 ....... Boston-Quincy, MA ................................................................................................................................... 36.2971 34.5496 

14500 ....... Boulder, CO .............................................................................................................................................. 31.3644 29.5797 

14540 ....... Bowling Green, KY ................................................................................................................................... 25.0757 24.0238 

14740 ....... Bremerton-Silverdale, WA ........................................................................................................................ 33.5585 31.9341 

14860 ....... Bridgeport-Stamford-Norwalk, CT ............................................................................................................. 39.9455 37.7175 

15180 ....... Brownsville-Harlingen, TX ......................................................................................................................... 29.6861 28.6894 

15260 ....... Brunswick, GA .......................................................................................................................................... 30.2808 29.1365 

15380 ....... Buffalo-Niagara Falls, NY ......................................................................................................................... 29.7130 28.1438 

15500 ....... Burlington, NC ........................................................................................................................................... 26.6539 25.6456 

15540 ....... Burlington-South Burlington, VT ............................................................................................................... 29.7238 28.0154 

15764 ....... Cambridge-Newton-Framingham, MA ...................................................................................................... 34.6193 32.8465 

15804 ....... Camden, NJ .............................................................................................................................................. 32.6154 31.0734 

15940 ....... Canton-Massillon, OH ............................................................................................................................... 27.6520 26.5054 

15980 ....... Cape Coral-Fort Myers, FL ....................................................................................................................... 29.4170 27.9198 

16180 ....... Carson City, NV ........................................................................................................................................ 29.0596 29.0305 

16220 ....... Casper, WY ............................................................................................................................................... 28.7554 26.9872 

16300 ....... Cedar Rapids, IA ...................................................................................................................................... 26.9340 25.8161 

16580 ....... Champaign-Urbana, IL .............................................................................................................................. 28.8897 28.0705 

16620 ....... Charleston, WV ......................................................................................................................................... 26.0301 25.1455 

16700 ....... Charleston-North Charleston, SC ............................................................................................................. 28.3391 27.1402 

16740 ....... Charlotte-Gastonia-Concord, NC-SC ........................................................................................................ 29.4846 28.2167 

16820 ....... Charlottesville, VA ..................................................................................................................................... 29.6186 29.3212 

16860 ....... Chattanooga, TN-GA ................................................................................................................................ 27.7965 26.6064 

16940 ....... Cheyenne, WY .......................................................................................................................................... 28.5771 26.7011 

16974 ....... Chicago-Naperville-Joliet, IL ..................................................................................................................... 32.4104 31.4301 

17020 ....... Chico, CA .................................................................................................................................................. 34.8348 32.3528 

17140 ....... Cincinnati-Middletown, OH-KY-IN ............................................................................................................. 29.9257 28.3705 

17300 ....... Clarksville, TN-KY ..................................................................................................................................... 25.4889 24.5649 

17420 ....... Cleveland, TN ........................................................................................................................................... 25.3391 24.1812 

17460 ....... Cleveland-Elyria-Mentor, OH .................................................................................................................... 29.0283 27.5817 

17660 ....... Coeur d’Alene, ID ..................................................................................................................................... 29.0137 27.8488 

17780 ....... College Station-Bryan, TX ........................................................................................................................ 28.4460 26.5695 

17820 ....... Colorado Springs, CO ............................................................................................................................... 29.3600 27.9536 

17860 ....... Columbia, MO ........................................................................................................................................... 26.4878 24.9744 

17900 ....... Columbia, SC ............................................................................................................................................ 27.2473 26.4178 

17980 ....... Columbus, GA-AL ..................................................................................................................................... 27.9688 25.7747 

18020 ....... Columbus, IN ............................................................................................................................................ 29.8515 28.2562 

18140 ....... Columbus, OH .......................................................................................................................................... 31.1465 29.5977 

18580 ....... Corpus Christi, TX .................................................................................................................................... 26.2244 25.0629 

18700 ....... Corvallis, OR ............................................................................................................................................. 33.1920 32.2199 

19060 ....... Cumberland, MD-WV ................................................................................................................................ 24.6964 24.8721 

19124 ....... Dallas-Plano-Irving, TX ............................................................................................................................. 30.3645 29.5263 

19140 ....... Dalton, GA ................................................................................................................................................ 26.6179 26.1939 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24919 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

19180 ....... Danville, IL ................................................................................................................................................ 28.6735 27.3133 

19260 ....... Danville, VA .............................................................................................................................................. 26.3059 25.1154 

19340 ....... Davenport-Moline-Rock Island, IA-IL ........................................................................................................ 27.2960 25.9226 

19380 ....... Dayton, OH ............................................................................................................................................... 28.7758 27.1442 

19460 ....... Decatur, AL ............................................................................................................................................... 24.4009 24.0134 

19500 ....... Decatur, IL ................................................................................................................................................ 25.1642 24.0538 

19660 ....... Deltona-Daytona Beach-Ormond Beach, FL ............................................................................................ 27.7363 27.0490 

19740 ....... Denver-Aurora, CO ................................................................................................................................... 32.5162 31.4369 

19780 ....... Des Moines-West Des Moines, IA ............................................................................................................ 28.4004 27.5531 

19804 ....... Detroit-Livonia-Dearborn, MI ..................................................................................................................... 31.1509 30.3767 

20020 ....... Dothan, AL ................................................................................................................................................ 22.9355 22.3197 

20100 ....... Dover, DE ................................................................................................................................................. 32.2239 29.9990 

20220 ....... Dubuque, IA .............................................................................................................................................. 27.5076 26.4788 

20260 ....... Duluth, MN-WI .......................................................................................................................................... 31.4670 30.1024 

20500 ....... Durham, NC .............................................................................................................................................. 30.4233 29.2561 

20740 ....... Eau Claire, WI ........................................................................................................................................... 29.1319 27.8408 

20764 ....... Edison, NJ ................................................................................................................................................. 34.3248 32.9557 

20940 ....... El Centro, CA ............................................................................................................................................ 28.4214 26.8331 

21060 ....... Elizabethtown, KY ..................................................................................................................................... 26.7267 25.6686 

21140 ....... Elkhart-Goshen, IN ................................................................................................................................... 29.2579 28.0411 

21300 ....... Elmira, NY ................................................................................................................................................. 25.8434 24.6042 

21340 ....... El Paso, TX ............................................................................................................................................... 28.3459 26.9978 

21500 ....... Erie, PA ..................................................................................................................................................... 26.3706 25.6869 

21660 ....... Eugene-Springfield, OR ............................................................................................................................ 34.1215 32.3046 

21780 ....... Evansville, IN-KY ...................................................................................................................................... 26.2541 25.6720 

21820 ....... Fairbanks, AK ........................................................................................................................................... 33.9363 32.8387 

21940 ....... Fajardo, PR ............................................................................................................................................... 12.7755 12.1173 

22020 ....... Fargo, ND-MN ........................................................................................................................................... 24.6368 24.1979 

22140 ....... Farmington, NM ........................................................................................................................................ 28.7944 25.7110 

22180 ....... Fayetteville, NC ......................................................................................................................................... 30.7692 28.3815 

22220 ....... Fayetteville-Springdale-Rogers, AR-MO ................................................................................................... 27.5150 26.2034 

22380 ....... Flagstaff, AZ .............................................................................................................................................. 35.8265 34.6818 

22420 ....... Flint, MI ..................................................................................................................................................... 34.3384 32.0516 

22500 ....... Florence, SC ............................................................................................................................................. 26.5418 25.8347 

22520 ....... Florence-Muscle Shoals, AL ..................................................................................................................... 24.6505 23.6965 

22540 ....... Fond du Lac, WI ....................................................................................................................................... 30.6626 29.5642 

22660 ....... Fort Collins-Loveland, CO ........................................................................................................................ 29.6510 28.4242 

22744 ....... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ........................................................................... 31.1393 30.0154 

22900 ....... Fort Smith, AR-OK .................................................................................................................................... 24.9728 23.7472 

23020 ....... Fort Walton Beach-Crestview-Destin, FL ................................................................................................. 26.8666 25.7305 

23060 ....... Fort Wayne, IN .......................................................................................................................................... 28.0400 27.6656 

23104 ....... Fort Worth-Arlington, TX ........................................................................................................................... 29.9000 28.3094 

23420 ....... Fresno, CA ................................................................................................................................................ 34.2325 32.2418 

23460 ....... Gadsden, AL ............................................................................................................................................. 25.1998 23.7672 

23540 ....... Gainesville, FL .......................................................................................................................................... 28.8449 27.7112 

23580 ....... Gainesville, GA ......................................................................................................................................... 29.2101 27.2811 

23844 ....... Gary, IN ..................................................................................................................................................... 28.6613 27.6146 

24020 ....... Glens Falls, NY ......................................................................................................................................... 26.4297 25.3758 

24140 ....... Goldsboro, NC .......................................................................................................................................... 28.7525 26.8565 

24220 ....... Grand Forks, ND-MN ................................................................................................................................ 23.9585 23.1800 

24300 ....... Grand Junction, CO .................................................................................................................................. 30.0980 28.4996 

24340 ....... Grand Rapids-Wyoming, MI ..................................................................................................................... 29.0748 27.9448 

24500 ....... Great Falls, MT ......................................................................................................................................... 26.4350 25.6359 

24540 ....... Greeley, CO .............................................................................................................................................. 30.9980 29.1621 

24580 ....... Green Bay, WI .......................................................................................................................................... 29.4038 28.1020 

24660 ....... Greensboro-High Point, NC ...................................................................................................................... 28.2420 26.8372 

24780 ....... Greenville, NC ........................................................................................................................................... 28.7422 27.6117 

24860 ....... Greenville-Mauldin-Easley, SC ................................................................................................................. 29.9557 28.7860 

25020 ....... Guayama, PR ........................................................................................................................................... 09.1324 09.2033 

25060 ....... Gulfport-Biloxi, MS .................................................................................................................................... 26.7144 25.8323 

25180 ....... Hagerstown-Martinsburg, MD-WV ............................................................................................................ 28.7017 27.6848 

25260 ....... Hanford-Corcoran, CA .............................................................................................................................. 33.0694 30.9554 

25420 ....... Harrisburg-Carlisle, PA ............................................................................................................................. 28.6428 27.5304 

25500 ....... Harrisonburg, VA ...................................................................................................................................... 27.8236 26.8453 

25540 ....... Hartford-West Hartford-East Hartford, CT ................................................................................................ 33.9586 32.5097 

25620 ....... Hattiesburg, MS ........................................................................................................................................ 23.3662 22.3924 

25860 ....... Hickory-Lenoir-Morganton, NC ................................................................................................................. 27.8269 26.5087 

25980 ....... 1Hinesville-Fort Stewart, GA ..................................................................................................................... .................... .................... 26100 ....... Holland-Grand Haven, MI ......................................................................................................................... 28.1052 26.9690 

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24920 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

26180 ....... Honolulu, HI .............................................................................................................................................. 34.9939 32.9065 

26300 ....... Hot Springs, AR ........................................................................................................................................ 28.2398 26.5588 

26380 ....... Houma-Bayou Cane-Thibodaux, LA ......................................................................................................... 24.7338 23.6332 

26420 ....... Houston- Sugar Land-Baytown, TX .......................................................................................................... 31.1464 29.7094 

26580 ....... Huntington-Ashland, WV-KY-OH .............................................................................................................. 27.4177 26.7237 

26620 ....... Huntsville, AL ............................................................................................................................................ 28.4420 26.8784 

26820 ....... Idaho Falls, ID ........................................................................................................................................... 28.6678 27.2911 

26900 ....... Indianapolis-Carmel, IN ............................................................................................................................ 30.1383 28.9656 

26980 ....... Iowa City, IA .............................................................................................................................................. 29.2276 28.3307 

27060 ....... Ithaca, NY ................................................................................................................................................. 29.5522 28.8425 

27100 ....... Jackson, MI ............................................................................................................................................... 29.3419 28.0558 

27140 ....... Jackson, MS ............................................................................................................................................. 24.9313 24.1807 

27180 ....... Jackson, TN .............................................................................................................................................. 26.6283 25.9384 

27260 ....... Jacksonville, FL ........................................................................................................................................ 28.2991 27.3023 

27340 ....... Jacksonville, NC ....................................................................................................................................... 25.6323 24.5577 

27500 ....... Janesville, WI ............................................................................................................................................ 30.4182 28.8010 

27620 ....... Jefferson City, MO .................................................................................................................................... 26.9868 25.3369 

27740 ....... Johnson City, TN ...................................................................................................................................... 24.0384 23.4502 

27780 ....... Johnstown, PA .......................................................................................................................................... 23.6933 24.1218 

27860 ....... Jonesboro, AR .......................................................................................................................................... 24.5409 23.3826 

27900 ....... Joplin, MO ................................................................................................................................................. 28.8838 26.2169 

28020 ....... Kalamazoo-Portage, MI ............................................................................................................................ 32.5642 31.2112 

28100 ....... Kankakee-Bradley, IL ................................................................................................................................ 36.1982 31.8459 

28140 ....... Kansas City, MO-KS ................................................................................................................................. 28.8920 27.7054 

28420 ....... Kennewick-Richland-Pasco, WA .............................................................................................................. 30.5712 30.0865 

28660 ....... Killeen-Temple-Fort Hood, TX .................................................................................................................. 25.7516 25.4181 

28700 ....... Kingsport-Bristol-Bristol, TN-VA ................................................................................................................ 24.1118 23.5801 

28740 ....... Kingston, NY ............................................................................................................................................. 29.5032 27.8057 

28940 ....... Knoxville, TN ............................................................................................................................................. 24.9295 24.3432 

29020 ....... Kokomo, IN ............................................................................................................................................... 29.3510 28.2549 

29100 ....... La Crosse, WI-MN .................................................................................................................................... 30.0801 28.4068 

29140 ....... Lafayette, IN .............................................................................................................................................. 26.9108 25.7887 

29180 ....... Lafayette, LA ............................................................................................................................................. 25.7276 24.7355 

29340 ....... Lake Charles, LA ...................................................................................................................................... 24.1373 23.1806 

29404 ....... Lake County-Kenosha County, IL-WI ....................................................................................................... 31.8873 30.9559 

29420 ....... 2Lake Havasu City-Kingman, AZ .............................................................................................................. 28.9023 27.6036 

29460 ....... Lakeland, FL ............................................................................................................................................. 27.3993 26.4643 

29540 ....... Lancaster, PA ........................................................................................................................................... 29.5748 28.7392 

29620 ....... Lansing-East Lansing, MI ......................................................................................................................... 31.1620 29.4193 

29700 ....... Laredo, TX ................................................................................................................................................ 26.2982 24.3954 

29740 ....... Las Cruces, NM ........................................................................................................................................ 26.4505 25.6128 

29820 ....... Las Vegas-Paradise, NV .......................................................................................................................... 35.4313 33.5557 

29940 ....... Lawrence, KS ............................................................................................................................................ 25.4425 24.7034 

30020 ....... Lawton, OK ............................................................................................................................................... 26.0576 24.4695 

30140 ....... Lebanon, PA ............................................................................................................................................. 25.4393 25.2120 

30300 ....... Lewiston, ID-WA ....................................................................................................................................... 28.6132 28.2893 

30340 ....... Lewiston-Auburn, ME ................................................................................................................................ 28.8104 27.4892 

30460 ....... Lexington-Fayette, KY .............................................................................................................................. 27.9807 26.6659 

30620 ....... Lima, OH ................................................................................................................................................... 28.7195 26.9710 

30700 ....... Lincoln, NE ................................................................................................................................................ 30.4893 29.5435 

30780 ....... Little Rock-North Little Rock-Conway, AR ................................................................................................ 27.7885 27.0599 

30860 ....... Logan, UT-ID ............................................................................................................................................ 28.4774 27.0281 

30980 ....... Longview, TX ............................................................................................................................................ 27.2722 26.0005 

31020 ....... Longview, WA ........................................................................................................................................... 34.1983 30.2983 

31084 ....... Los Angeles-Long Beach-Glendale, CA ................................................................................................... 36.0596 34.6113 

31140 ....... Louisville-Jefferson County, KY-IN ........................................................................................................... 28.0357 27.0524 

31180 ....... Lubbock, TX .............................................................................................................................................. 26.8986 25.6168 

31340 ....... Lynchburg, VA .......................................................................................................................................... 26.2578 25.3812 

31420 ....... Macon, GA ................................................................................................................................................ 30.2300 28.6691 

31460 ....... Madera, CA ............................................................................................................................................... 26.0875 25.2903 

31540 ....... Madison, WI .............................................................................................................................................. 34.6597 32.2701 

31700 ....... Manchester-Nashua, NH .......................................................................................................................... 30.9773 30.1064 

31900 ....... Mansfield, OH ........................................................................................................................................... 28.5629 27.8928 

32420 ....... Mayaguez, PR .......................................................................................................................................... 11.3424 11.2954 

32580 ....... McAllen-Edinburg-Mission, TX .................................................................................................................. 28.3334 26.4909 

32780 ....... Medford, OR ............................................................................................................................................. 31.9390 30.8468 

32820 ....... Memphis, TN-MS-AR ................................................................................................................................ 28.7998 27.5984 

32900 ....... Merced, CA ............................................................................................................................................... 37.0756 33.9058 

33124 ....... Miami-Miami Beach-Kendall, FL ............................................................................................................... 31.0677 29.1861 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24921 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

33140 ....... Michigan City-La Porte, IN ........................................................................................................................ 27.2497 26.8086 

33260 ....... Midland, TX ............................................................................................................................................... 31.0460 28.6440 

33340 ....... Milwaukee-Waukesha-West Allis, WI ....................................................................................................... 31.9156 30.3227 

33460 ....... Minneapolis-St. Paul-Bloomington, MN-WI .............................................................................................. 33.9752 32.3063 

33540 ....... Missoula, MT ............................................................................................................................................. 26.9875 26.3725 

33660 ....... Mobile, AL ................................................................................................................................................. 24.6422 23.3322 

33700 ....... Modesto, CA ............................................................................................................................................. 36.8586 35.0384 

33740 ....... Monroe, LA ............................................................................................................................................... 24.4029 23.5967 

33780 ....... Monroe, MI ................................................................................................................................................ 29.3700 28.3176 

33860 ....... Montgomery, AL ........................................................................................................................................ 25.9300 24.5421 

34060 ....... Morgantown, WV ...................................................................................................................................... 26.0745 25.0602 

34100 ....... Morristown, TN .......................................................................................................................................... 22.9428 22.9786 

34580 ....... Mount Vernon-Anacortes, WA .................................................................................................................. 31.5880 30.3305 

34620 ....... Muncie, IN ................................................................................................................................................. 24.8038 24.8594 

34740 ....... Muskegon-Norton Shores, MI ................................................................................................................... 30.7959 29.3584 

34820 ....... Myrtle Beach-Conway-North Myrtle Beach, SC ....................................................................................... 26.8331 26.0529 

34900 ....... Napa, CA .................................................................................................................................................. 42.8545 38.8227 

34940 ....... Naples-Marco Island, FL ........................................................................................................................... 30.2428 29.5403 

34980 ....... Nashville-Davidson-Murfreesboro-Franklin, .............................................................................................. 29.9892 28.8467 

35004 ....... Nassau-Suffolk, NY ................................................................................................................................... 39.6471 37.9525 

35084 ....... Newark-Union, NJ-PA ............................................................................................................................... 36.2090 34.7675 

35300 ....... New Haven-Milford, CT ............................................................................................................................ 37.0244 35.4080 

35380 ....... New Orleans-Metairie-Kenner, LA ............................................................................................................ 27.0691 25.9597 

35644 ....... New York-White Plains-Wayne, NY-NJ .................................................................................................... 40.9653 39.1524 

35660 ....... Niles-Benton Harbor, MI ........................................................................................................................... 28.3260 26.5609 

35980 ....... Norwich-New London, CT ......................................................................................................................... 35.7729 34.4608 

36084 ....... Oakland-Fremont-Hayward, CA ................................................................................................................ 47.2281 45.3887 

36100 ....... Ocala, FL .................................................................................................................................................. 26.6182 25.7575 

36140 ....... Ocean City, NJ .......................................................................................................................................... 33.3167 31.8219 

36220 ....... Odessa, TX ............................................................................................................................................... 30.8710 29.4945 

36260 ....... Ogden-Clearfield, UT ................................................................................................................................ 28.0897 26.7604 

36420 ....... Oklahoma City, OK ................................................................................................................................... 27.1668 26.2084 

36500 ....... Olympia, WA ............................................................................................................................................. 35.5354 32.8563 

36540 ....... Omaha-Council Bluffs, NE-IA ................................................................................................................... 29.1986 27.9651 

36740 ....... Orlando-Kissimmee, FL ............................................................................................................................ 29.0828 28.0089 

36780 ....... Oshkosh-Neenah, WI ................................................................................................................................ 29.1236 27.4235 

36980 ....... Owensboro, KY ......................................................................................................................................... 27.2813 25.9999 

37100 ....... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................... 35.2562 33.6195 

37340 ....... Palm Bay-Melbourne-Titusville, FL ........................................................................................................... 29.0897 28.3339 

37380 ....... 2Palm Coast, FL ....................................................................................................................................... 27.0971 27.5184 

37460 ....... Panama City-Lynn Haven, FL .................................................................................................................. 25.7289 24.1673 

37620 ....... Parkersburg-Marietta-Vienna, WV-OH ..................................................................................................... 25.5355 24.2911 

37700 ....... Pascagoula, MS ........................................................................................................................................ 26.4838 24.5080 

37764 ....... Peabody, MA (Formerly, Essex County, MA) .......................................................................................... 31.6602 30.7561 

37860 ....... Pensacola-Ferry Pass-Brent, FL .............................................................................................................. 25.1925 23.7365 

37900 ....... Peoria, IL ................................................................................................................................................... 29.0576 26.9647 

37964 ....... Philadelphia, PA ........................................................................................................................................ 33.8074 32.4521 

38060 ....... Phoenix-Mesa-Scottsdale, AZ .................................................................................................................. 31.3564 29.9787 

38220 ....... Pine Bluff, AR ........................................................................................................................................... 25.2804 25.1908 

38300 ....... Pittsburgh, PA ........................................................................................................................................... 26.0038 25.3862 

38340 ....... Pittsfield, MA ............................................................................................................................................. 31.2160 30.0714 

38540 ....... Pocatello, ID .............................................................................................................................................. 28.3768 27.2635 

38660 ....... Ponce, PR ................................................................................................................................................. 12.8969 13.5329 

38860 ....... Portland-South Portland-Biddeford, ME ................................................................................................... 31.0222 29.7900 

38900 ....... Portland-Vancouver-Beaverton, OR-WA .................................................................................................. 34.8208 33.1815 

38940 ....... Port St. Lucie, FL ...................................................................................................................................... 30.9663 29.5522 

39100 ....... Poughkeepsie-Newburgh-Middletown, NY ............................................................................................... 33.6441 32.2649 

39140 ....... Prescott, AZ .............................................................................................................................................. 30.7280 29.1556 

39300 ....... Providence-New Bedford-Fall River, RI-MA ............................................................................................. 33.0234 31.8841 

39340 ....... Provo-Orem, UT ........................................................................................................................................ 29.4108 28.0315 

39380 ....... Pueblo, CO ............................................................................................................................................... 27.0881 25.6375 

39460 ....... Punta Gorda, FL ....................................................................................................................................... 29.6415 28.1419 

39540 ....... Racine, WI ................................................................................................................................................ 29.7218 27.6179 

39580 ....... Raleigh-Cary, NC ...................................................................................................................................... 29.0544 28.3348 

39660 ....... Rapid City, SD .......................................................................................................................................... 26.9357 25.9831 

39740 ....... Reading, PA .............................................................................................................................................. 29.1969 28.3935 

39820 ....... Redding, CA .............................................................................................................................................. 39.7597 36.7887 

39900 ....... Reno-Sparks, NV ...................................................................................................................................... 34.2896 33.6154 

40060 ....... Richmond, VA ........................................................................................................................................... 28.6347 27.1477 

mmaher on DSK3CLS3C1PROD with $$_JOB

24922 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

40140 ....... Riverside-San Bernardino-Ontario, CA ..................................................................................................... 33.2757 32.0240 

40220 ....... Roanoke, VA ............................................................................................................................................. 29.2663 26.3177 

40340 ....... Rochester, MN .......................................................................................................................................... 33.3540 32.6100 

40380 ....... Rochester, NY ........................................................................................................................................... 27.5839 26.7250 

40420 ....... Rockford, IL ............................................................................................................................................... 29.9396 29.2179 

40484 ....... Rockingham County-Strafford County, NH ............................................................................................... 31.1882 30.1242 

40580 ....... Rocky Mount, NC ...................................................................................................................................... 27.9510 26.4642 

40660 ....... Rome, GA ................................................................................................................................................. 29.6009 28.2852 

40900 ....... Sacramento—Arden-Arcade—Roseville, CA ............................................................................................ 40.2929 38.4229 

40980 ....... Saginaw-Saginaw Township North, MI ..................................................................................................... 28.2929 27.0559 

41060 ....... St. Cloud, MN ........................................................................................................................................... 34.2927 31.6151 

41100 ....... St. George, UT .......................................................................................................................................... 29.5906 28.1994 

41140 ....... St. Joseph, MO-KS ................................................................................................................................... 27.3734 28.2406 

41180 ....... St. Louis, MO-IL ........................................................................................................................................ 27.5406 26.4397 

41420 ....... Salem, OR ................................................................................................................................................ 32.2483 30.6937 

41500 ....... Salinas, CA ............................................................................................................................................... 44.6611 42.1515 

41540 ....... Salisbury, MD ............................................................................................................................................ 27.6293 26.4517 

41620 ....... Salt Lake City, UT ..................................................................................................................................... 29.3945 28.0053 

41660 ....... San Angelo, TX ......................................................................................................................................... 26.8517 25.0303 

41700 ....... San Antonio, TX ........................................................................................................................................ 27.6376 26.4378 

41740 ....... San Diego-Carlsbad-San Marcos, CA ...................................................................................................... 34.4952 33.2115 

41780 ....... Sandusky, OH ........................................................................................................................................... 27.1537 26.6087 

41884 ....... San Francisco-San Mateo-Redwood City, CA ......................................................................................... 45.7716 44.5272 

41900 ....... San Germ[aacute]n-Cabo Rojo, PR ......................................................................................................... 14.2741 13.8608 

41940 ....... San Jose-Sunnyvale-Santa Clara, CA ..................................................................................................... 47.5716 45.1683 

41980 ....... San Juan-Caguas-Guaynabo, PR ............................................................................................................ 14.0009 13.3929 

42020 ....... San Luis Obispo-Paso Robles, CA .......................................................................................................... 36.9259 33.8666 

42044 ....... Santa Ana-Anaheim-Irvine, CA ................................................................................................................. 35.8808 33.9972 

42060 ....... Santa Barbara-Santa Maria-Goleta, CA ................................................................................................... 35.4727 33.4432 

42100 ....... Santa Cruz-Watsonville, CA ..................................................................................................................... 48.5637 45.3017 

42140 ....... Santa Fe, NM ............................................................................................................................................ 33.1322 31.9531 

42220 ....... Santa Rosa-Petaluma, CA ........................................................................................................................ 44.2225 41.4919 

42260 ....... Sarasota-Bradenton-Venice, FL ............................................................................................................... 30.2493 28.7208 

42340 ....... Savannah, GA ........................................................................................................................................... 27.8554 27.1733 

42540 ....... Scranton-Wilkes-Barre, PA ....................................................................................................................... 25.8844 24.7507 

42644 ....... Seattle-Bellevue-Everett, WA ................................................................................................................... 35.1860 33.6677 

42680 ....... Sebastian-Vero Beach, FL ........................................................................................................................ 30.0922 28.6105 

43100 ....... Sheboygan, WI ......................................................................................................................................... 28.0832 26.7407 

43300 ....... Sherman-Denison, TX .............................................................................................................................. 26.4564 26.2405 

43340 ....... Shreveport-Bossier City, LA ..................................................................................................................... 26.7055 25.8214 

43580 ....... Sioux City, IA-NE-SD ................................................................................................................................ 28.5808 27.2053 

43620 ....... Sioux Falls, SD ......................................................................................................................................... 29.6276 28.1066 

43780 ....... South Bend-Mishawaka, IN-MI ................................................................................................................. 29.9084 28.9199 

43900 ....... Spartanburg, SC ....................................................................................................................................... 28.9299 27.1549 

44060 ....... Spokane, WA ............................................................................................................................................ 32.1950 31.1767 

44100 ....... Springfield, IL ............................................................................................................................................ 27.7341 26.2610 

44140 ....... Springfield, MA .......................................................................................................................................... 31.7303 30.1941 

44180 ....... Springfield, MO ......................................................................................................................................... 28.5068 25.6242 

44220 ....... Springfield, OH .......................................................................................................................................... 26.3899 25.0448 

44300 ....... State College, PA ..................................................................................................................................... 26.7336 25.2069 

44700 ....... Stockton, CA ............................................................................................................................................. 36.3757 34.0601 

44940 ....... Sumter, SC ............................................................................................................................................... 27.5115 25.3139 

45060 ....... Syracuse, NY ............................................................................................................................................ 30.7252 28.8799 

45104 ....... Tacoma, WA ............................................................................................................................................. 33.9097 31.9619 

45220 ....... Tallahassee, FL ........................................................................................................................................ 27.9967 26.3266 

45300 ....... Tampa-St. Petersburg-Clearwater, FL ...................................................................................................... 28.2629 27.2055 

45460 ....... Terre Haute, IN ......................................................................................................................................... 27.3665 25.3379 

45500 ....... Texarkana, TX-Texarkana, AR ................................................................................................................. 25.2054 24.1254 

45780 ....... Toledo, OH ................................................................................................................................................ 28.7526 27.8529 

45820 ....... Topeka, KS ............................................................................................................................................... 26.5384 25.8360 

45940 ....... Trenton-Ewing, NJ .................................................................................................................................... 33.2291 31.9683 

46060 ....... Tucson, AZ ................................................................................................................................................ 29.4005 27.5680 

46140 ....... Tulsa, OK .................................................................................................................................................. 26.3616 25.0135 

46220 ....... Tuscaloosa, AL ......................................................................................................................................... 26.4544 25.5476 

46340 ....... Tyler, TX ................................................................................................................................................... 28.4878 26.8718 

46540 ....... Utica-Rome, NY ........................................................................................................................................ 27.1982 25.5595 

46660 ....... Valdosta, GA ............................................................................................................................................. 25.4416 25.1421 

46700 ....... Vallejo-Fairfield, CA .................................................................................................................................. 44.6372 43.5597 

47020 ....... Victoria, TX ............................................................................................................................................... 25.1770 24.3401 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24923 

TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued 

[*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] 

CBSA code Urban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

47220 ....... Vineland-Millville-Bridgeton, NJ ................................................................................................................ 33.0209 30.4618 

47260 ....... Virginia Beach-Norfolk-Newport News, VA-NC ........................................................................................ 27.2314 26.0029 

47300 ....... Visalia-Porterville, CA ............................................................................................................................... 31.6337 30.0704 

47380 ....... Waco, TX .................................................................................................................................................. 26.6527 25.4923 

47580 ....... Warner Robins, GA ................................................................................................................................... 29.8152 26.8109 

47644 ....... Warren-Troy-Farmington Hills, MI ............................................................................................................ 31.1213 29.5882 

47894 ....... Washington-Arlington-Alexandria, DC-VA-MD-WV .................................................................................. 33.1020 32.0904 

47940 ....... Waterloo-Cedar Falls, IA .......................................................................................................................... 27.0404 25.5291 

48140 ....... Wausau, WI .............................................................................................................................................. 30.5699 29.0605 

48260 ....... Weirton-Steubenville, WV-OH .................................................................................................................. 24.4652 23.3430 

48300 ....... Wenatchee, WA ........................................................................................................................................ 34.9702 31.3439 

48424 ....... West Palm Beach-Boca Raton-Boynton Beach, ...................................................................................... 29.7173 28.7189 

48540 ....... Wheeling, WV-OH ..................................................................................................................................... 21.7311 20.9330 

48620 ....... Wichita, KS ............................................................................................................................................... 27.9249 26.7367 

48660 ....... Wichita Falls, TX ....................................................................................................................................... 26.3114 24.9937 

48700 ....... Williamsport, PA ........................................................................................................................................ 24.6486 23.9556 

48864 ....... Wilmington, DE-MD-NJ ............................................................................................................................. 33.0781 31.3150 

48900 ....... Wilmington, NC ......................................................................................................................................... 28.9440 28.2419 

49020 ....... Winchester, VA-WV .................................................................................................................................. 30.5335 29.6408 

49180 ....... Winston-Salem, NC .................................................................................................................................. 28.1564 26.9277 

49340 ....... Worcester, MA .......................................................................................................................................... 35.1528 32.7168 

49420 ....... Yakima, WA .............................................................................................................................................. 31.6557 29.7156 

49500 ....... Yauco, PR ................................................................................................................................................. 09.9275 11.1279 

49620 ....... York-Hanover, PA ..................................................................................................................................... 28.8489 27.7627 

49660 ....... Youngstown-Warren-Boardman, OH-PA .................................................................................................. 27.8858 25.9934 

49700 ....... Yuba City, CA ........................................................................................................................................... 32.6357 31.5710 

49740 ....... Yuma, AZ .................................................................................................................................................. 29.3504 27.3749 

1 This area has no average hourly wage because there are no short-term, acute care hospitals in the area. 

2 This is a new CBSA for fiscal year 2008. To calculate the 3-year average hourly wage for this new area, we included the hospitals’ data from 

their previous geographic location for fiscal year 2006 and fiscal year 2007. 

TABLE 3B.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR RURAL AREAS BY CBSA 

[*Based on the sum of the salaries and hours computed for Federal fiscal years 2006, 2007, and 2008] 

CBSA code Nonurban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

01 ............. Alabama .................................................................................................................................................... 23.5521 22.3676 

02 ............. Alaska ....................................................................................................................................................... 36.6306 33.8985 

03 ............. Arizona ...................................................................................................................................................... 27.8285 26.2195 

04 ............. Arkansas ................................................................................................................................................... 23.2785 22.1149 

05 ............. California ................................................................................................................................................... 35.9780 33.1876 

06 ............. Colorado .................................................................................................................................................... 29.2965 27.4981 

07 ............. Connecticut ............................................................................................................................................... 36.3353 34.8991 

08 ............. Delaware ................................................................................................................................................... 30.2968 28.8250 

10 ............. Florida ....................................................................................................................................................... 26.6274 25.5376 

11 ............. Georgia ..................................................................................................................................................... 24.3756 23.0319 

12 ............. Hawaii ....................................................................................................................................................... 33.3239 31.5165 

13 ............. Idaho ......................................................................................................................................................... 24.4240 23.6078 

14 ............. Illinois ........................................................................................................................................................ 25.8984 24.5999 

15 ............. Indiana ...................................................................................................................................................... 26.6535 25.3496 

16 ............. Iowa ........................................................................................................................................................... 26.2882 25.1297 

17 ............. Kansas ...................................................................................................................................................... 24.6946 23.6039 

18 ............. Kentucky ................................................................................................................................................... 24.2146 23.0381 

19 ............. Louisiana ................................................................................................................................................... 23.5312 22.3366 

20 ............. Maine ........................................................................................................................................................ 26.0760 25.2175 

21 ............. Maryland ................................................................................................................................................... 27.6395 26.7366 

22 ............. Massachusetts 1 ....................................................................................................................................... .................... ....................

23 ............. Michigan .................................................................................................................................................... 27.5837 26.4032 

24 ............. Minnesota .................................................................................................................................................. 28.5541 27.0433 

25 ............. Mississippi ................................................................................................................................................. 24.5289 23.0377 

26 ............. Missouri ..................................................................................................................................................... 25.0101 23.6921 

27 ............. Montana .................................................................................................................................................... 25.8421 25.3487 

28 ............. Nebraska ................................................................................................................................................... 27.1777 25.6347 

29 ............. Nevada ...................................................................................................................................................... 30.0298 27.4114 

30 ............. New Hampshire ........................................................................................................................................ 33.8547 32.1650 

31 ............. New Jersey 1 ............................................................................................................................................ .................... ....................

mmaher on DSK3CLS3C1PROD with $$_JOB

24924 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 3B.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR RURAL AREAS BY CBSA—Continued 

[*Based on the sum of the salaries and hours computed for Federal fiscal years 2006, 2007, and 2008] 

CBSA code Nonurban area 

FY 2008 average hourly 

wage 

3-Year average hourly 

wage 

32 ............. New Mexico .............................................................................................................................................. 27.7898 25.6380 

33 ............. New York .................................................................................................................................................. 25.8757 24.4927 

34 ............. North Carolina ........................................................................................................................................... 26.6830 25.3984 

35 ............. North Dakota ............................................................................................................................................. 22.6664 21.5961 

36 ............. Ohio ........................................................................................................................................................... 26.9698 25.8025 

37 ............. Oklahoma .................................................................................................................................................. 23.8387 22.7968 

38 ............. Oregon ...................................................................................................................................................... 30.7212 28.9514 

39 ............. Pennsylvania ............................................................................................................................................. 25.8767 24.5786 

40 ............. Puerto Rico 1 ............................................................................................................................................ .................... .................... 41 ............. Rhode Island 1 .......................................................................................................................................... .................... .................... 42 ............. South Carolina .......................................................................................................................................... 27.2502 25.7842 

43 ............. South Dakota ............................................................................................................................................ 25.8592 24.7950 

44 ............. Tennessee ................................................................................................................................................ 24.3749 23.4834 

45 ............. Texas ........................................................................................................................................................ 25.4299 24.0807 

46 ............. Utah ........................................................................................................................................................... 25.6240 24.2425 

47 ............. Vermont ..................................................................................................................................................... 30.2045 28.6321 

49 ............. Virginia ...................................................................................................................................................... 25.0426 23.8317 

50 ............. Washington ............................................................................................................................................... 31.5068 30.3826 

51 ............. West Virginia ............................................................................................................................................. 23.4572 22.6937 

52 ............. Wisconsin .................................................................................................................................................. 29.8668 28.3189 

53 ............. Wyoming ................................................................................................................................................... 28.5623 27.0729 

1 All counties within the State or territory are classified as urban. 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008 

CBSA code Urban area (constituent counties) Wage 

index GAF 

10180 ....... Abilene, TX ....................................................................................................................................................... 0.8244 0.8761 

Callahan County, TX.

Jones County, TX.

Taylor County, TX.

10380 ....... Aguadilla-Isabela-San Sebasti[aacute]n, PR .................................................................................................... 0.3298 0.4678 

Aguada Municipio, PR.

Aguadilla Municipio, PR.

A[ntilde]asco Municipio, PR.

Isabela Municipio, PR.

Lares Municipio, PR.

Moca Municipio, PR.

Rinc[oacute]n Municipio, PR.

San Sebasti[aacute]n Municipio, PR.

10420 ....... Akron, OH ......................................................................................................................................................... 0.8854 0.9200 

Portage County, OH.

Summit County, OH.

10500 ....... Albany, GA ........................................................................................................................................................ 0.8671 0.9070 

Baker County, GA.

Dougherty County, GA.

Lee County, GA.

Terrell County, GA.

Worth County, GA.

10580 ....... Albany-Schenectady-Troy, NY .......................................................................................................................... 0.8672 0.9070 

Albany County, NY.

Rensselaer County, NY.

Saratoga County, NY.

Schenectady County, NY.

Schoharie County, NY.

10740 ....... Albuquerque, NM .............................................................................................................................................. 0.9740 0.9821 

Bernalillo County, NM.

Sandoval County, NM.

Torrance County, NM.

Valencia County, NM.

10780 ....... Alexandria, LA ................................................................................................................................................... 0.7982 0.8570 

Grant Parish, LA.

Rapides Parish, LA.

10900 ....... Allentown-Bethlehem-Easton, PA-NJ ............................................................................................................... 1.0024 1.0016 

Warren County, NJ.

Carbon County, PA.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24925 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Lehigh County, PA.

Northampton County, PA.

11020 ....... 2 Altoona, PA .................................................................................................................................................... 0.8366 0.8850 

Blair County, PA.

11100 ....... Amarillo, TX ...................................................................................................................................................... 0.9141 0.9403 

Armstrong County, TX.

Carson County, TX.

Potter County, TX.

Randall County, TX.

11180 ....... Ames, IA ........................................................................................................................................................... 0.9982 0.9988 

Story County, IA.

11260 ....... Anchorage, AK .................................................................................................................................................. 1.1840 1.1226 

Anchorage Municipality, AK.

Matanuska-Susitna Borough, AK.

11300 ....... Anderson, IN ..................................................................................................................................................... 0.8969 0.9282 

Madison County, IN.

11340 ....... Anderson, SC .................................................................................................................................................... 0.9087 0.9365 

Anderson County, SC.

11460 ....... Ann Arbor, MI .................................................................................................................................................... 1.0504 1.0342 

Washtenaw County, MI.

11500 ....... Anniston-Oxford, AL .......................................................................................................................................... 0.8042 0.8614 

Calhoun County, AL.

11540 ....... 2 Appleton, WI ................................................................................................................................................... 0.9635 0.9749 

Calumet County, WI.

Outagamie County, WI.

11700 ....... Asheville, NC .................................................................................................................................................... 0.9209 0.9451 

Buncombe County, NC.

Haywood County, NC.

Henderson County, NC.

Madison County, NC.

12020 ....... Athens-Clarke County, GA ................................................................................................................................ 1.0543 1.0369 

Clarke County, GA.

Madison County, GA.

Oconee County, GA.

Oglethorpe County, GA.

12060 ....... 1 Atlanta-Sandy Springs-Marietta, GA .............................................................................................................. 0.9845 0.9894 

Barrow County, GA.

Bartow County, GA.

Butts County, GA.

Carroll County, GA.

Cherokee County, GA.

Clayton County, GA.

Cobb County, GA.

Coweta County, GA.

Dawson County, GA.

DeKalb County, GA.

Douglas County, GA.

Fayette County, GA.

Forsyth County, GA.

Fulton County, GA.

Gwinnett County, GA.

Haralson County, GA.

Heard County, GA.

Henry County, GA.

Jasper County, GA.

Lamar County, GA.

Meriwether County, GA.

Newton County, GA.

Paulding County, GA.

Pickens County, GA.

Pike County, GA.

Rockdale County, GA.

Spalding County, GA.

Walton County, GA.

12100 ....... Atlantic City, NJ ................................................................................................................................................ 1.2095 1.1391 

Atlantic County, NJ.

12220 ....... Auburn-Opelika, AL ........................................................................................................................................... 0.8086 0.8646 

Lee County, AL.

12260 ....... Augusta-Richmond County, GA-SC .................................................................................................................. 0.9600 0.9724 

Burke County, GA.

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24926 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Columbia County, GA.

McDuffie County, GA.

Richmond County, GA.

Aiken County, SC.

Edgefield County, SC.

12420 ....... 1 Austin-Round Rock, TX .................................................................................................................................. 0.9518 0.9667 

Bastrop County, TX.

Caldwell County, TX.

Hays County, TX.

Travis County, TX.

Williamson County, TX.

12540 ....... 2 Bakersfield, CA ............................................................................................................................................... 1.1607 1.1074 

Kern County, CA.

12580 ....... 1 Baltimore-Towson, MD ................................................................................................................................... 1.0108 1.0074 

Anne Arundel County, MD.

Baltimore County, MD.

Carroll County, MD.

Harford County, MD.

Howard County, MD.

Queen Anne’s County, MD.

Baltimore City, MD.

12620 ....... Bangor, ME ....................................................................................................................................................... 0.9860 0.9904 

Penobscot County, ME.

12700 ....... Barnstable Town, MA ........................................................................................................................................ 1.2617 1.1726 

Barnstable County, MA.

12940 ....... Baton Rouge, LA .............................................................................................................................................. 0.8014 0.8593 

Ascension Parish, LA.

East Baton Rouge Parish, LA.

East Feliciana Parish, LA.

Iberville Parish, LA.

Livingston Parish, LA.

Pointe Coupee Parish, LA.

St. Helena Parish, LA.

West Baton Rouge Parish, LA.

West Feliciana Parish, LA.

12980 ....... Battle Creek, MI ................................................................................................................................................ 1.0042 1.0029 

Calhoun County, MI.

13020 ....... Bay City, MI ...................................................................................................................................................... 0.9399 0.9584 

Bay County, MI.

13140 ....... Beaumont-Port Arthur, TX ................................................................................................................................ 0.8587 0.9009 

Hardin County, TX.

Jefferson County, TX.

Orange County, TX.

13380 ....... Bellingham, WA ................................................................................................................................................ 1.1264 1.0849 

Whatcom County, WA.

13460 ....... Bend, OR .......................................................................................................................................................... 1.0592 1.0402 

Deschutes County, OR.

13644 ....... 1 Bethesda-Gaithersburg-Frederick, MD .......................................................................................................... 1.0990 1.0668 

Frederick County, MD.

Montgomery County, MD.

13740 ....... Billings, MT ....................................................................................................................................................... 0.8877 0.9217 

Carbon County, MT.

Yellowstone County, MT.

13780 ....... Binghamton, NY ................................................................................................................................................ 0.9072 0.9355 

Broome County, NY.

Tioga County, NY.

13820 ....... 1 Birmingham-Hoover, AL ................................................................................................................................. 0.8873 0.9214 

Bibb County, AL.

Blount County, AL.

Chilton County, AL.

Jefferson County, AL.

St. Clair County, AL.

Shelby County, AL.

Walker County, AL.

13900 ....... Bismarck, ND .................................................................................................................................................... 0.7329 0.8083 

Burleigh County, ND.

Morton County, ND.

13980 ....... 2 Blacksburg-Christiansburg-Radford, VA ........................................................................................................ 0.8095 0.8653 

Giles County, VA.

Montgomery County, VA.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24927 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Pulaski County, VA.

Radford City, VA.

14020 ....... Bloomington, IN ................................................................................................................................................ 0.9327 0.9534 

Greene County, IN.

Monroe County, IN.

Owen County, IN.

14060 ....... Bloomington-Normal, IL .................................................................................................................................... 0.9488 0.9646 

McLean County, IL.

14260 ....... Boise City-Nampa, ID ....................................................................................................................................... 0.9501 0.9656 

Ada County, ID.

Boise County, ID.

Canyon County, ID.

Gem County, ID.

Owyhee County, ID.

14484 ....... 1 Boston-Quincy, MA ........................................................................................................................................ 1.1710 1.1142 

Norfolk County, MA.

Plymouth County, MA.

Suffolk County, MA.

14500 ....... Boulder, CO ...................................................................................................................................................... 1.0118 1.0081 

Boulder County, CO.

14540 ....... Bowling Green, KY ........................................................................................................................................... 0.8089 0.8648 

Edmonson County, KY.

Warren County, KY.

14740 ....... Bremerton-Silverdale, WA ................................................................................................................................. 1.0826 1.0559 

Kitsap County, WA.

14860 ....... Bridgeport-Stamford-Norwalk, CT ..................................................................................................................... 1.2886 1.1896 

Fairfield County, CT.

15180 ....... Brownsville-Harlingen, TX ................................................................................................................................. 0.9577 0.9708 

Cameron County, TX.

15260 ....... Brunswick, GA .................................................................................................................................................. 0.9768 0.9841 

Brantley County, GA.

Glynn County, GA.

McIntosh County, GA.

15380 ....... 1 Buffalo-Niagara Falls, NY ............................................................................................................................... 0.9586 0.9715 

Erie County, NY.

Niagara County, NY.

15500 ....... 2 Burlington, NC ................................................................................................................................................ 0.8608 0.9024 

Alamance County, NC.

15540 ....... 2 Burlington-South Burlington, VT ..................................................................................................................... 1.0401 1.0273 

Chittenden County, VT.

Franklin County, VT.

Grand Isle County, VT.

15764 ....... 1 Cambridge-Newton-Framingham, MA ............................................................................................................ 1.1168 1.0786 

Middlesex County, MA.

15804 ....... 1 Camden, NJ ................................................................................................................................................... 1.0522 1.0355 

Burlington County, NJ.

Camden County, NJ.

Gloucester County, NJ.

15940 ....... Canton-Massillon, OH ....................................................................................................................................... 0.8921 0.9248 

Carroll County, OH.

Stark County, OH.

15980 ....... Cape Coral-Fort Myers, FL ............................................................................................................................... 0.9490 0.9648 

Lee County, FL.

16180 ....... 2 Carson City, NV ............................................................................................................................................. 0.9688 0.9785 

Carson City, NV.

16220 ....... Casper, WY ....................................................................................................................................................... 0.9277 0.9499 

Natrona County, WY.

16300 ....... Cedar Rapids, IA .............................................................................................................................................. 0.8689 0.9083 

Benton County, IA.

Jones County, IA.

Linn County, IA.

16580 ....... Champaign-Urbana, IL ...................................................................................................................................... 0.9320 0.9529 

Champaign County, IL.

Ford County, IL.

Piatt County, IL.

16620 ....... Charleston, WV ................................................................................................................................................. 0.8397 0.8872 

Boone County, WV.

Clay County, WV.

Kanawha County, WV.

Lincoln County, WV.

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24928 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Putnam County, WV.

16700 ....... Charleston-North Charleston, SC ..................................................................................................................... 0.9144 0.9406 

Berkeley County, SC.

Charleston County, SC.

Dorchester County, SC.

16740 ....... 1 Charlotte-Gastonia-Concord, NC-SC ............................................................................................................. 0.9512 0.9663 

Anson County, NC.

Cabarrus County, NC.

Gaston County, NC.

Mecklenburg County, NC.

Union County, NC.

York County, SC.

16820 ....... Charlottesville, VA ............................................................................................................................................. 0.9555 0.9693 

Albemarle County, VA.

Fluvanna County, VA.

Greene County, VA.

Nelson County, VA.

Charlottesville City, VA.

16860 ....... Chattanooga, TN-GA ........................................................................................................................................ 0.8967 0.9281 

Catoosa County, GA.

Dade County, GA.

Walker County, GA.

Hamilton County, TN.

Marion County, TN.

Sequatchie County, TN.

16940 ....... Cheyenne, WY .................................................................................................................................................. 0.9219 0.9458 

Laramie County, WY.

16974 ....... 1 Chicago-Naperville-Joliet, IL .......................................................................................................................... 1.0455 1.0309 

Cook County, IL.

DeKalb County, IL.

DuPage County, IL.

Grundy County, IL.

Kane County, IL.

Kendall County, IL.

McHenry County, IL.

Will County, IL.

17020 ....... 2 Chico, CA ....................................................................................................................................................... 1.1607 1.1074 

Butte County, CA.

17140 ....... 1 Cincinnati-Middletown, OH-KY-IN .................................................................................................................. 0.9654 0.9762 

Dearborn County, IN.

Franklin County, IN.

Ohio County, IN.

Boone County, KY.

Bracken County, KY.

Campbell County, KY.

Gallatin County, KY.

Grant County, KY.

Kenton County, KY.

Pendleton County, KY.

Brown County, OH.

Butler County, OH.

Clermont County, OH.

Hamilton County, OH.

Warren County, OH.

17300 ....... Clarksville, TN-KY ............................................................................................................................................. 0.8223 0.8746 

Christian County, KY.

Trigg County, KY.

Montgomery County, TN.

Stewart County, TN.

17420 ....... Cleveland, TN ................................................................................................................................................... 0.8174 0.8710 

Bradley County, TN.

Polk County, TN.

17460 ....... 1 Cleveland-Elyria-Mentor, OH ......................................................................................................................... 0.9365 0.9561 

Cuyahoga County, OH.

Geauga County, OH.

Lake County, OH.

Lorain County, OH.

Medina County, OH.

17660 ....... Coeur d’Alene, ID ............................................................................................................................................. 0.9360 0.9557 

Kootenai County, ID.

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TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

17780 ....... College Station-Bryan, TX ................................................................................................................................ 0.9177 0.9429 

Brazos County, TX.

Burleson County, TX.

Robertson County, TX.

17820 ....... Colorado Springs, CO ....................................................................................................................................... 0.9471 0.9635 

El Paso County, CO.

Teller County, CO.

17860 ....... Columbia, MO ................................................................................................................................................... 0.8545 0.8979 

Boone County, MO.

Howard County, MO.

17900 ....... 2 Columbia, SC ................................................................................................................................................. 0.8791 0.9155 

Calhoun County, SC.

Fairfield County, SC.

Kershaw County, SC.

Lexington County, SC.

Richland County, SC.

Saluda County, SC.

17980 ....... Columbus, GA-AL ............................................................................................................................................. 0.9023 0.9320 

Russell County, AL.

Chattahoochee County, GA.

Harris County, GA.

Marion County, GA.

Muscogee County, GA.

18020 ....... Columbus, IN .................................................................................................................................................... 0.9630 0.9745 

Bartholomew County, IN.

18140 ....... 1 Columbus, OH ................................................................................................................................................ 1.0048 1.0033 

Delaware County, OH.

Fairfield County, OH.

Franklin County, OH.

Licking County, OH.

Madison County, OH.

Morrow County, OH.

Pickaway County, OH.

Union County, OH.

18580 ....... Corpus Christi, TX ............................................................................................................................................. 0.8460 0.8918 

Aransas County, TX.

Nueces County, TX.

San Patricio County, TX.

18700 ....... Corvallis, OR ..................................................................................................................................................... 1.0708 1.0480 

Benton County, OR.

19060 ....... 2 Cumberland, MD-WV (MD Hospitals) ............................................................................................................ 0.8917 0.9245 

Allegany County, MD.

Mineral County, WV.

19060 ....... Cumberland, MD-WV (WV Hospitals) ............................................................................................................... 0.7967 0.8559 

Allegany County, MD.

Mineral County, WV.

19124 ....... 1 Dallas-Plano-Irving, TX .................................................................................................................................. 0.9795 0.9859 

Collin County, TX.

Dallas County, TX.

Delta County, TX.

Denton County, TX.

Ellis County, TX.

Hunt County, TX.

Kaufman County, TX.

Rockwall County, TX.

19140 ....... Dalton, GA ........................................................................................................................................................ 0.8587 0.9009 

Murray County, GA.

Whitfield County, GA.

19180 ....... Danville, IL ........................................................................................................................................................ 0.9250 0.9480 

Vermilion County, IL.

19260 ....... Danville, VA ...................................................................................................................................................... 0.8486 0.8937 

Pittsylvania County, VA.

Danville City, VA.

19340 ....... Davenport-Moline-Rock Island, IA-IL ................................................................................................................ 0.8898 0.9232 

Henry County, IL.

Mercer County, IL.

Rock Island County, IL.

Scott County, IA.

19380 ....... Dayton, OH ....................................................................................................................................................... 0.9283 0.9503 

Greene County, OH.

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24930 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Miami County, OH.

Montgomery County, OH.

Preble County, OH.

19460 ....... Decatur, AL ....................................................................................................................................................... 0.7927 0.8529 

Lawrence County, AL.

Morgan County, AL.

19500 ....... 2 Decatur, IL ...................................................................................................................................................... 0.8355 0.8842 

Macon County, IL.

19660 ....... Deltona-Daytona Beach-Ormond Beach, FL .................................................................................................... 0.8948 0.9267 

Volusia County, FL.

19740 ....... 1 Denver-Aurora, CO ........................................................................................................................................ 1.0490 1.0333 

Adams County, CO.

Arapahoe County, CO.

Broomfield County, CO.

Clear Creek County, CO.

Denver County, CO.

Douglas County, CO.

Elbert County, CO.

Gilpin County, CO.

Jefferson County, CO.

Park County, CO.

19780 ....... Des Moines-West Des Moines, IA .................................................................................................................... 0.9162 0.9418 

Dallas County, IA.

Guthrie County, IA.

Madison County, IA.

Polk County, IA.

Warren County, IA.

19804 ....... 1 Detroit-Livonia-Dearborn, MI .......................................................................................................................... 1.0091 1.0062 

Wayne County, MI.

20020 ....... 2 Dothan, AL ..................................................................................................................................................... 0.7598 0.8285 

Geneva County, AL.

Henry County, AL.

Houston County, AL.

20100 ....... Dover, DE ......................................................................................................................................................... 1.0396 1.0270 

Kent County, DE.

20220 ....... Dubuque, IA ...................................................................................................................................................... 0.8874 0.9215 

Dubuque County, IA.

20260 ....... Duluth, MN-WI .................................................................................................................................................. 1.0151 1.0103 

Carlton County, MN.

St. Louis County, MN.

Douglas County, WI.

20500 ....... Durham, NC ...................................................................................................................................................... 0.9814 0.9872 

Chatham County, NC.

Durham County, NC.

Orange County, NC.

Person County, NC.

20740 ....... 2 Eau Claire, WI ................................................................................................................................................ 0.9635 0.9749 

Chippewa County, WI.

Eau Claire County, WI.

20764 ....... 1 Edison, NJ ...................................................................................................................................................... 1.1131 1.0761 

Middlesex County, NJ.

Monmouth County, NJ.

Ocean County, NJ.

Somerset County, NJ.

20940 ....... 2 El Centro, CA ................................................................................................................................................. 1.1607 1.1074 

Imperial County, CA.

21060 ....... Elizabethtown, KY ............................................................................................................................................. 0.8622 0.9035 

Hardin County, KY.

Larue County, KY.

21140 ....... Elkhart-Goshen, IN ........................................................................................................................................... 0.9438 0.9612 

Elkhart County, IN.

21300 ....... 2 Elmira, NY ...................................................................................................................................................... 0.8440 0.8903 

Chemung County, NY.

21340 ....... El Paso, TX ....................................................................................................................................................... 0.9144 0.9406 

El Paso County, TX.

21500 ....... Erie, PA ............................................................................................................................................................. 0.8507 0.8952 

Erie County, PA.

21660 ....... Eugene-Springfield, OR .................................................................................................................................... 1.1008 1.0680 

Lane County, OR.

21780 ....... 2 Evansville, IN-KY (IN Hospitals) .................................................................................................................... 0.8599 0.9018 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24931 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Gibson County, IN.

Posey County, IN.

Vanderburgh County, IN.

Warrick County, IN.

Henderson County, KY.

Webster County, KY.

21780 ....... Evansville, IN-KY (KY Hospitals) ...................................................................................................................... 0.8469 0.8924 

Gibson County, IN.

Posey County, IN.

Vanderburgh County, IN.

Warrick County, IN.

Henderson County, KY.

Webster County, KY.

21820 ....... 2 Fairbanks, AK ................................................................................................................................................. 1.1817 1.1211 

Fairbanks North Star Borough, AK.

21940 ....... Fajardo, PR ....................................................................................................................................................... 0.4121 0.5449 

Ceiba Municipio, PR.

Fajardo Municipio, PR.

Luquillo Municipio, PR.

22020 ....... 2 Fargo, ND-MN (MN Hospitals) ....................................................................................................................... 0.9212 0.9453 

Clay County, MN.

Cass County, ND.

22020 ....... Fargo, ND-MN (ND Hospitals) .......................................................................................................................... 0.8189 0.8721 

Clay County, MN.

Cass County, ND.

22140 ....... Farmington, NM ................................................................................................................................................ 0.9289 0.9507 

San Juan County, NM.

22180 ....... Fayetteville, NC ................................................................................................................................................. 0.9926 0.9949 

Cumberland County, NC.

Hoke County, NC.

22220 ....... Fayetteville-Springdale-Rogers, AR-MO ........................................................................................................... 0.8876 0.9216 

Benton County, AR.

Madison County, AR.

Washington County, AR.

McDonald County, MO.

22380 ....... Flagstaff, AZ ...................................................................................................................................................... 1.1558 1.1042 

Coconino County, AZ.

22420 ....... Flint, MI ............................................................................................................................................................. 1.1078 1.0726 

Genesee County, MI.

22500 ....... 2 Florence, SC .................................................................................................................................................. 0.8791 0.9155 

Darlington County, SC.

Florence County, SC.

22520 ....... Florence-Muscle Shoals, AL ............................................................................................................................. 0.7971 0.8562 

Colbert County, AL.

Lauderdale County, AL.

22540 ....... Fond du Lac, WI ............................................................................................................................................... 0.9892 0.9926 

Fond du Lac County, WI.

22660 ....... Fort Collins-Loveland, CO ................................................................................................................................. 0.9577 0.9708 

Larimer County, CO.

22744 ....... 1 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ................................................................................. 1.0245 1.0167 

Broward County, FL.

22900 ....... Fort Smith, AR-OK ............................................................................................................................................ 0.8056 0.8624 

Crawford County, AR.

Franklin County, AR.

Sebastian County, AR.

Le Flore County, OK.

Sequoyah County, OK.

23020 ....... 2 Fort Walton Beach-Crestview-Destin, FL ....................................................................................................... 0.8749 0.9125 

Okaloosa County, FL.

23060 ....... Fort Wayne, IN .................................................................................................................................................. 0.9046 0.9336 

Allen County, IN.

Wells County, IN.

Whitley County, IN.

23104 ....... 1 Fort Worth-Arlington, TX ................................................................................................................................ 0.9646 0.9756 

Johnson County, TX.

Parker County, TX.

Tarrant County, TX.

Wise County, TX.

23420 ....... 2 Fresno, CA ..................................................................................................................................................... 1.1607 1.1074 

Fresno County, CA.

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24932 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

23460 ....... Gadsden, AL ..................................................................................................................................................... 0.8129 0.8677 

Etowah County, AL.

23540 ....... Gainesville, FL .................................................................................................................................................. 0.9306 0.9519 

Alachua County, FL.

Gilchrist County, FL.

23580 ....... Gainesville, GA ................................................................................................................................................. 0.9423 0.9601 

Hall County, GA.

23844 ....... Gary, IN ............................................................................................................................................................. 0.9246 0.9477 

Jasper County, IN.

Lake County, IN.

Newton County, IN.

Porter County, IN.

24020 ....... Glens Falls, NY ................................................................................................................................................. 0.8526 0.8965 

Warren County, NY.

Washington County, NY.

24140 ....... Goldsboro, NC .................................................................................................................................................. 0.9276 0.9498 

Wayne County, NC.

24220 ....... 2 Grand Forks, ND-MN (MN Hospitals) ............................................................................................................ 0.9212 0.9453 

Polk County, MN.

Grand Forks County, ND.

24220 ....... Grand Forks, ND-MN (ND Hospitals) ............................................................................................................... 0.7729 0.8383 

Polk County, MN.

Grand Forks County, ND.

24300 ....... Grand Junction, CO .......................................................................................................................................... 1.0141 1.0096 

Mesa County, CO.

24340 ....... Grand Rapids-Wyoming, MI .............................................................................................................................. 0.9380 0.9571 

Barry County, MI.

Ionia County, MI.

Kent County, MI.

Newaygo County, MI.

24500 ....... Great Falls, MT ................................................................................................................................................. 0.8765 0.9137 

Cascade County, MT.

24540 ....... Greeley, CO ...................................................................................................................................................... 1.0000 1.0000 

Weld County, CO.

24580 ....... 2 Green Bay, WI ................................................................................................................................................ 0.9635 0.9749 

Brown County, WI.

Kewaunee County, WI.

Oconto County, WI.

24660 ....... Greensboro-High Point, NC .............................................................................................................................. 0.9111 0.9382 

Guilford County, NC.

Randolph County, NC.

Rockingham County, NC.

24780 ....... Greenville, NC ................................................................................................................................................... 0.9272 0.9496 

Greene County, NC.

Pitt County, NC.

24860 ....... Greenville-Mauldin-Easley, SC ......................................................................................................................... 0.9664 0.9769 

Greenville County, SC.

Laurens County, SC.

Pickens County, SC.

25020 ....... Guayama, PR ................................................................................................................................................... 0.2946 0.4330 

Arroyo Municipio, PR.

Guayama Municipio, PR.

Patillas Municipio, PR.

25060 ....... Gulfport-Biloxi, MS ............................................................................................................................................ 0.8618 0.9032 

Hancock County, MS.

Harrison County, MS.

Stone County, MS.

25180 ....... Hagerstown-Martinsburg, MD-WV .................................................................................................................... 0.9259 0.9486 

Washington County, MD.

Berkeley County, WV.

Morgan County, WV.

25260 ....... 2 Hanford-Corcoran, CA .................................................................................................................................... 1.1607 1.1074 

Kings County, CA.

25420 ....... Harrisburg-Carlisle, PA ..................................................................................................................................... 0.9240 0.9473 

Cumberland County, PA.

Dauphin County, PA.

Perry County, PA.

25500 ....... Harrisonburg, VA .............................................................................................................................................. 0.8976 0.9287 

Rockingham County, VA.

Harrisonburg City, VA.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24933 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

25540 ....... 1 2 Hartford-West Hartford-East Hartford, CT ................................................................................................... 1.2439 1.1612 

Hartford County, CT.

Litchfield County, CT.

Middlesex County, CT.

Tolland County, CT.

25620 ....... 2 Hattiesburg, MS .............................................................................................................................................. 0.7915 0.8520 

Forrest County, MS.

Lamar County, MS.

Perry County, MS.

25860 ....... Hickory-Lenoir-Morganton, NC ......................................................................................................................... 0.8977 0.9288 

Alexander County, NC.

Burke County, NC.

Caldwell County, NC.

Catawba County, NC.

25980 ....... Hinesville-Fort Stewart, GA ............................................................................................................................... 0.7864 0.8483 

Liberty County, GA.

Long County, GA.

26100 ....... Holland-Grand Haven, MI ................................................................................................................................. 0.9066 0.9351 

Ottawa County, MI.

26180 ....... Honolulu, HI ...................................................................................................................................................... 1.1289 1.0866 

Honolulu County, HI.

26300 ....... Hot Springs, AR ................................................................................................................................................ 0.9110 0.9382 

Garland County, AR.

26380 ....... Houma-Bayou Cane-Thibodaux, LA ................................................................................................................. 0.7980 0.8568 

Lafourche Parish, LA.

Terrebonne Parish, LA.

26420 ....... 1 Houston-Sugar Land-Baytown, TX ................................................................................................................ 1.0048 1.0033 

Austin County, TX.

Brazoria County, TX.

Chambers County, TX.

Fort Bend County, TX.

Galveston County, TX.

Harris County, TX.

Liberty County, TX.

Montgomery County, TX.

San Jacinto County, TX.

Waller County, TX.

26580 ....... Huntington-Ashland, WV-KY-OH ...................................................................................................................... 0.8845 0.9194 

Boyd County, KY.

Greenup County, KY.

Lawrence County, OH.

Cabell County, WV.

Wayne County, WV.

26620 ....... Huntsville, AL .................................................................................................................................................... 0.9175 0.9427 

Limestone County, AL.

Madison County, AL.

26820 ....... Idaho Falls, ID ................................................................................................................................................... 0.9352 0.9552 

Bonneville County, ID.

Jefferson County, ID.

26900 ....... 1 Indianapolis-Carmel, IN .................................................................................................................................. 0.9723 0.9809 

Boone County, IN.

Brown County, IN.

Hamilton County, IN.

Hancock County, IN.

Hendricks County, IN.

Johnson County, IN.

Marion County, IN.

Morgan County, IN.

Putnam County, IN.

Shelby County, IN.

26980 ....... Iowa City, IA ...................................................................................................................................................... 0.9428 0.9605 

Johnson County, IA.

Washington County, IA.

27060 ....... Ithaca, NY ......................................................................................................................................................... 0.9715 0.9804 

Tompkins County, NY.

27100 ....... Jackson, MI ....................................................................................................................................................... 0.9465 0.9630 

Jackson County, MI.

27140 ....... Jackson, MS ..................................................................................................................................................... 0.8273 0.8782 

Copiah County, MS.

Hinds County, MS.

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24934 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Madison County, MS.

Rankin County, MS.

Simpson County, MS.

27180 ....... Jackson, TN ...................................................................................................................................................... 0.8590 0.9012 

Chester County, TN.

Madison County, TN.

27260 ....... 1 Jacksonville, FL .............................................................................................................................................. 0.9129 0.9395 

Baker County, FL.

Clay County, FL.

Duval County, FL.

Nassau County, FL.

St. Johns County, FL.

27340 ....... 2 Jacksonville, NC ............................................................................................................................................. 0.8608 0.9024 

Onslow County, NC.

27500 ....... Janesville, WI .................................................................................................................................................... 0.9813 0.9872 

Rock County, WI.

27620 ....... Jefferson City, MO ............................................................................................................................................ 0.8706 0.9095 

Callaway County, MO.

Cole County, MO.

Moniteau County, MO.

Osage County, MO.

27740 ....... 2 Johnson City, TN ............................................................................................................................................ 0.7916 0.8521 

Carter County, TN.

Unicoi County, TN.

Washington County, TN.

27780 ....... 2 Johnstown, PA ............................................................................................................................................... 0.8366 0.8850 

Cambria County, PA.

27860 ....... Jonesboro, AR .................................................................................................................................................. 0.8507 0.8952 

Craighead County, AR.

Poinsett County, AR.

27900 ....... Joplin, MO ......................................................................................................................................................... 0.9318 0.9528 

Jasper County, MO.

Newton County, MO.

28020 ....... Kalamazoo-Portage, MI .................................................................................................................................... 1.0505 1.0343 

Kalamazoo County, MI.

Van Buren County, MI.

28100 ....... Kankakee-Bradley, IL ........................................................................................................................................ 1.1678 1.1121 

Kankakee County, IL.

28140 ....... 1 Kansas City, MO-KS ...................................................................................................................................... 0.9321 0.9530 

Franklin County, KS.

Johnson County, KS.

Leavenworth County, KS.

Linn County, KS.

Miami County, KS.

Wyandotte County, KS.

Bates County, MO.

Caldwell County, MO.

Cass County, MO.

Clay County, MO.

Clinton County, MO.

Jackson County, MO.

Lafayette County, MO.

Platte County, MO.

Ray County, MO.

28420 ....... 2 Kennewick-Richland-Pasco, WA .................................................................................................................... 1.0565 1.0384 

Benton County, WA.

Franklin County, WA.

28660 ....... Killeen-Temple-Fort Hood, TX .......................................................................................................................... 0.8308 0.8808 

Bell County, TX.

Coryell County, TX.

Lampasas County, TX.

28700 ....... 2 Kingsport-Bristol-Bristol, TN-VA (TN Hospitals) ............................................................................................. 0.7916 0.8521 

Hawkins County, TN.

Sullivan County, TN.

Bristol City, VA.

Scott County, VA.

Washington County, VA.

28700 ....... 2 Kingsport-Bristol-Bristol, TN-VA (VA Hospitals) ............................................................................................. 0.8095 0.8653 

Hawkins County, TN.

Sullivan County, TN.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24935 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Bristol City, VA.

Scott County, VA.

Washington County, VA.

28740 ....... Kingston, NY ..................................................................................................................................................... 0.9518 0.9667 

Ulster County, NY.

28940 ....... Knoxville, TN ..................................................................................................................................................... 0.8042 0.8614 

Anderson County, TN.

Blount County, TN.

Knox County, TN.

Loudon County, TN.

Union County, TN.

29020 ....... Kokomo, IN ....................................................................................................................................................... 0.9468 0.9633 

Howard County, IN.

Tipton County, IN.

29100 ....... La Crosse, WI-MN ............................................................................................................................................ 0.9704 0.9796 

Houston County, MN.

La Crosse County, WI.

29140 ....... Lafayette, IN ...................................................................................................................................................... 0.8682 0.9078 

Benton County, IN.

Carroll County, IN.

Tippecanoe County, IN.

29180 ....... Lafayette, LA ..................................................................................................................................................... 0.8323 0.8819 

Lafayette Parish, LA.

St. Martin Parish, LA.

29340 ....... Lake Charles, LA .............................................................................................................................................. 0.7787 0.8426 

Calcasieu Parish, LA.

Cameron Parish, LA.

29404 ....... Lake County-Kenosha County, IL-WI ............................................................................................................... 1.0287 1.0196 

Lake County, IL.

Kenosha County, WI.

29420 ....... 2 Lake Havasu City-Kingman, AZ ..................................................................................................................... 0.9386 0.9575 

Mohave County, AZ.

29460 ....... Lakeland, FL ..................................................................................................................................................... 0.8839 0.9190 

Polk County, FL.

29540 ....... Lancaster, PA ................................................................................................................................................... 0.9589 0.9717 

Lancaster County, PA.

29620 ....... Lansing-East Lansing, MI ................................................................................................................................. 1.0053 1.0036 

Clinton County, MI.

Eaton County, MI.

Ingham County, MI.

29700 ....... Laredo, TX ........................................................................................................................................................ 0.8484 0.8935 

Webb County, TX.

29740 ....... 2 Las Cruces, NM ............................................................................................................................................. 0.8965 0.9279 

Dona Ana County, NM.

29820 ....... 1 Las Vegas-Paradise, NV ................................................................................................................................ 1.1431 1.0959 

Clark County, NV.

29940 ....... Lawrence, KS .................................................................................................................................................... 0.8208 0.8735 

Douglas County, KS.

30020 ....... Lawton, OK ....................................................................................................................................................... 0.8406 0.8879 

Comanche County, OK.

30140 ....... 2 Lebanon, PA ................................................................................................................................................... 0.8366 0.8850 

Lebanon County, PA.

30300 ....... Lewiston, ID-WA (ID Hospitals) ........................................................................................................................ 0.9231 0.9467 

Nez Perce County, ID.

Asotin County, WA.

30300 ....... 2 Lewiston, ID-WA (WA Hospitals) ................................................................................................................... 1.0565 1.0384 

Nez Perce County, ID.

Asotin County, WA.

30340 ....... Lewiston-Auburn, ME ........................................................................................................................................ 0.9295 0.9512 

Androscoggin County, ME.

30460 ....... Lexington-Fayette, KY ...................................................................................................................................... 0.9027 0.9323 

Bourbon County, KY.

Clark County, KY.

Fayette County, KY.

Jessamine County, KY.

Scott County, KY.

Woodford County, KY.

30620 ....... Lima, OH ........................................................................................................................................................... 0.9312 0.9524 

Allen County, OH.

30700 ....... Lincoln, NE ........................................................................................................................................................ 0.9836 0.9887 

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24936 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Lancaster County, NE.

Seward County, NE.

30780 ....... Little Rock-North Little Rock-Conway, AR ........................................................................................................ 0.8965 0.9279 

Faulkner County, AR.

Grant County, AR.

Lonoke County, AR.

Perry County, AR.

Pulaski County, AR.

Saline County, AR.

30860 ....... Logan, UT-ID .................................................................................................................................................... 0.9219 0.9458 

Franklin County, ID.

Cache County, UT.

30980 ....... Longview, TX .................................................................................................................................................... 0.8875 0.9215 

Gregg County, TX.

Rusk County, TX.

Upshur County, TX.

31020 ....... Longview, WA ................................................................................................................................................... 1.1033 1.0696 

Cowlitz County, WA.

31084 ....... 1 Los Angeles-Long Beach-Glendale, CA ........................................................................................................ 1.1633 1.1091 

Los Angeles County, CA.

31140 ....... 1 Louisville-Jefferson County, KY-IN ................................................................................................................ 0.9045 0.9336 

Clark County, IN.

Floyd County, IN.

Harrison County, IN.

Washington County, IN.

Bullitt County, KY.

Henry County, KY.

Jefferson County, KY.

Meade County, KY.

Nelson County, KY.

Oldham County, KY.

Shelby County, KY.

Spencer County, KY.

Trimble County, KY.

31180 ....... Lubbock, TX ...................................................................................................................................................... 0.8678 0.9075 

Crosby County, TX.

Lubbock County, TX.

31340 ....... Lynchburg, VA .................................................................................................................................................. 0.8490 0.8940 

Amherst County, VA.

Appomattox County, VA.

Bedford County, VA.

Campbell County, VA.

Bedford City, VA.

Lynchburg City, VA.

31420 ....... Macon, GA ........................................................................................................................................................ 0.9752 0.9829 

Bibb County, GA.

Crawford County, GA.

Jones County, GA.

Monroe County, GA.

Twiggs County, GA.

31460 ....... 2 Madera, CA .................................................................................................................................................... 1.1607 1.1074 

Madera County, CA.

31540 ....... Madison, WI ...................................................................................................................................................... 1.1181 1.0794 

Columbia County, WI.

Dane County, WI.

Iowa County, WI.

31700 ....... 2 Manchester-Nashua, NH ................................................................................................................................ 1.1266 1.0851 

Hillsborough County, NH.

Merrimack County, NH.

31900 ....... Mansfield, OH ................................................................................................................................................... 0.9214 0.9455 

Richland County, OH.

32420 ....... Mayag[uuml]ez, PR ........................................................................................................................................... 0.3659 0.5023 

Hormigueros Municipio, PR.

Mayag[uuml]ez Municipio, PR.

32580 ....... McAllen-Edinburg-Mission, TX .......................................................................................................................... 0.9140 0.9403 

Hidalgo County, TX.

32780 ....... Medford, OR ..................................................................................................................................................... 1.0304 1.0207 

Jackson County, OR.

32820 ....... 1 Memphis, TN-MS-AR ..................................................................................................................................... 0.9291 0.9509 

Crittenden County, AR.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24937 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

DeSoto County, MS.

Marshall County, MS.

Tate County, MS.

Tunica County, MS.

Fayette County, TN.

Shelby County, TN.

Tipton County, TN.

32900 ....... Merced, CA ....................................................................................................................................................... 1.1961 1.1305 

Merced County, CA.

33124 ....... 1 Miami-Miami Beach-Kendall, FL .................................................................................................................... 1.0023 1.0016 

Miami-Dade County, FL.

33140 ....... Michigan City-La Porte, IN ................................................................................................................................ 0.8791 0.9155 

LaPorte County, IN.

33260 ....... Midland, TX ....................................................................................................................................................... 1.0016 1.0011 

Midland County, TX.

33340 ....... 1 Milwaukee-Waukesha-West Allis, WI ............................................................................................................. 1.0296 1.0202 

Milwaukee County, WI.

Ozaukee County, WI.

Washington County, WI.

Waukesha County, WI.

33460 ....... 1 Minneapolis-St. Paul-Bloomington, MN-WI .................................................................................................... 1.0961 1.0649 

Anoka County, MN.

Carver County, MN.

Chisago County, MN.

Dakota County, MN.

Hennepin County, MN.

Isanti County, MN.

Ramsey County, MN.

Scott County, MN.

Sherburne County, MN.

Washington County, MN.

Wright County, MN.

Pierce County, WI.

St. Croix County, WI.

33540 ....... Missoula, MT ..................................................................................................................................................... 0.8737 0.9117 

Missoula County, MT.

33660 ....... Mobile, AL ......................................................................................................................................................... 0.7950 0.8546 

Mobile County, AL.

33700 ....... Modesto, CA ..................................................................................................................................................... 1.1989 1.1323 

Stanislaus County, CA.

33740 ....... Monroe, LA ....................................................................................................................................................... 0.7872 0.8489 

Ouachita Parish, LA.

Union Parish, LA.

33780 ....... Monroe, MI ........................................................................................................................................................ 0.9475 0.9637 

Monroe County, MI.

33860 ....... Montgomery, AL ................................................................................................................................................ 0.8366 0.8850 

Autauga County, AL.

Elmore County, AL.

Lowndes County, AL.

Montgomery County, AL.

34060 ....... Morgantown, WV .............................................................................................................................................. 0.8411 0.8883 

Monongalia County, WV.

Preston County, WV.

34100 ....... 2 Morristown, TN ............................................................................................................................................... 0.7916 0.8521 

Grainger County, TN.

Hamblen County, TN.

Jefferson County, TN.

34580 ....... 2 Mount Vernon-Anacortes, WA ....................................................................................................................... 1.0565 1.0384 

Skagit County, WA.

34620 ....... 2 Muncie, IN ...................................................................................................................................................... 0.8599 0.9018 

Delaware County, IN.

34740 ....... Muskegon-Norton Shores, MI ........................................................................................................................... 0.9935 0.9955 

Muskegon County, MI.

34820 ....... 2 Myrtle Beach-Conway-North Myrtle Beach, SC ............................................................................................. 0.8791 0.9155 

Horry County, SC.

34900 ....... Napa, CA .......................................................................................................................................................... 1.3825 1.2483 

Napa County, CA.

34940 ....... Naples-Marco Island, FL ................................................................................................................................... 0.9756 0.9832 

Collier County, FL.

34980 ....... 1 Nashville-Davidson-Murfreesboro-Franklin, TN ............................................................................................. 0.9675 0.9776 

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24938 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Cannon County, TN.

Cheatham County, TN.

Davidson County, TN.

Dickson County, TN.

Hickman County, TN.

Macon County, TN.

Robertson County, TN.

Rutherford County, TN.

Smith County, TN.

Sumner County, TN.

Trousdale County, TN.

Williamson County, TN.

Wilson County, TN.

35004 ....... 1 Nassau-Suffolk, NY ........................................................................................................................................ 1.2791 1.1836 

Nassau County, NY.

Suffolk County, NY.

35084 ....... 1 Newark-Union, NJ-PA .................................................................................................................................... 1.1681 1.1123 

Essex County, NJ.

Hunterdon County, NJ.

Morris County, NJ.

Sussex County, NJ.

Union County, NJ.

Pike County, PA.

35300 ....... 2 New Haven-Milford, CT .................................................................................................................................. 1.2439 1.1612 

New Haven County, CT.

35380 ....... 1 New Orleans-Metairie-Kenner, LA ................................................................................................................. 0.8732 0.9113 

Jefferson Parish, LA.

Orleans Parish, LA.

Plaquemines Parish, LA.

St. Bernard Parish, LA.

St. Charles Parish, LA.

St. John the Baptist Parish, LA.

St. Tammany Parish, LA.

35644 ....... 1 New York-White Plains-Wayne, NY-NJ ......................................................................................................... 1.3215 1.2103 

Bergen County, NJ.

Hudson County, NJ.

Passaic County, NJ.

Bronx County, NY.

Kings County, NY.

New York County, NY.

Putnam County, NY.

Queens County, NY.

Richmond County, NY.

Rockland County, NY.

Westchester County, NY.

35660 ....... Niles-Benton Harbor, MI ................................................................................................................................... 0.9138 0.9401 

Berrien County, MI.

35980 ....... 2 Norwich-New London, CT .............................................................................................................................. 1.2439 1.1612 

New London County, CT.

36084 ....... 1 Oakland-Fremont-Hayward, CA ..................................................................................................................... 1.5299 1.3380 

Alameda County, CA.

Contra Costa County, CA.

36100 ....... 2 Ocala, FL ........................................................................................................................................................ 0.8749 0.9125 

Marion County, FL.

36140 ....... Ocean City, NJ .................................................................................................................................................. 1.0749 1.0507 

Cape May County, NJ.

36220 ....... Odessa, TX ....................................................................................................................................................... 0.9959 0.9972 

Ector County, TX.

36260 ....... Ogden-Clearfield, UT ........................................................................................................................................ 0.9061 0.9347 

Davis County, UT.

Morgan County, UT.

Weber County, UT.

36420 ....... 1 Oklahoma City, OK ........................................................................................................................................ 0.8764 0.9136 

Canadian County, OK.

Cleveland County, OK.

Grady County, OK.

Lincoln County, OK.

Logan County, OK.

McClain County, OK.

Oklahoma County, OK.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24939 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

36500 ....... Olympia, WA ..................................................................................................................................................... 1.1463 1.0980 

Thurston County, WA.

36540 ....... Omaha-Council Bluffs, NE-IA ........................................................................................................................... 0.9419 0.9598 

Harrison County, IA.

Mills County, IA.

Pottawattamie County, IA.

Cass County, NE.

Douglas County, NE.

Sarpy County, NE.

Saunders County, NE.

Washington County, NE.

36740 ....... 1 Orlando-Kissimmee, FL .................................................................................................................................. 0.9383 0.9573 

Lake County, FL.

Orange County, FL.

Osceola County, FL.

Seminole County, FL.

36780 ....... 2 Oshkosh-Neenah, WI ..................................................................................................................................... 0.9635 0.9749 

Winnebago County, WI.

36980 ....... Owensboro, KY ................................................................................................................................................. 0.8801 0.9163 

Daviess County, KY.

Hancock County, KY.

McLean County, KY.

37100 ....... 2 Oxnard-Thousand Oaks-Ventura, CA ............................................................................................................ 1.1607 1.1074 

Ventura County, CA.

37340 ....... Palm Bay-Melbourne-Titusville, FL ................................................................................................................... 0.9385 0.9575 

Brevard County, FL.

37380 ....... 2 Palm Coast, FL .............................................................................................................................................. 0.8749 0.9125 

Flager County, FL.

37460 ....... 2 Panama City-Lynn Haven, FL ........................................................................................................................ 0.8749 0.9125 

Bay County, FL.

37620 ....... 2 Parkersburg-Marietta-Vienna, WV-OH (OH Hospitals) .................................................................................. 0.8701 0.9091 

Washington County, OH.

Pleasants County, WV.

Wirt County, WV.

Wood County, WV.

37620 ....... Parkersburg-Marietta-Vienna, WV-OH (WV Hospitals) .................................................................................... 0.8238 0.8757 

Washington County, OH.

Pleasants County, WV.

Wirt County, WV.

Wood County, WV.

37700 ....... Pascagoula, MS ................................................................................................................................................ 0.8544 0.8978 

George County, MS.

Jackson County, MS.

37764 ....... Peabody, MA .................................................................................................................................................... 1.0214 1.0146 

Essex County, MA.

37860 ....... 2 Pensacola-Ferry Pass-Brent, FL .................................................................................................................... 0.8749 0.9125 

Escambia County, FL.

Santa Rosa County, FL.

37900 ....... Peoria, IL ........................................................................................................................................................... 0.9374 0.9567 

Marshall County, IL.

Peoria County, IL.

Stark County, IL.

Tazewell County, IL.

Woodford County, IL.

37964 ....... 1 Philadelphia, PA ............................................................................................................................................. 1.0906 1.0612 

Bucks County, PA.

Chester County, PA.

Delaware County, PA.

Montgomery County, PA.

Philadelphia County, PA.

38060 ....... 1 Phoenix-Mesa-Scottsdale, AZ ........................................................................................................................ 1.0115 1.0079 

Maricopa County, AZ.

Pinal County, AZ.

38220 ....... Pine Bluff, AR ................................................................................................................................................... 0.8155 0.8696 

Cleveland County, AR.

Jefferson County, AR.

Lincoln County, AR.

38300 ....... 1 Pittsburgh, PA ................................................................................................................................................ 0.8388 0.8866 

Allegheny County, PA.

Armstrong County, PA.

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24940 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Beaver County, PA.

Butler County, PA.

Fayette County, PA.

Washington County, PA.

Westmoreland County, PA.

38340 ....... Pittsfield, MA ..................................................................................................................................................... 1.0071 1.0049 

Berkshire County, MA.

38540 ....... Pocatello, ID ...................................................................................................................................................... 0.9158 0.9415 

Bannock County, ID.

Power County, ID.

38660 ....... Ponce, PR ......................................................................................................................................................... 0.4161 0.5486 

Juana D[iacute]az Municipio, PR.

Ponce Municipio, PR.

Villalba Municipio, PR.

38860 ....... Portland-South Portland-Biddeford, ME ............................................................................................................ 1.0008 1.0005 

Cumberland County, ME.

Sagadahoc County, ME.

York County, ME.

38900 ....... 1 Portland-Vancouver-Beaverton, OR-WA ........................................................................................................ 1.1233 1.0829 

Clackamas County, OR.

Columbia County, OR.

Multnomah County, OR.

Washington County, OR.

Yamhill County, OR.

Clark County, WA.

Skamania County, WA.

38940 ....... Port St. Lucie, FL .............................................................................................................................................. 0.9990 0.9993 

Martin County, FL.

St. Lucie County, FL.

39100 ....... Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... 1.0853 1.0577 

Dutchess County, NY.

Orange County, NY.

39140 ....... Prescott, AZ ...................................................................................................................................................... 0.9913 0.9940 

Yavapai County, AZ.

39300 ....... 1 Providence-New Bedford-Fall River, RI-MA .................................................................................................. 1.0654 1.0443 

Bristol County, MA.

Bristol County, RI.

Kent County, RI.

Newport County, RI.

Providence County, RI.

Washington County, RI.

39340 ....... Provo-Orem, UT ................................................................................................................................................ 0.9488 0.9646 

Juab County, UT.

Utah County, UT.

39380 ....... 2 Pueblo, CO ..................................................................................................................................................... 0.9451 0.9621 

Pueblo County, CO.

39460 ....... Punta Gorda, FL ............................................................................................................................................... 0.9562 0.9698 

Charlotte County, FL.

39540 ....... 2 Racine, WI ...................................................................................................................................................... 0.9635 0.9749 

Racine County, WI.

39580 ....... Raleigh-Cary, NC .............................................................................................................................................. 0.9373 0.9566 

Franklin County, NC.

Johnston County, NC.

Wake County, NC.

39660 ....... Rapid City, SD .................................................................................................................................................. 0.8690 0.9083 

Meade County, SD.

Pennington County, SD.

39740 ....... Reading, PA ...................................................................................................................................................... 0.9419 0.9598 

Berks County, PA.

39820 ....... Redding, CA ...................................................................................................................................................... 1.2826 1.1858 

Shasta County, CA.

39900 ....... Reno-Sparks, NV .............................................................................................................................................. 1.1062 1.0716 

Storey County, NV.

Washoe County, NV.

40060 ....... 1 Richmond, VA ................................................................................................................................................ 0.9238 0.9472 

Amelia County, VA.

Caroline County, VA.

Charles City County, VA.

Chesterfield County, VA.

Cumberland County, VA.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24941 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Dinwiddie County, VA.

Goochland County, VA.

Hanover County, VA.

Henrico County, VA.

King and Queen County, VA.

King William County, VA.

Louisa County, VA.

New Kent County, VA.

Powhatan County, VA.

Prince George County, VA.

Sussex County, VA.

Colonial Heights City, VA.

Hopewell City, VA.

Petersburg City, VA.

Richmond City, VA.

40140 ....... 1, 2 Riverside-San Bernardino-Ontario, CA .................................................................................................. 1.1607 1.1074 

Riverside County, CA.

San Bernardino County, CA.

40220 ....... Roanoke, VA ..................................................................................................................................................... 0.9441 0.9614 

Botetourt County, VA.

Craig County, VA.

Franklin County, VA.

Roanoke County, VA.

Roanoke City, VA.

Salem City, VA.

40340 ....... Rochester, MN .................................................................................................................................................. 1.0761 1.0515 

Dodge County, MN.

Olmsted County, MN.

Wabasha County, MN.

40380 ....... 1 Rochester, NY ................................................................................................................................................ 0.8899 0.9232 

Livingston County, NY.

Monroe County, NY.

Ontario County, NY.

Orleans County, NY.

Wayne County, NY.

40420 ....... Rockford, IL ....................................................................................................................................................... 0.9659 0.9765 

Boone County, IL.

Winnebago County, IL.

40484 ....... 2 Rockingham County-Strafford County, NH .................................................................................................... 1.1266 1.0851 

Rockingham County, NH.

Strafford County, NH.

40580 ....... Rocky Mount, NC .............................................................................................................................................. 0.9017 0.9316 

Nash County, NC.

40660 ....... Rome, GA ......................................................................................................................................................... 0.9549 0.9689 

Floyd County, GA.

40900 ....... 1 Sacramento--Arden-Arcade--Roseville, CA ................................................................................................... 1.2999 1.1968 

El Dorado County, CA.

Placer County, CA.

Sacramento County, CA.

Yolo County, CA.

40980 ....... Saginaw-Saginaw Township North, MI ............................................................................................................. 0.9127 0.9394 

Saginaw County, MI.

41060 ....... St. Cloud, MN ................................................................................................................................................... 1.1063 1.0716 

Benton County, MN.

Stearns County, MN.

41100 ....... St. George, UT .................................................................................................................................................. 0.9546 0.9687 

Washington County, UT.

41140 ....... St. Joseph, MO-KS ........................................................................................................................................... 0.8831 0.9184 

Doniphan County, KS.

Andrew County, MO.

Buchanan County, MO.

DeKalb County, MO.

41180 ....... 1 St. Louis, MO-IL ............................................................................................................................................. 0.8885 0.9222 

Bond County, IL.

Calhoun County, IL.

Clinton County, IL.

Jersey County, IL.

Macoupin County, IL.

Madison County, IL.

Monroe County, IL.

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24942 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

St. Clair County, IL.

Crawford County, MO.

Franklin County, MO.

Jefferson County, MO.

Lincoln County, MO.

St. Charles County, MO.

St. Louis County, MO.

Warren County, MO.

Washington County, MO.

St. Louis City, MO.

41420 ....... Salem, OR ........................................................................................................................................................ 1.0404 1.0275 

Marion County, OR.

Polk County, OR.

41500 ....... Salinas, CA ....................................................................................................................................................... 1.4408 1.2841 

Monterey County, CA.

41540 ....... 2 Salisbury, MD ................................................................................................................................................. 0.8917 0.9245 

Somerset County, MD.

Wicomico County, MD.

41620 ....... Salt Lake City, UT ............................................................................................................................................. 0.9482 0.9642 

Salt Lake County, UT.

Summit County, UT.

Tooele County, UT.

41660 ....... San Angelo, TX ................................................................................................................................................. 0.8663 0.9064 

Irion County, TX.

Tom Green County, TX.

41700 ....... 1 San Antonio, TX ............................................................................................................................................. 0.8916 0.9244 

Atascosa County, TX.

Bandera County, TX.

Bexar County, TX.

Comal County, TX.

Guadalupe County, TX.

Kendall County, TX.

Medina County, TX.

Wilson County, TX.

41740 ....... 1, 2 San Diego-Carlsbad-San Marcos, CA ................................................................................................... 1.1607 1.1074 

San Diego County, CA.

41780 ....... Sandusky, OH ................................................................................................................................................... 0.8760 0.9133 

Erie County, OH.

41884 ....... 1 San Francisco-San Mateo-Redwood City, CA ............................................................................................... 1.4766 1.3059 

Marin County, CA.

San Francisco County, CA.

San Mateo County, CA.

41900 ....... San Germ[aacute]n-Cabo Rojo, PR ................................................................................................................. 0.4605 0.5880 

Cabo Rojo Municipio, PR.

Lajas Municipio, PR.

Sabana Grande Municipio, PR.

San Germ[aacute]n Municipio, PR.

41940 ....... 1 San Jose-Sunnyvale-Santa Clara, CA ........................................................................................................... 1.5378 1.3427 

San Benito County, CA.

Santa Clara County, CA.

41980 ....... 1 San Juan-Caguas-Guaynabo, PR .................................................................................................................. 0.4517 0.5803 

Aguas Buenas Municipio, PR.

Aibonito Municipio, PR.

Arecibo Municipio, PR.

Barceloneta Municipio, PR.

Barranquitas Municipio, PR.

Bayam[oacute]n Municipio, PR.

Caguas Municipio, PR.

Camuy Municipio, PR.

Can[oacute]vanas Municipio, PR.

Carolina Municipio, PR.

Cata[ntilde]o Municipio, PR.

Cayey Municipio, PR.

Ciales Municipio, PR.

Cidra Municipio, PR.

Comer[iacute]o Municipio, PR.

Corozal Municipio, PR.

Dorado Municipio, PR.

Florida Municipio, PR.

Guaynabo Municipio, PR.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24943 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Gurabo Municipio, PR.

Hatillo Municipio, PR.

Humacao Municipio, PR.

Juncos Municipio, PR.

Las Piedras Municipio, PR.

Lo[iacute]za Municipio, PR.

Manat[iacute] Municipio, PR.

Maunabo Municipio, PR.

Morovis Municipio, PR.

Naguabo Municipio, PR.

Naranjito Municipio, PR.

Orocovis Municipio, PR.

Quebradillas Municipio, PR.

R[iacute]o Grande Municipio, PR.

San Juan Municipio, PR.

San Lorenzo Municipio, PR.

Toa Alta Municipio, PR.

Toa Baja Municipio, PR.

Trujillo Alto Municipio, PR.

Vega Alta Municipio, PR.

Vega Baja Municipio, PR.

Yabucoa Municipio, PR.

42020 ....... San Luis Obispo-Paso Robles, CA ................................................................................................................... 1.1912 1.1273 

San Luis Obispo County, CA.

42044 ....... 1, 2 Santa Ana-Anaheim-Irvine, CA .............................................................................................................. 1.1607 1.1074 

Orange County, CA.

42060 ....... 2 Santa Barbara-Santa Maria-Goleta, CA ........................................................................................................ 1.1607 1.1074 

Santa Barbara County, CA.

42100 ....... Santa Cruz-Watsonville, CA ............................................................................................................................. 1.5667 1.3600 

Santa Cruz County, CA.

42140 ....... Santa Fe, NM .................................................................................................................................................... 1.0689 1.0467 

Santa Fe County, NM.

42220 ....... Santa Rosa-Petaluma, CA ................................................................................................................................ 1.4266 1.2755 

Sonoma County, CA.

42260 ....... Sarasota-Bradenton-Venice, FL ........................................................................................................................ 0.9758 0.9834 

Manatee County, FL.

Sarasota County, FL.

42340 ....... Savannah, GA ................................................................................................................................................... 0.8987 0.9295 

Bryan County, GA.

Chatham County, GA.

Effingham County, GA.

42540 ....... 2 Scranton--Wilkes-Barre, PA ........................................................................................................................... 0.8366 0.8850 

Lackawanna County, PA.

Luzerne County, PA.

Wyoming County, PA.

42644 ....... 1 Seattle-Bellevue-Everett, WA ......................................................................................................................... 1.1351 1.0907 

King County, WA.

Snohomish County, WA.

42680 ....... Sebastian-Vero Beach, FL ................................................................................................................................ 0.9708 0.9799 

Indian River County, FL.

43100 ....... 2 Sheboygan, WI ............................................................................................................................................... 0.9635 0.9749 

Sheboygan County, WI.

43300 ....... Sherman-Denison, TX ....................................................................................................................................... 0.8535 0.8972 

Grayson County, TX.

43340 ....... Shreveport-Bossier City, LA .............................................................................................................................. 0.8615 0.9029 

Bossier Parish, LA.

Caddo Parish, LA.

De Soto Parish, LA.

43580 ....... Sioux City, IA-NE-SD ........................................................................................................................................ 0.9220 0.9459 

Woodbury County, IA.

Dakota County, NE.

Dixon County, NE.

Union County, SD.

43620 ....... Sioux Falls, SD ................................................................................................................................................. 0.9558 0.9695 

Lincoln County, SD.

McCook County, SD.

Minnehaha County, SD.

Turner County, SD.

43780 ....... South Bend-Mishawaka, IN-MI ......................................................................................................................... 0.9649 0.9758 

St. Joseph County, IN.

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24944 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Cass County, MI.

43900 ....... Spartanburg, SC ............................................................................................................................................... 0.9334 0.9539 

Spartanburg County, SC.

44060 ....... 2 Spokane, WA ................................................................................................................................................. 1.0565 1.0384 

Spokane County, WA.

44100 ....... Springfield, IL .................................................................................................................................................... 0.8947 0.9266 

Menard County, IL.

Sangamon County, IL.

44140 ....... Springfield, MA .................................................................................................................................................. 1.0236 1.0161 

Franklin County, MA.

Hampden County, MA.

Hampshire County, MA.

44180 ....... Springfield, MO ................................................................................................................................................. 0.9196 0.9442 

Christian County, MO.

Dallas County, MO.

Greene County, MO.

Polk County, MO.

Webster County, MO.

44220 ....... 2 Springfield, OH ............................................................................................................................................... 0.8701 0.9091 

Clark County, OH.

44300 ....... State College, PA ............................................................................................................................................. 0.8625 0.9037 

Centre County, PA.

44700 ....... Stockton, CA ..................................................................................................................................................... 1.1735 1.1158 

San Joaquin County, CA.

44940 ....... Sumter, SC ....................................................................................................................................................... 0.8875 0.9215 

Sumter County, SC.

45060 ....... Syracuse, NY .................................................................................................................................................... 0.9912 0.9940 

Madison County, NY.

Onondaga County, NY.

Oswego County, NY.

45104 ....... Tacoma, WA ..................................................................................................................................................... 1.1060 1.0714 

Pierce County, WA.

45220 ....... Tallahassee, FL ................................................................................................................................................ 0.9032 0.9327 

Gadsden County, FL.

Jefferson County, FL.

Leon County, FL.

Wakulla County, FL.

45300 ....... 1 Tampa-St. Petersburg-Clearwater, FL ........................................................................................................... 0.9174 0.9427 

Hernando County, FL.

Hillsborough County, FL.

Pasco County, FL.

Pinellas County, FL.

45460 ....... Terre Haute, IN ................................................................................................................................................. 0.8828 0.9182 

Clay County, IN.

Sullivan County, IN.

Vermillion County, IN.

Vigo County, IN.

45500 ....... Texarkana, TX-Texarkana, AR (AR Hospitals) ................................................................................................. 0.8131 0.8679 

Miller County, AR.

Bowie County, TX.

45500 ....... 2 Texarkana, TX-Texarkana, AR (TX Hospitals) .............................................................................................. 0.8204 0.8732 

Miller County, AR.

Bowie County, TX.

45780 ....... Toledo, OH ........................................................................................................................................................ 0.9276 0.9498 

Fulton County, OH.

Lucas County, OH.

Ottawa County, OH.

Wood County, OH.

45820 ....... Topeka, KS ....................................................................................................................................................... 0.8561 0.8991 

Jackson County, KS.

Jefferson County, KS.

Osage County, KS.

Shawnee County, KS.

Wabaunsee County, KS.

45940 ....... Trenton-Ewing, NJ ............................................................................................................................................ 1.0720 1.0488 

Mercer County, NJ.

46060 ....... Tucson, AZ ........................................................................................................................................................ 0.9484 0.9644 

Pima County, AZ.

46140 ....... Tulsa, OK .......................................................................................................................................................... 0.8504 0.8950 

Creek County, OK.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24945 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Okmulgee County, OK.

Osage County, OK.

Pawnee County, OK.

Rogers County, OK.

Tulsa County, OK.

Wagoner County, OK.

46220 ....... Tuscaloosa, AL ................................................................................................................................................. 0.8534 0.8971 

Greene County, AL.

Hale County, AL.

Tuscaloosa County, AL.

46340 ....... Tyler, TX ........................................................................................................................................................... 0.9190 0.9438 

Smith County, TX.

46540 ....... Utica-Rome, NY ................................................................................................................................................ 0.8774 0.9143 

Herkimer County, NY.

Oneida County, NY.

46660 ....... Valdosta, GA ..................................................................................................................................................... 0.8208 0.8735 

Brooks County, GA.

Echols County, GA.

Lanier County, GA.

Lowndes County, GA.

46700 ....... Vallejo-Fairfield, CA .......................................................................................................................................... 1.4400 1.2837 

Solano County, CA.

47020 ....... 2 Victoria, TX ..................................................................................................................................................... 0.8204 0.8732 

Calhoun County, TX.

Goliad County, TX.

Victoria County, TX.

47220 ....... Vineland-Millville-Bridgeton, NJ ........................................................................................................................ 1.0653 1.0443 

Cumberland County, NJ.

47260 ....... 1 Virginia Beach-Norfolk-Newport News, VA-NC ............................................................................................. 0.8785 0.9151 

Currituck County, NC.

Gloucester County, VA.

Isle of Wight County, VA.

James City County, VA.

Mathews County, VA.

Surry County, VA.

York County, VA.

Chesapeake City, VA.

Hampton City, VA.

Newport News City, VA.

Norfolk City, VA.

Poquoson City, VA.

Portsmouth City, VA.

Suffolk City, VA.

Virginia Beach City, VA.

Williamsburg City, VA.

47300 ....... 2 Visalia-Porterville, CA ..................................................................................................................................... 1.1607 1.1074 

Tulare County, CA.

47380 ....... Waco, TX .......................................................................................................................................................... 0.8598 0.9017 

McLennan County, TX.

47580 ....... Warner Robins, GA ........................................................................................................................................... 0.9619 0.9737 

Houston County, GA.

47644 ....... 1 Warren-Troy-Farmington Hills, MI .................................................................................................................. 1.0040 1.0027 

Lapeer County, MI.

Livingston County, MI.

Macomb County, MI.

Oakland County, MI.

St. Clair County, MI.

47894 ....... 1 Washington-Arlington-Alexandria, DC-VA-MD-WV ........................................................................................ 1.0679 1.0460 

District of Columbia, DC.

Calvert County, MD.

Charles County, MD.

Prince George’s County, MD.

Arlington County, VA.

Clarke County, VA.

Fairfax County, VA.

Fauquier County, VA.

Loudoun County, VA.

Prince William County, VA.

Spotsylvania County, VA.

Stafford County, VA.

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24946 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Warren County, VA.

Alexandria City, VA.

Fairfax City, VA.

Falls Church City, VA.

Fredericksburg City, VA.

Manassas City, VA.

Manassas Park City, VA.

Jefferson County, WV.

47940 ....... Waterloo-Cedar Falls, IA ................................................................................................................................... 0.8891 0.9227 

Black Hawk County, IA.

Bremer County, IA.

Grundy County, IA.

48140 ....... Wausau, WI ...................................................................................................................................................... 1.0011 1.0008 

Marathon County, WI.

48260 ....... 2 Weirton-Steubenville, WV-OH (OH Hospitals) ............................................................................................... 0.8701 0.9091 

Jefferson County, OH.

Brooke County, WV.

Hancock County, WV.

48260 ....... Weirton-Steubenville, WV-OH (WV Hospitals) ................................................................................................. 0.7893 0.8504 

Jefferson County, OH.

Brooke County, WV.

Hancock County, WV.

48300 ....... Wenatchee, WA ................................................................................................................................................ 1.1281 1.0860 

Chelan County, WA.

Douglas County, WA.

48424 ....... 1 West Palm Beach-Boca Raton-Boynton Beach, FL ...................................................................................... 0.9587 0.9715 

Palm Beach County, FL.

48540 ....... 2 Wheeling, WV-OH (OH Hospitals) ................................................................................................................. 0.8701 0.9091 

Belmont County, OH.

Marshall County, WV.

Ohio County, WV.

48540 ....... 2 Wheeling, WV-OH (WV Hospitals) ................................................................................................................. 0.7568 0.8263 

Belmont County, OH.

Marshall County, WV.

Ohio County, WV.

48620 ....... Wichita, KS ....................................................................................................................................................... 0.9009 0.9310 

Butler County, KS.

Harvey County, KS.

Sedgwick County, KS.

Sumner County, KS.

48660 ....... Wichita Falls, TX ............................................................................................................................................... 0.8488 0.8938 

Archer County, TX.

Clay County, TX.

Wichita County, TX.

48700 ....... 2 Williamsport, PA ............................................................................................................................................. 0.8366 0.8850 

Lycoming County, PA.

48864 ....... Wilmington, DE-MD-NJ ..................................................................................................................................... 1.0752 1.0509 

New Castle County, DE.

Cecil County, MD.

Salem County, NJ.

48900 ....... Wilmington, NC ................................................................................................................................................. 0.9338 0.9542 

Brunswick County, NC.

New Hanover County, NC.

Pender County, NC.

49020 ....... Winchester, VA-WV .......................................................................................................................................... 0.9850 0.9897 

Frederick County, VA.

Winchester City, VA.

Hampshire County, WV.

49180 ....... Winston-Salem, NC ........................................................................................................................................... 0.9083 0.9363 

Davie County, NC.

Forsyth County, NC.

Stokes County, NC.

Yadkin County, NC.

49340 ....... Worcester, MA .................................................................................................................................................. 1.1341 1.0900 

Worcester County, MA.

49420 ....... 2 Yakima, WA .................................................................................................................................................... 1.0565 1.0384 

Yakima County, WA.

49500 ....... Yauco, PR ......................................................................................................................................................... 0.3203 0.4586 

Gu[aacute]nica Municipio, PR.

Guayanilla Municipio, PR.

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24947 

TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 

2008—Continued 

CBSA code Urban area (constituent counties) Wage 

index GAF 

Pe[ntilde]uelas Municipio, PR.

Yauco Municipio, PR.

49620 ....... York-Hanover, PA ............................................................................................................................................. 0.9307 0.9520 

York County, PA.

49660 ....... Youngstown-Warren-Boardman, OH-PA .......................................................................................................... 0.8996 0.9301 

Mahoning County, OH.

Trumbull County, OH.

Mercer County, PA.

49700 ....... 2 Yuba City, CA ................................................................................................................................................. 1.1607 1.1074 

Sutter County, CA.

Yuba County, CA.

49740 ....... Yuma, AZ .......................................................................................................................................................... 0.9468 0.9633 

Yuma County, AZ.

1 Large urban area. 2 Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2008. 

TABLE 4B.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT (GAF) FOR RURAL AREAS BY CBSA—FY 2008 

CBSA code Nonurban area Wage 

index GAF 

01 ............. Alabama ............................................................................................................................................................ 0.7598 0.8285 

02 ............. Alaska ............................................................................................................................................................... 1.1817 1.1211 

03 ............. Arizona .............................................................................................................................................................. 0.9386 0.9575 

04 ............. Arkansas ........................................................................................................................................................... 0.7519 0.8226 

05 ............. California ........................................................................................................................................................... 1.1607 1.1074 

06 ............. Colorado ............................................................................................................................................................ 0.9451 0.9621 

07 ............. Connecticut ....................................................................................................................................................... 1.2439 1.1612 

08 ............. Delaware ........................................................................................................................................................... 0.9825 0.9880 

10 ............. Florida ............................................................................................................................................................... 0.8749 0.9125 

11 ............. Georgia ............................................................................................................................................................. 0.7864 0.8483 

12 ............. Hawaii ............................................................................................................................................................... 1.0751 1.0508 

13 ............. Idaho ................................................................................................................................................................. 0.7879 0.8494 

14 ............. Illinois ................................................................................................................................................................ 0.8355 0.8842 

15 ............. Indiana .............................................................................................................................................................. 0.8599 0.9018 

16 ............. Iowa ................................................................................................................................................................... 0.8480 0.8932 

17 ............. Kansas .............................................................................................................................................................. 0.7989 0.8575 

18 ............. Kentucky ........................................................................................................................................................... 0.7812 0.8444 

19 ............. Louisiana ........................................................................................................................................................... 0.7591 0.8280 

20 ............. Maine ................................................................................................................................................................ 0.8412 0.8883 

21 ............. Maryland ........................................................................................................................................................... 0.8917 0.9245 

22 ............. Massachusetts .................................................................................................................................................. 0.9739 0.9821 

23 ............. Michigan ............................................................................................................................................................ 0.8899 0.9232 

24 ............. Minnesota .......................................................................................................................................................... 0.9212 0.9453 

25 ............. Mississippi ......................................................................................................................................................... 0.7915 0.8520 

26 ............. Missouri ............................................................................................................................................................. 0.8145 0.8689 

27 ............. Montana ............................................................................................................................................................ 0.8337 0.8829 

28 ............. Nebraska ........................................................................................................................................................... 0.8848 0.9196 

29 ............. Nevada .............................................................................................................................................................. 0.9688 0.9785 

30 ............. New Hampshire ................................................................................................................................................ 1.1266 1.0851 

31 ............. New Jersey 1 ..................................................................................................................................................... ................ ................

32 ............. New Mexico ...................................................................................................................................................... 0.8965 0.9279 

33 ............. New York .......................................................................................................................................................... 0.8440 0.8903 

34 ............. North Carolina ................................................................................................................................................... 0.8608 0.9024 

35 ............. North Dakota ..................................................................................................................................................... 0.7313 0.8071 

36 ............. Ohio ................................................................................................................................................................... 0.8701 0.9091 

37 ............. Oklahoma .......................................................................................................................................................... 0.7702 0.8363 

38 ............. Oregon .............................................................................................................................................................. 0.9950 0.9966 

39 ............. Pennsylvania ..................................................................................................................................................... 0.8366 0.8850 

40 ............. Puerto Rico 1 ..................................................................................................................................................... ................ ................

41 ............. Rhode Island 1 .................................................................................................................................................. ................ ................

42 ............. South Carolina .................................................................................................................................................. 0.8791 0.9155 

43 ............. South Dakota .................................................................................................................................................... 0.8343 0.8833 

44 ............. Tennessee ........................................................................................................................................................ 0.7916 0.8521 

45 ............. Texas ................................................................................................................................................................ 0.8204 0.8732 

46 ............. Utah ................................................................................................................................................................... 0.8267 0.8778 

47 ............. Vermont ............................................................................................................................................................. 1.0401 1.0273 

49 ............. Virginia .............................................................................................................................................................. 0.8095 0.8653 

50 ............. Washington ....................................................................................................................................................... 1.0565 1.0384 

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24948 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4B.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT (GAF) FOR RURAL AREAS BY CBSA—FY 2008— 

Continued 

CBSA code Nonurban area Wage 

index GAF 

51 ............. West Virginia ..................................................................................................................................................... 0.7568 0.8263 

52 ............. Wisconsin .......................................................................................................................................................... 0.9635 0.9749 

53 ............. Wyoming ........................................................................................................................................................... 0.9214 0.9455 

1 All counties in the State or Territory are classified as urban. 

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE

RECLASSIFIED BY CBSA—FY 2008 

CBSA code Area Wage 

index GAF 

10420 ....... Akron, OH ......................................................................................................................................................... 0.8854 0.9200 

10500 ....... Albany, GA ........................................................................................................................................................ 0.8671 0.9070 

10580 ....... Albany-Schenectady-Troy, NY .......................................................................................................................... 0.8672 0.9070 

10740 ....... Albuquerque, NM .............................................................................................................................................. 0.9740 0.9821 

10780 ....... Alexandria, LA ................................................................................................................................................... 0.7982 0.8570 

10900 ....... Allentown-Bethlehem-Easton, PAN-J ............................................................................................................... 1.0024 1.0016 

11100 ....... Amarillo, TX ...................................................................................................................................................... 0.9141 0.9403 

11180 ....... Ames, IA ........................................................................................................................................................... 0.9227 0.9464 

11260 ....... Anchorage, AK .................................................................................................................................................. 1.1840 1.1226 

11460 ....... Ann Arbor, MI .................................................................................................................................................... 1.0138 1.0094 

11500 ....... Anniston-Oxford, AL .......................................................................................................................................... 0.8042 0.8614 

12060 ....... Atlanta-Sandy Springs-Marietta, GA ................................................................................................................. 0.9845 0.9894 

12420 ....... Austin-Round Rock, TX .................................................................................................................................... 0.9518 0.9667 

12580 ....... Baltimore-Towson, MD ...................................................................................................................................... 1.0108 1.0074 

12620 ....... Bangor, ME ....................................................................................................................................................... 0.9860 0.9904 

12940 ....... Baton Rouge, LA .............................................................................................................................................. 0.8014 0.8593 

13020 ....... Bay City, MI ...................................................................................................................................................... 0.9399 0.9584 

13644 ....... Bethesda-Gaithersburg-Frederick, MD ............................................................................................................. 1.0990 1.0668 

13780 ....... Binghamton, NY ................................................................................................................................................ 0.8779 0.9147 

13820 ....... Birmingham-Hoover, AL .................................................................................................................................... 0.8737 0.9117 

13900 ....... Bismarck, ND .................................................................................................................................................... 0.7329 0.8083 

13980 ....... Blacksburg-Christiansburg-Radford, VA ........................................................................................................... 0.7744 0.8394 

14020 ....... Bloomington, IN ................................................................................................................................................ 0.8828 0.9182 

14484 ....... Boston-Quincy, MA ........................................................................................................................................... 1.1256 1.0844 

14540 ....... Bowling Green, KY ........................................................................................................................................... 0.8089 0.8648 

14740 ....... Bremerton-Silverdale, WA ................................................................................................................................. 1.0826 1.0559 

14860 ....... Bridgeport-Stamford-Norwalk, CT ..................................................................................................................... 1.2380 1.1574 

15380 ....... Buffalo-Niagara Falls, NY ................................................................................................................................. 0.9586 0.9715 

15540 ....... Burlington-South Burlington, VT ....................................................................................................................... 0.9589 0.9717 

15764 ....... Cambridge-Newton-Framingham, MA .............................................................................................................. 1.1266 1.0851 

15940 ....... Canton-Massillon, OH ....................................................................................................................................... 0.8810 0.9169 

16180 ....... Carson City, NV ................................................................................................................................................ 0.9688 0.9785 

16620 ....... Charleston, WV ................................................................................................................................................. 0.8294 0.8798 

16700 ....... Charleston-North Charleston, SC ..................................................................................................................... 0.9144 0.9406 

16740 ....... Charlotte-Gastonia-Concord, NC-SC ................................................................................................................ 0.9348 0.9549 

16820 ....... Charlottesville, VA ............................................................................................................................................. 0.9353 0.9552 

16860 ....... Chattanooga, TN-GA ........................................................................................................................................ 0.8967 0.9281 

16974 ....... Chicago-Naperville-Joliet, IL ............................................................................................................................. 1.0455 1.0309 

17140 ....... Cincinnati-Middletown, OH-KY-IN ..................................................................................................................... 0.9654 0.9762 

17300 ....... Clarksville, TN-KY ............................................................................................................................................. 0.8116 0.8668 

17460 ....... Cleveland-Elyria-Mentor, OH ............................................................................................................................ 0.9238 0.9472 

17780 ....... College Station-Bryan, TX ................................................................................................................................ 0.9177 0.9429 

17860 ....... Columbia, MO ................................................................................................................................................... 0.8545 0.8979 

17980 ....... Columbus, GA-AL ............................................................................................................................................. 0.8594 0.9014 

18140 ....... Columbus, OH .................................................................................................................................................. 0.9840 0.9890 

18700 ....... Corvallis, OR ..................................................................................................................................................... 1.0322 1.0219 

19124 ....... Dallas-Plano-Irving, TX ..................................................................................................................................... 0.9681 0.9780 

19340 ....... Davenport-Moline-Rock Island, IA-IL ................................................................................................................ 0.8898 0.9232 

19380 ....... Dayton, OH ....................................................................................................................................................... 0.9283 0.9503 

19460 ....... Decatur, AL ....................................................................................................................................................... 0.7927 0.8529 

19740 ....... Denver-Aurora, CO ........................................................................................................................................... 1.0490 1.0333 

19804 ....... Detroit-Livonia-Dearborn, MI ............................................................................................................................. 1.0091 1.0062 

20100 ....... Dover, DE ......................................................................................................................................................... 1.0023 1.0016 

20260 ....... Duluth, MN–WI .................................................................................................................................................. 1.0020 1.0014 

20500 ....... Durham, NC ...................................................................................................................................................... 0.9603 0.9726 

20764 ....... Edison, NJ ......................................................................................................................................................... 1.1131 1.0761 

21060 ....... Elizabethtown, KY ............................................................................................................................................. 0.7983 0.8570 

21500 ....... Erie, PA ............................................................................................................................................................. 0.8440 0.8903 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24949 

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE

RECLASSIFIED BY CBSA—FY 2008—Continued 

CBSA code Area Wage 

index GAF 

21660 ....... Eugene-Springfield, OR .................................................................................................................................... 1.0713 1.0483 

21780 ....... Evansville, IN-KY (KY Hospitals) ...................................................................................................................... 0.8127 0.8676 

21780 ....... Evansville, IN-KY (IN Hospitals) ....................................................................................................................... 0.8599 0.9018 

22020 ....... Fargo, ND-MN (ND Hospitals) .......................................................................................................................... 0.8189 0.8721 

22020 ....... Fargo, ND-MN (SD Hospitals) .......................................................................................................................... 0.8343 0.8833 

22180 ....... Fayetteville, NC ................................................................................................................................................. 0.9600 0.9724 

22220 ....... Fayetteville-Springdale-Rogers, AR-MO ........................................................................................................... 0.8719 0.9104 

22380 ....... Flagstaff, AZ ...................................................................................................................................................... 1.1310 1.0880 

22420 ....... Flint, MI ............................................................................................................................................................. 1.0272 1.0185 

22520 ....... Florence-Muscle Shoals, AL ............................................................................................................................. 0.7971 0.8562 

22540 ....... Fond du Lac, WI ............................................................................................................................................... 0.9721 0.9808 

22660 ....... Fort Collins-Loveland, CO ................................................................................................................................. 0.9577 0.9708 

22744 ....... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ................................................................................... 1.0245 1.0167 

23020 ....... Fort Walton Beach-Crestview-Destin, FL ......................................................................................................... 0.8749 0.9125 

23060 ....... Fort Wayne, IN .................................................................................................................................................. 0.9046 0.9336 

23104 ....... Fort Worth-Arlington, TX ................................................................................................................................... 0.9646 0.9756 

23540 ....... Gainesville, FL .................................................................................................................................................. 0.9306 0.9519 

23844 ....... Gary, IN ............................................................................................................................................................. 0.9246 0.9477 

24300 ....... Grand Junction, CO .......................................................................................................................................... 1.0141 1.0096 

24340 ....... Grand Rapids-Wyoming, MI .............................................................................................................................. 0.9380 0.9571 

24500 ....... Great Falls, MT ................................................................................................................................................. 0.8765 0.9137 

24540 ....... Greeley, CO ...................................................................................................................................................... 0.9746 0.9825 

24580 ....... Green Bay, WI (MI Hospitals) ........................................................................................................................... 0.9339 0.9542 

24580 ....... Green Bay, WI (WI Hospitals) .......................................................................................................................... 0.9635 0.9749 

24660 ....... Greensboro-High Point, NC .............................................................................................................................. 0.9111 0.9382 

24780 ....... Greenville, NC ................................................................................................................................................... 0.9272 0.9496 

24860 ....... Greenville-Mauldin-Easley, SC ......................................................................................................................... 0.9386 0.9575 

25060 ....... Gulfport-Biloxi, MS ............................................................................................................................................ 0.8223 0.8746 

25420 ....... Harrisburg-Carlisle, PA ..................................................................................................................................... 0.9130 0.9396 

25540 ....... Hartford-West Hartford-East Hartford, CT (CT Hospitals) ................................................................................ 1.2439 1.1612 

25540 ....... Hartford-West Hartford-East Hartford, CT (MA Hospitals) ............................................................................... 1.0955 1.0645 

25860 ....... Hickory-Lenoir-Morganton, NC ......................................................................................................................... 0.8819 0.9175 

26100 ....... Holland-Grand Haven, MI ................................................................................................................................. 0.9066 0.9351 

26180 ....... Honolulu, HI ...................................................................................................................................................... 1.1289 1.0866 

26420 ....... Houston-Sugar Land-Baytown, TX ................................................................................................................... 1.0048 1.0033 

26580 ....... Huntington-Ashland, WV-KY-OH ...................................................................................................................... 0.8706 0.9095 

26620 ....... Huntsville, AL .................................................................................................................................................... 0.8760 0.9133 

26820 ....... Idaho Falls, ID ................................................................................................................................................... 0.9352 0.9552 

26900 ....... Indianapolis-Carmel, IN ..................................................................................................................................... 0.9723 0.9809 

26980 ....... Iowa City, IA ...................................................................................................................................................... 0.9142 0.9404 

27060 ....... Ithaca, NY ......................................................................................................................................................... 0.9715 0.9804 

27140 ....... Jackson, MS ..................................................................................................................................................... 0.8273 0.8782 

27180 ....... Jackson, TN ...................................................................................................................................................... 0.8432 0.8898 

27260 ....... Jacksonville, FL ................................................................................................................................................ 0.9129 0.9395 

27620 ....... Jefferson City, MO ............................................................................................................................................ 0.8706 0.9095 

27780 ....... Johnstown, PA .................................................................................................................................................. 0.8366 0.8850 

27860 ....... Jonesboro, AR .................................................................................................................................................. 0.8507 0.8952 

27900 ....... Joplin, MO ......................................................................................................................................................... 0.9040 0.9332 

28020 ....... Kalamazoo-Portage, MI .................................................................................................................................... 1.0151 1.0103 

28100 ....... Kankakee-Bradley, IL ........................................................................................................................................ 1.1678 1.1121 

28140 ....... Kansas City, MO-KS ......................................................................................................................................... 0.9321 0.9530 

28420 ....... Kennewick-Richland-Pasco, WA (ID Hospitals) ............................................................................................... 0.9620 0.9738 

28420 ....... Kennewick-Richland-Pasco, WA (WA Hospitals) ............................................................................................. 1.0565 1.0384 

28700 ....... Kingsport-Bristol-Bristol, TN-VA (KY Hospitals) ............................................................................................... 0.7840 0.8465 

28700 ....... Kingsport-Bristol-Bristol, TN-VA (TN Hospitals) ............................................................................................... 0.7916 0.8521 

28700 ....... Kingsport-Bristol-Bristol, TN-VA (VA Hospitals) ............................................................................................... 0.8095 0.8653 

28740 ....... Kingston, NY ..................................................................................................................................................... 0.9231 0.9467 

28940 ....... Knoxville, TN ..................................................................................................................................................... 0.8042 0.8614 

29180 ....... Lafayette, LA ..................................................................................................................................................... 0.8323 0.8819 

29404 ....... Lake County-Kenosha County, IL-WI ............................................................................................................... 1.0287 1.0196 

29460 ....... Lakeland, FL ..................................................................................................................................................... 0.8839 0.9190 

29540 ....... Lancaster, PA ................................................................................................................................................... 0.9589 0.9717 

29620 ....... Lansing-East Lansing, MI ................................................................................................................................. 0.9933 0.9954 

29740 ....... Las Cruces, NM ................................................................................................................................................ 0.8965 0.9279 

29820 ....... Las Vegas-Paradise, NV ................................................................................................................................... 1.1205 1.0810 

30020 ....... Lawton, OK ....................................................................................................................................................... 0.8071 0.8635 

30460 ....... Lexington-Fayette, KY ...................................................................................................................................... 0.8815 0.9173 

30620 ....... Lima, OH ........................................................................................................................................................... 0.9312 0.9524 

30700 ....... Lincoln, NE ........................................................................................................................................................ 0.9603 0.9726 

30780 ....... Little Rock-North Little Rock-Conway, AR ........................................................................................................ 0.8720 0.9105 

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24950 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE

RECLASSIFIED BY CBSA—FY 2008—Continued 

CBSA code Area Wage 

index GAF 

30860 ....... Logan, UT-ID .................................................................................................................................................... 0.9219 0.9458 

30980 ....... Longview, TX .................................................................................................................................................... 0.8875 0.9215 

31084 ....... Los Angeles-Long Beach-Santa Ana, CA ........................................................................................................ 1.1607 1.1074 

31140 ....... Louisville-Jefferson County, KY-IN ................................................................................................................... 0.9045 0.9336 

31340 ....... Lynchburg, VA .................................................................................................................................................. 0.8490 0.8940 

31420 ....... Macon, GA ........................................................................................................................................................ 0.9571 0.9704 

31540 ....... Madison, WI ...................................................................................................................................................... 1.1002 1.0676 

31700 ....... Manchester-Nashua, NH ................................................................................................................................... 1.1266 1.0851 

32780 ....... Medford, OR ..................................................................................................................................................... 1.0151 1.0103 

32820 ....... Memphis, TN-MS-AR ........................................................................................................................................ 0.8951 0.9269 

33124 ....... Miami-Miami Beach-Kendall, FL ....................................................................................................................... 1.0023 1.0016 

33340 ....... Milwaukee-Waukesha-West Allis, WI ............................................................................................................... 1.0296 1.0202 

33460 ....... Minneapolis-St. Paul-Bloomington, MN-WI ....................................................................................................... 1.0961 1.0649 

33540 ....... Missoula, MT ..................................................................................................................................................... 0.8737 0.9117 

33660 ....... Mobile, AL ......................................................................................................................................................... 0.7950 0.8546 

33700 ....... Modesto, CA ..................................................................................................................................................... 1.1989 1.1323 

33740 ....... Monroe, LA ....................................................................................................................................................... 0.7766 0.8410 

33860 ....... Montgomery, AL ................................................................................................................................................ 0.8366 0.8850 

34060 ....... Morgantown, WV .............................................................................................................................................. 0.8244 0.8761 

34740 ....... Muskegon-Norton Shores, MI ........................................................................................................................... 0.9472 0.9635 

34820 ....... Myrtle Beach-Conway-North Myrtle Beach, SC ............................................................................................... 0.8791 0.9155 

34980 ....... Nashville-Davidson-Murfreesboro-Franklin, TN ................................................................................................ 0.9407 0.9590 

35004 ....... Nassau-Suffolk, NY ........................................................................................................................................... 1.2565 1.1692 

35084 ....... Newark-Union, NJPA ........................................................................................................................................ 1.1578 1.1055 

35300 ....... New Haven-Milford, CT ..................................................................................................................................... 1.2439 1.1612 

35380 ....... New Orleans-Metairie-Kenner, LA .................................................................................................................... 0.8732 0.9113 

35644 ....... New York-White Plains-Wayne, NY-NJ ............................................................................................................ 1.2993 1.1964 

35980 ....... Norwich-New London, CT ................................................................................................................................. 1.1794 1.1196 

36084 ....... Oakland-Fremont-Hayward, CA ........................................................................................................................ 1.5299 1.3380 

36140 ....... Ocean City, NJ .................................................................................................................................................. 1.0358 1.0244 

36220 ....... Odessa, TX ....................................................................................................................................................... 0.9527 0.9674 

36420 ....... Oklahoma City, OK ........................................................................................................................................... 0.8764 0.9136 

36500 ....... Olympia, WA ..................................................................................................................................................... 1.1325 1.0889 

36740 ....... Orlando-Kissimmee, FL .................................................................................................................................... 0.9245 0.9477 

37700 ....... Pascagoula, MS ................................................................................................................................................ 0.8544 0.8978 

37860 ....... Pensacola-Ferry Pass-Brent, FL ....................................................................................................................... 0.8127 0.8676 

37900 ....... Peoria, IL ........................................................................................................................................................... 0.9217 0.9457 

37964 ....... Philadelphia, PA ................................................................................................................................................ 1.0777 1.0526 

38220 ....... Pine Bluff, AR ................................................................................................................................................... 0.7959 0.8553 

38300 ....... Pittsburgh, PA (PA and WV Hospitals) ............................................................................................................. 0.8388 0.8866 

38300 ....... Pittsburgh, PA (OH Hospitals) .......................................................................................................................... 0.8701 0.9091 

38340 ....... Pittsfield, MA ..................................................................................................................................................... 1.0401 1.0273 

38540 ....... Pocatello, ID ...................................................................................................................................................... 0.9158 0.9415 

38860 ....... Portland-South Portland-Biddeford, ME ............................................................................................................ 0.9601 0.9725 

38900 ....... Portland-Vancouver-Beaverton, OR-WA .......................................................................................................... 1.1233 1.0829 

38940 ....... Port St. Lucie, FL .............................................................................................................................................. 0.9990 0.9993 

39100 ....... Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... 1.0644 1.0437 

39140 ....... Prescott, AZ ...................................................................................................................................................... 0.9534 0.9678 

39340 ....... Provo-Orem, UT ................................................................................................................................................ 0.9388 0.9577 

39580 ....... Raleigh-Cary, NC .............................................................................................................................................. 0.9373 0.9566 

39740 ....... Reading, PA ...................................................................................................................................................... 0.9419 0.9598 

39820 ....... Redding, CA ...................................................................................................................................................... 1.2666 1.1757 

39900 ....... Reno-Sparks, NV .............................................................................................................................................. 1.0851 1.0575 

40060 ....... Richmond, VA ................................................................................................................................................... 0.9238 0.9472 

40220 ....... Roanoke, VA ..................................................................................................................................................... 0.9190 0.9438 

40340 ....... Rochester, MN .................................................................................................................................................. 1.0761 1.0515 

40380 ....... Rochester, NY ................................................................................................................................................... 0.8899 0.9232 

40420 ....... Rockford, IL ....................................................................................................................................................... 0.9659 0.9765 

40484 ....... Rockingham County, NH .................................................................................................................................. 1.0179 1.0122 

40660 ....... Rome, GA ......................................................................................................................................................... 0.9391 0.9579 

40900 ....... Sacramento-Arden-Arcade-Roseville, CA ......................................................................................................... 1.2853 1.1875 

40980 ....... Saginaw-Saginaw Township North, MI ............................................................................................................. 0.8979 0.9289 

41060 ....... St. Cloud, MN ................................................................................................................................................... 1.0390 1.0265 

41100 ....... St. George, UT .................................................................................................................................................. 0.9546 0.9687 

41140 ....... St. Joseph, MO-KS ........................................................................................................................................... 0.8831 0.9184 

41180 ....... St. Louis, MO-IL ................................................................................................................................................ 0.8885 0.9222 

41620 ....... Salt Lake City, UT (UT Hospitals) .................................................................................................................... 0.9482 0.9642 

41620 ....... Salt Lake City, UT (NV Hospitals) .................................................................................................................... 0.9688 0.9785 

41700 ....... San Antonio, TX ................................................................................................................................................ 0.8916 0.9244 

41884 ....... San Francisco-San Mateo-Redwood City, CA ................................................................................................. 1.4766 1.3059 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24951 

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE

RECLASSIFIED BY CBSA—FY 2008—Continued 

CBSA code Area Wage 

index GAF 

41940 ....... San Jose-Sunnyvale-Santa Clara, CA .............................................................................................................. 1.5378 1.3427 

41980 ....... San Juan-Caguas-Guaynabo, PR .................................................................................................................... 0.4517 0.5803 

42044 ....... Santa Ana-Anaheim-Irvine, CA ......................................................................................................................... 1.1607 1.1074 

42140 ....... Santa Fe, NM .................................................................................................................................................... 1.0376 1.0256 

42220 ....... Santa Rosa-Petaluma, CA ................................................................................................................................ 1.3959 1.2566 

42260 ....... Sarasota-Bradenton-Venice, FL ........................................................................................................................ 0.9758 0.9834 

42340 ....... Savannah, GA ................................................................................................................................................... 0.8987 0.9295 

42644 ....... Seattle-Bellevue-Everett, WA ............................................................................................................................ 1.1202 1.0808 

42680 ....... Sebastian-Vero Beach, FL ................................................................................................................................ 0.9482 0.9642 

43300 ....... Sherman-Denison, TX ....................................................................................................................................... 0.8535 0.8972 

43340 ....... Shreveport-Bossier City, LA .............................................................................................................................. 0.8615 0.9029 

43580 ....... Sioux City, IA-NE-SD ........................................................................................................................................ 0.8848 0.9196 

43620 ....... Sioux Falls, SD ................................................................................................................................................. 0.9395 0.9582 

43780 ....... South Bend-Mishawaka, IN-MI ......................................................................................................................... 0.9488 0.9646 

43900 ....... Spartanburg, SC ............................................................................................................................................... 0.9334 0.9539 

44060 ....... Spokane, WA .................................................................................................................................................... 1.0220 1.0150 

44180 ....... Springfield, MO ................................................................................................................................................. 0.8943 0.9264 

44940 ....... Sumter, SC ....................................................................................................................................................... 0.8791 0.9155 

45060 ....... Syracuse, NY .................................................................................................................................................... 0.9577 0.9708 

45104 ....... Tacoma, WA ..................................................................................................................................................... 1.1060 1.0714 

45220 ....... Tallahassee, FL ................................................................................................................................................ 0.8458 0.8916 

45300 ....... Tampa-St. Petersburg-Clearwater, FL .............................................................................................................. 0.9174 0.9427 

45500 ....... Texarkana, TX-Texarkana, AR ......................................................................................................................... 0.8131 0.8679 

45780 ....... Toledo, OH ........................................................................................................................................................ 0.9276 0.9498 

45820 ....... Topeka, KS ....................................................................................................................................................... 0.8455 0.8914 

46140 ....... Tulsa, OK .......................................................................................................................................................... 0.8504 0.8950 

46220 ....... Tuscaloosa, AL ................................................................................................................................................. 0.8166 0.8705 

46340 ....... Tyler, TX ........................................................................................................................................................... 0.9190 0.9438 

46700 ....... Vallejo-Fairfield, CA .......................................................................................................................................... 1.4200 1.2714 

47260 ....... Virginia Beach-Norfolk-Newport News, VA ....................................................................................................... 0.8785 0.9151 

47894 ....... Washington-Arlington-Alexandria DC-VA ......................................................................................................... 1.0679 1.0460 

47940 ....... Waterloo-Cedar Falls, IA ................................................................................................................................... 0.8891 0.9227 

48140 ....... Wausau, WI ...................................................................................................................................................... 1.0011 1.0008 

48620 ....... Wichita, KS ....................................................................................................................................................... 0.8761 0.9134 

48700 ....... Williamsport, PA ................................................................................................................................................ 0.8366 0.8850 

48864 ....... Wilmington, DE-MD-NJ ..................................................................................................................................... 1.0752 1.0509 

48900 ....... Wilmington, NC ................................................................................................................................................. 0.9172 0.9425 

49180 ....... Winston-Salem, NC ........................................................................................................................................... 0.9083 0.9363 

49660 ....... Youngstown-Warren-Boardman, OH-PA .......................................................................................................... 0.8775 0.9144 

03 ............. Rural Arizona .................................................................................................................................................... 0.9386 0.9575 

04 ............. Rural Arkansas ................................................................................................................................................. 0.7591 0.8280 

05 ............. Rural California ................................................................................................................................................. 1.1607 1.1074 

07 ............. Rural Connecticut ............................................................................................................................................. 1.2439 1.1612 

10 ............. Rural Florida ..................................................................................................................................................... 0.8749 0.9125 

14 ............. Rural Illinois ...................................................................................................................................................... 0.8355 0.8842 

16 ............. Rural Iowa ......................................................................................................................................................... 0.8480 0.8932 

17 ............. Rural Kansas .................................................................................................................................................... 0.7989 0.8575 

22 ............. Rural Massachusetts ........................................................................................................................................ 0.9739 0.9821 

23 ............. Rural Michigan .................................................................................................................................................. 0.8899 0.9232 

25 ............. Rural Mississippi ............................................................................................................................................... 0.7915 0.8520 

26 ............. Rural Missouri ................................................................................................................................................... 0.8145 0.8689 

29 ............. Rural Nevada .................................................................................................................................................... 0.8780 0.9148 

30 ............. Rural New Hampshire ....................................................................................................................................... 1.0782 1.0529 

33 ............. Rural New York ................................................................................................................................................. 0.8440 0.8903 

34 ............. Rural North Carolina ......................................................................................................................................... 0.8608 0.9024 

36 ............. Rural Ohio ......................................................................................................................................................... 0.8701 0.9091 

37 ............. Rural Oklahoma ................................................................................................................................................ 0.7702 0.8363 

38 ............. Rural Oregon .................................................................................................................................................... 0.9950 0.9966 

39 ............. Rural Pennsylvania (PA Hospitals) ................................................................................................................... 0.8366 0.8850 

39 ............. Rural Pennsylvania (NY Hospitals) ................................................................................................................... 0.8440 0.8903 

44 ............. Rural Tennessee ............................................................................................................................................... 0.7916 0.8521 

45 ............. Rural Texas ....................................................................................................................................................... 0.8204 0.8732 

47 ............. Rural Vermont ................................................................................................................................................... 0.9431 0.9607 

49 ............. Rural Virginia .................................................................................................................................................... 0.8095 0.8653 

50 ............. Rural Washington ............................................................................................................................................. 1.0565 1.0384 

52 ............. Rural Wisconsin ................................................................................................................................................ 0.9635 0.9749 

53 ............. Rural Wyoming ................................................................................................................................................. 0.9049 0.9339 

mmaher on DSK3CLS3C1PROD with $$_JOB

24952 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4F.—PUERTO RICO WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY CBSA—FY 2008 

CBSA 

code Area Wage index GAF 

Wage 

index—reclassified 

hospitals 

GAF—reclassified 

hospitals 

10380 ......... Aguadilla-Isabela-San Sebasti[aacute]n, PR ........................................................................... 0.7690 0.8354 ........................ ........................

21940 ......... Fajardo, PR .............................................................................................................................. 0.9543 0.9685 ........................ ........................

25020 ......... Guayama, PR ........................................................................................................................... 0.6904 0.7759 ........................ ........................

32420 ......... Mayag[uuml]ez, PR .................................................................................................................. 0.8532 0.8970 ........................ ........................

38660 ......... Ponce, PR ................................................................................................................................ 0.9692 0.9788 ........................ ........................

41900 ......... San Germ[aacute]n-Cabo Rojo, PR ......................................................................................... 1.0616 1.0418 ........................ ........................

41980 ......... San Juan-Caguas-Guaynabo, PR ............................................................................................ 1.0437 1.0297 1.0437 1.0297 

49500 ......... Yauco, PR ................................................................................................................................ 0.7478 0.8195 ........................ ........................

The following list represents all 

hospitals that are eligible to have their 

wage index increased by the 

outmigration adjustment listed in this 

table. Hospitals cannot receive the 

outmigration adjustment if they are 

reclassified under section 1886(d)(10) of 

the Act or redesignated under section 

1886(d)(8) of the Act. Hospitals that 

have already been reclassified under 

section 1886(d)(10) of the Act or 

redesignated under section 

1886(d)(8(B)) of the Act are designated 

with an asterisk. We will automatically 

assume that hospitals that have already 

been reclassified under section 

1886(d)(10) of the Act or redesignated 

under section 1886(d)(8) of the Act wish 

to retain their reclassification/ 

redesignation status and waive the 

application of the outmigration 

adjustment. Section 1886(d)(10) 

hospitals that wish to receive the 

outmigration adjustment, rather than 

their reclassification, should follow the 

termination/withdrawal procedures 

specified in 42 CFR 412.273 and section 

III.I.3. of the preamble of this proposed 

rule. Otherwise, they will be deemed to 

have waived the outmigration 

adjustment. Hospitals redesignated 

under section 1886(d)(8) of the Act will 

be deemed to have waived the 

outmigration adjustment, unless they 

explicitly notify CMS that they elect to 

receive the outmigration adjustment 

instead within 45 days from the 

publication of this proposed rule. These 

notifications should be sent to the 

following address: Centers for Medicare 

and Medicaid Services, Center for 

Medicare Management, Attention: Wage 

Index Adjustment Waivers, Division of 

Acute Care, Room C40806, 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

010005 ....................................................................... * 0.0322 MARSHALL ............................................................... 01470 

010008 ....................................................................... ............................ 0.0245 CRENSHAW ............................................................. 01200 

010009 ....................................................................... * 0.0177 MORGAN .................................................................. 01510 

010010 ....................................................................... * 0.0322 MARSHALL ............................................................... 01470 

010012 ....................................................................... * 0.0182 DE KALB ................................................................... 01240 

010015 ....................................................................... ............................ 0.0043 CLARKE .................................................................... 01120 

010022 ....................................................................... * 0.1106 CHEROKEE .............................................................. 01090 

010025 ....................................................................... * 0.0188 CHAMBERS .............................................................. 01080 

010029 ....................................................................... * 0.0281 LEE ............................................................................ 01400 

010032 ....................................................................... ............................ 0.0320 RANDOLPH .............................................................. 01550 

010035 ....................................................................... * 0.0263 CULLMAN ................................................................. 01210 

010038 ....................................................................... ............................ 0.0038 CALHOUN ................................................................. 01070 

010045 ....................................................................... * 0.0216 FAYETTE .................................................................. 01280 

010047 ....................................................................... ............................ 0.0179 BUTLER .................................................................... 01060 

010052 ....................................................................... ............................ 0.0124 TALLAPOOSA ........................................................... 01610 

010054 ....................................................................... * 0.0177 MORGAN .................................................................. 01510 

010061 ....................................................................... ............................ 0.0566 JACKSON ................................................................. 01350 

010065 ....................................................................... * 0.0124 TALLAPOOSA ........................................................... 01610 

010078 ....................................................................... ............................ 0.0038 CALHOUN ................................................................. 01070 

010083 ....................................................................... * 0.0125 BALDWIN .................................................................. 01010 

010085 ....................................................................... * 0.0177 MORGAN .................................................................. 01510 

010091 ....................................................................... ............................ 0.0043 CLARKE .................................................................... 01120 

010100 ....................................................................... * 0.0125 BALDWIN .................................................................. 01010 

010101 ....................................................................... * 0.0209 TALLADEGA ............................................................. 01600 

010109 ....................................................................... ............................ 0.0369 PICKENS ................................................................... 01530 

010110 ....................................................................... ............................ 0.0303 BULLOCK .................................................................. 01050 

010125 ....................................................................... ............................ 0.0471 WINSTON ................................................................. 01660 

010128 ....................................................................... ............................ 0.0043 CLARKE .................................................................... 01120 

010129 ....................................................................... ............................ 0.0125 BALDWIN .................................................................. 01010 

010138 ....................................................................... ............................ 0.0113 SUMTER ................................................................... 01590 

010143 ....................................................................... * 0.0263 CULLMAN ................................................................. 01210 

010146 ....................................................................... ............................ 0.0038 CALHOUN ................................................................. 01070 

010150 ....................................................................... * 0.0179 BUTLER .................................................................... 01060 

010158 ....................................................................... * 0.0067 FRANKLIN ................................................................. 01290 

010164 ....................................................................... * 0.0209 TALLADEGA ............................................................. 01600 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24953 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

030040 ....................................................................... ............................ 0.0012 SANTA CRUZ ........................................................... 03110 

030067 ....................................................................... ............................ 0.0230 LAPAZ ....................................................................... 03055 

040014 ....................................................................... * 0.0163 WHITE ....................................................................... 04720 

040019 ....................................................................... * 0.0254 ST. FRANCIS ............................................................ 04610 

040039 ....................................................................... * 0.0172 GREENE ................................................................... 04270 

040047 ....................................................................... ............................ 0.0117 RANDOLPH .............................................................. 04600 

040067 ....................................................................... ............................ 0.0008 COLUMBIA ................................................................ 04130 

040071 ....................................................................... * 0.0149 JEFFERSON ............................................................. 04340 

040076 ....................................................................... * 0.1001 HOT SPRING ............................................................ 04290 

040081 ....................................................................... ............................ 0.0358 PIKE .......................................................................... 04540 

040100 ....................................................................... * 0.0163 WHITE ....................................................................... 04720 

050002 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050007 ....................................................................... ............................ 0.0140 SAN MATEO ............................................................. 05510 

050009 ....................................................................... * 0.0196 NAPA ......................................................................... 05380 

050013 ....................................................................... * 0.0196 NAPA ......................................................................... 05380 

050014 ....................................................................... * 0.0147 AMADOR ................................................................... 05020 

050042 ....................................................................... * 0.0184 TEHAMA ................................................................... 05620 

050043 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050069 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050070 ....................................................................... ............................ 0.0140 SAN MATEO ............................................................. 05510 

050073 ....................................................................... * 0.0169 SOLANO ................................................................... 05580 

050075 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050084 ....................................................................... ............................ 0.0135 SAN JOAQUIN .......................................................... 05490 

050089 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050090 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050099 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050101 ....................................................................... * 0.0169 SOLANO ................................................................... 05580 

050113 ....................................................................... ............................ 0.0140 SAN MATEO ............................................................. 05510 

050118 ....................................................................... * 0.0135 SAN JOAQUIN .......................................................... 05490 

050122 ....................................................................... ............................ 0.0135 SAN JOAQUIN .......................................................... 05490 

050129 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050133 ....................................................................... * 0.0186 YUBA ......................................................................... 05680 

050136 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050140 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050150 ....................................................................... * 0.0357 NEVADA .................................................................... 05390 

050167 ....................................................................... ............................ 0.0135 SAN JOAQUIN .......................................................... 05490 

050168 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050173 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050174 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050193 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050195 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050197 ....................................................................... * 0.0140 SAN MATEO ............................................................. 05510 

050211 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050224 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050226 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050230 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050245 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050264 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050272 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050279 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050283 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050289 ....................................................................... ............................ 0.0140 SAN MATEO ............................................................. 05510 

050291 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050298 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050300 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050305 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050313 ....................................................................... ............................ 0.0135 SAN JOAQUIN .......................................................... 05490 

050320 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050325 ....................................................................... ............................ 0.0046 TUOLUMNE .............................................................. 05650 

050327 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050335 ....................................................................... ............................ 0.0046 TUOLUMNE .............................................................. 05650 

050336 ....................................................................... ............................ 0.0135 SAN JOAQUIN .......................................................... 05490 

050348 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050366 ....................................................................... ............................ 0.0025 CALAVERAS ............................................................. 05040 

050367 ....................................................................... * 0.0169 SOLANO ................................................................... 05580 

050385 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050426 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050444 ....................................................................... ............................ 0.0229 MERCED ................................................................... 05340 

050476 ....................................................................... * 0.0275 LAKE ......................................................................... 05160 

050488 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

mmaher on DSK3CLS3C1PROD with $$_JOB

24954 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

050494 ....................................................................... * 0.0357 NEVADA .................................................................... 05390 

050512 ....................................................................... ............................ 0.0009 ALAMEDA ................................................................. 05000 

050517 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050526 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050528 ....................................................................... * 0.0229 MERCED ................................................................... 05340 

050541 ....................................................................... * 0.0140 SAN MATEO ............................................................. 05510 

050543 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050547 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050548 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050551 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050567 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050570 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050580 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050584 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050586 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050589 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050603 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050609 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050618 ....................................................................... * 0.0005 SAN BERNARDINO .................................................. 05460 

050667 ....................................................................... * 0.0196 NAPA ......................................................................... 05380 

050678 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050680 ....................................................................... * 0.0169 SOLANO ................................................................... 05580 

050690 ....................................................................... * 0.0085 SONOMA .................................................................. 05590 

050693 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050707 ....................................................................... ............................ 0.0140 SAN MATEO ............................................................. 05510 

050720 ....................................................................... * 0.0006 ORANGE ................................................................... 05400 

050744 ....................................................................... ............................ 0.0006 ORANGE ................................................................... 05400 

050745 ....................................................................... ............................ 0.0006 ORANGE ................................................................... 05400 

050746 ....................................................................... ............................ 0.0006 ORANGE ................................................................... 05400 

050747 ....................................................................... ............................ 0.0006 ORANGE ................................................................... 05400 

050748 ....................................................................... ............................ 0.0135 SAN JOAQUIN .......................................................... 05490 

050754 ....................................................................... ............................ 0.0140 SAN MATEO ............................................................. 05510 

050756 ....................................................................... ............................ 0.0005 SAN BERNARDINO .................................................. 05460 

060001 ....................................................................... * 0.0045 WELD ........................................................................ 06610 

060003 ....................................................................... * 0.0075 BOULDER ................................................................. 06060 

060010 ....................................................................... ............................ 0.0087 LARIMER .................................................................. 06340 

060027 ....................................................................... * 0.0075 BOULDER ................................................................. 06060 

060030 ....................................................................... ............................ 0.0087 LARIMER .................................................................. 06340 

060103 ....................................................................... * 0.0075 BOULDER ................................................................. 06060 

060116 ....................................................................... * 0.0075 BOULDER ................................................................. 06060 

080001 ....................................................................... * 0.0018 NEW CASTLE ........................................................... 08010 

080003 ....................................................................... * 0.0018 NEW CASTLE ........................................................... 08010 

100014 ....................................................................... * 0.0059 VOLUSIA ................................................................... 10630 

100017 ....................................................................... * 0.0059 VOLUSIA ................................................................... 10630 

100045 ....................................................................... * 0.0059 VOLUSIA ................................................................... 10630 

100047 ....................................................................... * 0.0026 CHARLOTTE ............................................................. 10070 

100068 ....................................................................... * 0.0059 VOLUSIA ................................................................... 10630 

100072 ....................................................................... * 0.0059 VOLUSIA ................................................................... 10630 

100077 ....................................................................... * 0.0026 CHARLOTTE ............................................................. 10070 

100118 ....................................................................... * 0.0179 FLAGLER .................................................................. 10170 

100232 ....................................................................... * 0.0057 PUTNAM ................................................................... 10530 

100236 ....................................................................... * 0.0026 CHARLOTTE ............................................................. 10070 

100252 ....................................................................... * 0.0146 OKEECHOBEE ......................................................... 10460 

100290 ....................................................................... ............................ 0.0390 SUMTER ................................................................... 10590 

110023 ....................................................................... * 0.0416 GORDON .................................................................. 11500 

110029 ....................................................................... * 0.0056 HALL ......................................................................... 11550 

110040 ....................................................................... * 0.1727 JACKSON ................................................................. 11610 

110041 ....................................................................... * 0.0624 HABERSHAM ............................................................ 11540 

110100 ....................................................................... ............................ 0.0789 JEFFERSON ............................................................. 11620 

110101 ....................................................................... ............................ 0.0067 COOK ........................................................................ 11311 

110142 ....................................................................... ............................ 0.0202 EVANS ...................................................................... 11441 

110146 ....................................................................... * 0.0438 CAMDEN ................................................................... 11170 

110150 ....................................................................... * 0.0227 BALDWIN .................................................................. 11030 

110187 ....................................................................... * 0.0643 LUMPKIN .................................................................. 11701 

110190 ....................................................................... ............................ 0.0242 MACON ..................................................................... 11710 

110205 ....................................................................... ............................ 0.0514 GILMER ..................................................................... 11471 

130024 ....................................................................... ............................ 0.0422 BONNER ................................................................... 13080 

130049 ....................................................................... * 0.0319 KOOTENAI ................................................................ 13270 

130066 ....................................................................... ............................ 0.0319 KOOTENAI ................................................................ 13270 

130067 ....................................................................... * 0.0697 BINGHAM .................................................................. 13050 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24955 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

130068 ....................................................................... ............................ 0.0319 KOOTENAI ................................................................ 13270 

140001 ....................................................................... ............................ 0.0362 FULTON .................................................................... 14370 

140026 ....................................................................... ............................ 0.0288 LA SALLE .................................................................. 14580 

140043 ....................................................................... * 0.0055 WHITESIDE .............................................................. 14988 

140058 ....................................................................... * 0.0125 MORGAN .................................................................. 14770 

140110 ....................................................................... * 0.0288 LA SALLE .................................................................. 14580 

140160 ....................................................................... * 0.0302 STEPHENSON .......................................................... 14970 

140161 ....................................................................... * 0.0193 LIVINGSTON ............................................................. 14610 

140167 ....................................................................... * 0.1054 IROQUOIS ................................................................ 14460 

140234 ....................................................................... ............................ 0.0288 LA SALLE .................................................................. 14580 

150006 ....................................................................... * 0.0085 LA PORTE ................................................................ 15450 

150015 ....................................................................... ............................ 0.0085 LA PORTE ................................................................ 15450 

150022 ....................................................................... ............................ 0.0151 MONTGOMERY ........................................................ 15530 

150030 ....................................................................... * 0.0186 HENRY ...................................................................... 15320 

150072 ....................................................................... ............................ 0.0101 CASS ......................................................................... 15080 

150076 ....................................................................... * 0.0210 MARSHALL ............................................................... 15490 

150088 ....................................................................... * 0.0111 MADISON .................................................................. 15470 

150091 ....................................................................... * 0.0047 HUNTINGTON .......................................................... 15340 

150102 ....................................................................... * 0.0103 STARKE .................................................................... 15740 

150113 ....................................................................... * 0.0111 MADISON .................................................................. 15470 

150133 ....................................................................... * 0.0167 KOSCIUSKO ............................................................. 15420 

150146 ....................................................................... * 0.0081 NOBLE ...................................................................... 15560 

160013 ....................................................................... ............................ 0.0179 MUSCATINE ............................................................. 16690 

160032 ....................................................................... ............................ 0.0235 JASPER .................................................................... 16490 

160080 ....................................................................... * 0.0066 CLINTON ................................................................... 16220 

170137 ....................................................................... * 0.0387 DOUGLAS ................................................................. 17220 

170150 ....................................................................... ............................ 0.0176 COWLEY ................................................................... 17170 

180012 ....................................................................... * 0.0081 HARDIN ..................................................................... 18460 

180017 ....................................................................... * 0.0035 BARREN ................................................................... 18040 

180049 ....................................................................... * 0.0497 MADISON .................................................................. 18750 

180064 ....................................................................... ............................ 0.0320 MONTGOMERY ........................................................ 18860 

180066 ....................................................................... * 0.0450 LOGAN ...................................................................... 18700 

180070 ....................................................................... ............................ 0.0240 GRAYSON ................................................................ 18420 

180079 ....................................................................... ............................ 0.0264 HARRISON ............................................................... 18480 

190003 ....................................................................... * 0.0085 IBERIA ....................................................................... 19220 

190015 ....................................................................... * 0.0231 TANGIPAHOA ........................................................... 19520 

190017 ....................................................................... * 0.0184 ST. LANDRY ............................................................. 19480 

190034 ....................................................................... ............................ 0.0188 VERMILION ............................................................... 19560 

190044 ....................................................................... ............................ 0.0259 ACADIA ..................................................................... 19000 

190050 ....................................................................... ............................ 0.0044 BEAUREGARD ......................................................... 19050 

190053 ....................................................................... ............................ 0.0100 JEFFRSON DAVIS ................................................... 19260 

190054 ....................................................................... ............................ 0.0085 IBERIA ....................................................................... 19220 

190078 ....................................................................... ............................ 0.0184 ST. LANDRY ............................................................. 19480 

190086 ....................................................................... * 0.0050 LINCOLN ................................................................... 19300 

190088 ....................................................................... * 0.0410 WEBSTER ................................................................. 19590 

190099 ....................................................................... * 0.0189 AVOYELLES ............................................................. 19040 

190106 ....................................................................... * 0.0101 ALLEN ....................................................................... 19010 

190116 ....................................................................... ............................ 0.0084 MOREHOUSE ........................................................... 19330 

190133 ....................................................................... ............................ 0.0101 ALLEN ....................................................................... 19010 

190140 ....................................................................... ............................ 0.0034 FRANKLIN ................................................................. 19200 

190144 ....................................................................... * 0.0410 WEBSTER ................................................................. 19590 

190145 ....................................................................... ............................ 0.0090 LA SALLE .................................................................. 19290 

190184 ....................................................................... * 0.0075 CALDWELL ............................................................... 19100 

190190 ....................................................................... ............................ 0.0075 CALDWELL ............................................................... 19100 

190191 ....................................................................... * 0.0184 ST. LANDRY ............................................................. 19480 

190246 ....................................................................... ............................ 0.0075 CALDWELL ............................................................... 19100 

190257 ....................................................................... ............................ 0.0050 LINCOLN ................................................................... 19300 

200024 ....................................................................... * 0.0092 ANDROSCOGGIN .................................................... 20000 

200032 ....................................................................... ............................ 0.0316 OXFORD ................................................................... 20080 

200034 ....................................................................... * 0.0092 ANDROSCOGGIN .................................................... 20000 

200050 ....................................................................... * 0.0223 HANCOCK ................................................................ 20040 

210001 ....................................................................... ............................ 0.0184 WASHINGTON .......................................................... 21210 

210023 ....................................................................... ............................ 0.0070 ANNE ARUNDEL ...................................................... 21010 

210028 ....................................................................... ............................ 0.0356 ST. MARYS ............................................................... 21180 

210043 ....................................................................... ............................ 0.0070 ANNE ARUNDEL ...................................................... 21010 

220002 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220010 ....................................................................... * 0.0461 ESSEX ...................................................................... 22040 

220011 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220029 ....................................................................... * 0.0461 ESSEX ...................................................................... 22040 

220033 ....................................................................... * 0.0461 ESSEX ...................................................................... 22040 

mmaher on DSK3CLS3C1PROD with $$_JOB

24956 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

220035 ....................................................................... * 0.0461 ESSEX ...................................................................... 22040 

220049 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220063 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220070 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220080 ....................................................................... * 0.0461 ESSEX ...................................................................... 22040 

220082 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220084 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220098 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220101 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220105 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220171 ....................................................................... * 0.0235 MIDDLESEX .............................................................. 22090 

220174 ....................................................................... * 0.0461 ESSEX ...................................................................... 22040 

230003 ....................................................................... * 0.0217 OTTAWA ................................................................... 23690 

230005 ....................................................................... ............................ 0.0473 LENAWEE ................................................................. 23450 

230013 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230015 ....................................................................... ............................ 0.0297 ST. JOSEPH ............................................................. 23740 

230019 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230021 ....................................................................... * 0.0099 BERRIEN .................................................................. 23100 

230022 ....................................................................... * 0.0212 BRANCH ................................................................... 23110 

230029 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230035 ....................................................................... * 0.0096 MONTCALM .............................................................. 23580 

230037 ....................................................................... * 0.0211 HILLSDALE ............................................................... 23290 

230047 ....................................................................... * 0.0018 MACOMB .................................................................. 23490 

230069 ....................................................................... * 0.0208 LIVINGSTON ............................................................. 23460 

230071 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230072 ....................................................................... * 0.0217 OTTAWA ................................................................... 23690 

230075 ....................................................................... ............................ 0.0048 CALHOUN ................................................................. 23120 

230078 ....................................................................... * 0.0099 BERRIEN .................................................................. 23100 

230092 ....................................................................... * 0.0221 JACKSON ................................................................. 23370 

230093 ....................................................................... ............................ 0.0060 MECOSTA ................................................................. 23530 

230096 ....................................................................... * 0.0297 ST. JOSEPH ............................................................. 23740 

230099 ....................................................................... * 0.0230 MONROE .................................................................. 23570 

230121 ....................................................................... * 0.0695 SHIAWASSEE ........................................................... 23770 

230130 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230151 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230174 ....................................................................... * 0.0217 OTTAWA ................................................................... 23690 

230195 ....................................................................... * 0.0018 MACOMB .................................................................. 23490 

230204 ....................................................................... * 0.0018 MACOMB .................................................................. 23490 

230207 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230208 ....................................................................... * 0.0096 MONTCALM .............................................................. 23580 

230217 ....................................................................... * 0.0048 CALHOUN ................................................................. 23120 

230222 ....................................................................... * 0.0037 MIDLAND .................................................................. 23550 

230223 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230227 ....................................................................... * 0.0018 MACOMB .................................................................. 23490 

230254 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230257 ....................................................................... * 0.0018 MACOMB .................................................................. 23490 

230264 ....................................................................... * 0.0018 MACOMB .................................................................. 23490 

230269 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230277 ....................................................................... * 0.0023 OAKLAND ................................................................. 23620 

230279 ....................................................................... * 0.0208 LIVINGSTON ............................................................. 23460 

240018 ....................................................................... ............................ 0.0873 GOODHUE ................................................................ 24240 

240044 ....................................................................... ............................ 0.0671 WINONA .................................................................... 24840 

240064 ....................................................................... * 0.0130 ITASCA ..................................................................... 24300 

240069 ....................................................................... * 0.0301 STEELE ..................................................................... 24730 

240071 ....................................................................... * 0.0377 RICE .......................................................................... 24650 

240117 ....................................................................... ............................ 0.0593 MOWER .................................................................... 24490 

240211 ....................................................................... ............................ 0.0386 PINE .......................................................................... 24570 

250023 ....................................................................... * 0.0430 PEARL RIVER .......................................................... 25540 

250040 ....................................................................... * 0.0022 JACKSON ................................................................. 25290 

250117 ....................................................................... * 0.0430 PEARL RIVER .......................................................... 25540 

250128 ....................................................................... ............................ 0.0393 PANOLA .................................................................... 25530 

250160 ....................................................................... ............................ 0.0393 PANOLA .................................................................... 25530 

260059 ....................................................................... ............................ 0.0127 LACLEDE .................................................................. 26520 

260064 ....................................................................... * 0.0092 AUDRAIN .................................................................. 26030 

260097 ....................................................................... ............................ 0.0295 JOHNSON ................................................................. 26500 

270081 ....................................................................... ............................ 0.0236 MUSSELSHELL ........................................................ 27320 

280077 ....................................................................... ............................ 0.0057 DODGE ..................................................................... 28260 

280123 ....................................................................... ............................ 0.0118 GAGE ........................................................................ 28330 

290002 ....................................................................... * 0.0280 LYON ......................................................................... 29090 

310002 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24957 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

310009 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310010 ....................................................................... * 0.0159 MERCER ................................................................... 31260 

310013 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310018 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310021 ....................................................................... ............................ 0.0159 MERCER ................................................................... 31260 

310031 ....................................................................... * 0.0130 BURLINGTON ........................................................... 31150 

310032 ....................................................................... * 0.0027 CUMBERLAND ......................................................... 31190 

310038 ....................................................................... * 0.0368 MIDDLESEX .............................................................. 31270 

310039 ....................................................................... * 0.0368 MIDDLESEX .............................................................. 31270 

310044 ....................................................................... * 0.0159 MERCER ................................................................... 31260 

310054 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310057 ....................................................................... ............................ 0.0130 BURLINGTON ........................................................... 31150 

310061 ....................................................................... ............................ 0.0130 BURLINGTON ........................................................... 31150 

310070 ....................................................................... * 0.0368 MIDDLESEX .............................................................. 31270 

310076 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310083 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310092 ....................................................................... * 0.0159 MERCER ................................................................... 31260 

310093 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310096 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310108 ....................................................................... * 0.0368 MIDDLESEX .............................................................. 31270 

310110 ....................................................................... ............................ 0.0159 MERCER ................................................................... 31260 

310119 ....................................................................... * 0.0264 ESSEX ...................................................................... 31200 

310127 ....................................................................... ............................ 0.0130 BURLINGTON ........................................................... 31150 

320003 ....................................................................... * 0.0480 SAN MIGUEL ............................................................ 32230 

320011 ....................................................................... ............................ 0.0337 RIO ARRIBA ............................................................. 32190 

320018 ....................................................................... ............................ 0.0025 DONA ANA ............................................................... 32060 

320085 ....................................................................... ............................ 0.0025 DONA ANA ............................................................... 32060 

330004 ....................................................................... * 0.0615 ULSTER .................................................................... 33740 

330008 ....................................................................... * 0.0102 WYOMING ................................................................ 33900 

330010 ....................................................................... ............................ 0.0042 MONTGOMERY ........................................................ 33380 

330027 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330033 ....................................................................... ............................ 0.0205 CHENANGO .............................................................. 33080 

330047 ....................................................................... ............................ 0.0042 MONTGOMERY ........................................................ 33380 

330073 ....................................................................... * 0.0122 GENESEE ................................................................. 33290 

330094 ....................................................................... * 0.0463 COLUMBIA ................................................................ 33200 

330103 ....................................................................... ............................ 0.0121 CATTARAUGUS ....................................................... 33040 

330106 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330126 ....................................................................... * 0.0675 ORANGE ................................................................... 33540 

330132 ....................................................................... * 0.0121 CATTARAUGUS ....................................................... 33040 

330135 ....................................................................... * 0.0675 ORANGE ................................................................... 33540 

330167 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330175 ....................................................................... ............................ 0.0241 CORTLAND ............................................................... 33210 

330181 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330182 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330191 ....................................................................... * 0.0017 WARREN .................................................................. 33750 

330198 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330205 ....................................................................... * 0.0675 ORANGE ................................................................... 33540 

330224 ....................................................................... * 0.0615 ULSTER .................................................................... 33740 

330225 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330235 ....................................................................... * 0.0281 CAYUGA ................................................................... 33050 

330259 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330264 ....................................................................... * 0.0675 ORANGE ................................................................... 33540 

330331 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330332 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330372 ....................................................................... * 0.0148 NASSAU .................................................................... 33400 

330386 ....................................................................... * 0.0687 SULLIVAN ................................................................. 33710 

340020 ....................................................................... ............................ 0.0143 LEE ............................................................................ 34520 

340021 ....................................................................... * 0.0162 CLEVELAND ............................................................. 34220 

340024 ....................................................................... ............................ 0.0171 SAMPSON ................................................................ 34810 

340027 ....................................................................... * 0.0125 LENOIR ..................................................................... 34530 

340037 ....................................................................... ............................ 0.0162 CLEVELAND ............................................................. 34220 

340038 ....................................................................... * 0.0253 BEAUFORT ............................................................... 34060 

340039 ....................................................................... * 0.0101 IREDELL ................................................................... 34480 

340068 ....................................................................... * 0.0094 COLUMBUS .............................................................. 34230 

340069 ....................................................................... * 0.0083 WAKE ........................................................................ 34910 

340070 ....................................................................... * 0.0417 ALAMANCE ............................................................... 34000 

340071 ....................................................................... * 0.0168 HARNETT ................................................................. 34420 

340073 ....................................................................... * 0.0083 WAKE ........................................................................ 34910 

340085 ....................................................................... ............................ 0.0250 DAVIDSON ................................................................ 34280 

340096 ....................................................................... ............................ 0.0250 DAVIDSON ................................................................ 34280 

mmaher on DSK3CLS3C1PROD with $$_JOB

24958 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

340104 ....................................................................... * 0.0162 CLEVELAND ............................................................. 34220 

340114 ....................................................................... * 0.0083 WAKE ........................................................................ 34910 

340124 ....................................................................... * 0.0168 HARNETT ................................................................. 34420 

340126 ....................................................................... * 0.0084 WILSON .................................................................... 34970 

340129 ....................................................................... * 0.0101 IREDELL ................................................................... 34480 

340133 ....................................................................... ............................ 0.0242 MARTIN ..................................................................... 34580 

340138 ....................................................................... * 0.0083 WAKE ........................................................................ 34910 

340144 ....................................................................... * 0.0101 IREDELL ................................................................... 34480 

340145 ....................................................................... * 0.0337 LINCOLN ................................................................... 34540 

340151 ....................................................................... ............................ 0.0053 HALIFAX ................................................................... 34410 

340173 ....................................................................... * 0.0083 WAKE ........................................................................ 34910 

360002 ....................................................................... ............................ 0.0142 ASHLAND ................................................................. 36020 

360010 ....................................................................... * 0.0075 TUSCARAWAS ......................................................... 36800 

360013 ....................................................................... * 0.0135 SHELBY .................................................................... 36760 

360025 ....................................................................... * 0.0073 ERIE .......................................................................... 36220 

360036 ....................................................................... * 0.0168 WAYNE ..................................................................... 36860 

360040 ....................................................................... ............................ 0.0392 KNOX ........................................................................ 36430 

360044 ....................................................................... ............................ 0.0123 DARKE ...................................................................... 36190 

360065 ....................................................................... * 0.0077 HURON ..................................................................... 36400 

360071 ....................................................................... ............................ 0.0035 VAN WERT ............................................................... 36820 

360086 ....................................................................... * 0.0187 CLARK ...................................................................... 36110 

360096 ....................................................................... * 0.0071 COLUMBIANA ........................................................... 36140 

360107 ....................................................................... * 0.0095 SANDUSKY ............................................................... 36730 

360125 ....................................................................... * 0.0137 ASHTABULA ............................................................. 36030 

360156 ....................................................................... ............................ 0.0095 SANDUSKY ............................................................... 36730 

360175 ....................................................................... * 0.0175 CLINTON ................................................................... 36130 

360185 ....................................................................... * 0.0071 COLUMBIANA ........................................................... 36140 

360187 ....................................................................... * 0.0187 CLARK ...................................................................... 36110 

360245 ....................................................................... * 0.0137 ASHTABULA ............................................................. 36030 

370014 ....................................................................... * 0.0363 BRYAN ...................................................................... 37060 

370015 ....................................................................... * 0.0369 MAYES ...................................................................... 37480 

370023 ....................................................................... ............................ 0.0090 STEPHENS ............................................................... 37680 

370065 ....................................................................... ............................ 0.0097 CRAIG ....................................................................... 37170 

370072 ....................................................................... ............................ 0.0260 LATIMER ................................................................... 37380 

370083 ....................................................................... ............................ 0.0051 PUSHMATAHA ......................................................... 37630 

370100 ....................................................................... ............................ 0.0101 CHOCTAW ................................................................ 37110 

370149 ....................................................................... * 0.0292 POTTAWATOMIE ..................................................... 37620 

370156 ....................................................................... ............................ 0.0122 GARVIN ..................................................................... 37240 

370169 ....................................................................... ............................ 0.0164 MCINTOSH ............................................................... 37450 

370172 ....................................................................... ............................ 0.0260 LATIMER ................................................................... 37380 

370214 ....................................................................... ............................ 0.0122 GARVIN ..................................................................... 37240 

380022 ....................................................................... * 0.0069 LINN .......................................................................... 38210 

390008 ....................................................................... ............................ 0.0055 LAWRENCE .............................................................. 39450 

390016 ....................................................................... * 0.0055 LAWRENCE .............................................................. 39450 

390030 ....................................................................... * 0.0163 SCHUYLKILL ............................................................ 39650 

390031 ....................................................................... * 0.0163 SCHUYLKILL ............................................................ 39650 

390044 ....................................................................... * 0.0191 BERKS ...................................................................... 39110 

390052 ....................................................................... ............................ 0.0044 CLEARFIELD ............................................................ 39230 

390065 ....................................................................... * 0.0489 ADAMS ...................................................................... 39000 

390066 ....................................................................... * 0.0364 LEBANON ................................................................. 39460 

390086 ....................................................................... * 0.0044 CLEARFIELD ............................................................ 39230 

390096 ....................................................................... * 0.0191 BERKS ...................................................................... 39110 

390113 ....................................................................... * 0.0049 CRAWFORD ............................................................. 39260 

390122 ....................................................................... ............................ 0.0049 CRAWFORD ............................................................. 39260 

390138 ....................................................................... * 0.0212 FRANKLIN ................................................................. 39350 

390146 ....................................................................... ............................ 0.0019 WARREN .................................................................. 39740 

390150 ....................................................................... * 0.0019 GREENE ................................................................... 39370 

390151 ....................................................................... * 0.0212 FRANKLIN ................................................................. 39350 

390181 ....................................................................... * 0.0163 SCHUYLKILL ............................................................ 39650 

390183 ....................................................................... * 0.0163 SCHUYLKILL ............................................................ 39650 

390201 ....................................................................... * 0.1091 MONROE .................................................................. 39550 

390313 ....................................................................... * 0.0163 SCHUYLKILL ............................................................ 39650 

420007 ....................................................................... * 0.0037 SPARTANBURG ....................................................... 42410 

420019 ....................................................................... ............................ 0.0142 CHESTER ................................................................. 42110 

420027 ....................................................................... * 0.0145 ANDERSON .............................................................. 42030 

420030 ....................................................................... * 0.0051 COLLETON ............................................................... 42140 

420039 ....................................................................... * 0.0148 UNION ....................................................................... 42430 

420043 ....................................................................... ............................ 0.0132 CHEROKEE .............................................................. 42100 

420062 ....................................................................... * 0.0096 CHESTERFIELD ....................................................... 42120 

420069 ....................................................................... * 0.0023 CLARENDON ............................................................ 42130 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24959 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

420083 ....................................................................... * 0.0037 SPARTANBURG ....................................................... 42410 

430008 ....................................................................... ............................ 0.0537 BROOKINGS ............................................................. 43050 

430048 ....................................................................... * 0.0055 LAWRENCE .............................................................. 43400 

430094 ....................................................................... ............................ 0.0055 LAWRENCE .............................................................. 43400 

440007 ....................................................................... ............................ 0.0226 COFFEE .................................................................... 44150 

440008 ....................................................................... * 0.0449 HENDERSON ........................................................... 44380 

440016 ....................................................................... ............................ 0.0144 CARROLL ................................................................. 44080 

440024 ....................................................................... * 0.0230 BRADLEY .................................................................. 44050 

440030 ....................................................................... ............................ 0.0015 HAMBLEN ................................................................. 44310 

440031 ....................................................................... ............................ 0.0025 ROANE ...................................................................... 44720 

440033 ....................................................................... ............................ 0.0036 CAMPBELL ............................................................... 44060 

440035 ....................................................................... * 0.0309 MONTGOMERY ........................................................ 44620 

440047 ....................................................................... ............................ 0.0338 GIBSON .................................................................... 44260 

440051 ....................................................................... ............................ 0.0071 MCNAIRY .................................................................. 44540 

440057 ....................................................................... ............................ 0.0028 CLAIBORNE .............................................................. 44120 

440060 ....................................................................... * 0.0338 GIBSON .................................................................... 44260 

440067 ....................................................................... * 0.0015 HAMBLEN ................................................................. 44310 

440070 ....................................................................... ............................ 0.0109 DECATUR ................................................................. 44190 

440081 ....................................................................... ............................ 0.0069 SEVIER ..................................................................... 44770 

440084 ....................................................................... ............................ 0.0034 MONROE .................................................................. 44610 

440109 ....................................................................... ............................ 0.0070 HARDIN ..................................................................... 44350 

440115 ....................................................................... ............................ 0.0338 GIBSON .................................................................... 44260 

440137 ....................................................................... ............................ 0.0763 BEDFORD ................................................................. 44010 

440144 ....................................................................... * 0.0226 COFFEE .................................................................... 44150 

440148 ....................................................................... * 0.0306 DE KALB ................................................................... 44200 

440174 ....................................................................... ............................ 0.0310 HAYWOOD ............................................................... 44370 

440180 ....................................................................... ............................ 0.0036 CAMPBELL ............................................................... 44060 

440181 ....................................................................... ............................ 0.0361 HARDEMAN .............................................................. 44340 

440182 ....................................................................... ............................ 0.0144 CARROLL ................................................................. 44080 

440185 ....................................................................... * 0.0230 BRADLEY .................................................................. 44050 

450032 ....................................................................... * 0.0253 HARRISON ............................................................... 45620 

450039 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450052 ....................................................................... * 0.0276 BOSQUE ................................................................... 45160 

450059 ....................................................................... * 0.0074 COMAL ...................................................................... 45320 

450064 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450087 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450090 ....................................................................... ............................ 0.0651 COOKE ..................................................................... 45340 

450099 ....................................................................... * 0.0143 GRAY ........................................................................ 45563 

450135 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450137 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450144 ....................................................................... ............................ 0.0558 ANDREWS ................................................................ 45010 

450163 ....................................................................... ............................ 0.0053 KLEBERG ................................................................. 45743 

450192 ....................................................................... ............................ 0.0271 HILL ........................................................................... 45651 

450194 ....................................................................... ............................ 0.0213 CHEROKEE .............................................................. 45281 

450210 ....................................................................... ............................ 0.0150 PANOLA .................................................................... 45842 

450224 ....................................................................... * 0.0195 WOOD ....................................................................... 45974 

450236 ....................................................................... ............................ 0.0389 HOPKINS .................................................................. 45654 

450270 ....................................................................... ............................ 0.0271 HILL ........................................................................... 45651 

450283 ....................................................................... * 0.0655 VAN ZANDT .............................................................. 45947 

450347 ....................................................................... * 0.0379 WALKER ................................................................... 45949 

450348 ....................................................................... * 0.0058 FALLS ....................................................................... 45500 

450370 ....................................................................... ............................ 0.0241 COLORADO .............................................................. 45312 

450389 ....................................................................... * 0.0619 HENDERSON ........................................................... 45640 

450395 ....................................................................... * 0.0452 POLK ......................................................................... 45850 

450419 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450438 ....................................................................... * 0.0241 COLORADO .............................................................. 45312 

450451 ....................................................................... ............................ 0.0537 SOMERVELL ............................................................ 45893 

450460 ....................................................................... ............................ 0.0048 TYLER ....................................................................... 45942 

450497 ....................................................................... ............................ 0.0395 MONTAGUE .............................................................. 45800 

450539 ....................................................................... ............................ 0.0071 HALE ......................................................................... 45582 

450547 ....................................................................... ............................ 0.0195 WOOD ....................................................................... 45974 

450563 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450565 ....................................................................... ............................ 0.0481 PALO PINTO ............................................................. 45841 

450573 ....................................................................... ............................ 0.0115 JASPER .................................................................... 45690 

450596 ....................................................................... * 0.0744 HOOD ........................................................................ 45653 

450639 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450641 ....................................................................... ............................ 0.0395 MONTAGUE .............................................................. 45800 

450672 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450675 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450677 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

mmaher on DSK3CLS3C1PROD with $$_JOB

24960 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued 

Provider No. Reclassified 

for FY 2008 

Out-migration 

Adjustment Qualifying county name County code 

450698 ....................................................................... ............................ 0.0135 LAMB ......................................................................... 45751 

450747 ....................................................................... * 0.0127 ANDERSON .............................................................. 45000 

450755 ....................................................................... ............................ 0.0295 HOCKLEY ................................................................. 45652 

450770 ....................................................................... * 0.0182 MILAM ....................................................................... 45795 

450779 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450813 ....................................................................... * 0.0127 ANDERSON .............................................................. 45000 

450838 ....................................................................... ............................ 0.0115 JASPER .................................................................... 45690 

450872 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450880 ....................................................................... * 0.0024 TARRANT ................................................................. 45910 

450884 ....................................................................... ............................ 0.0050 UPSHUR ................................................................... 45943 

450886 ....................................................................... ............................ 0.0024 TARRANT ................................................................. 45910 

450888 ....................................................................... ............................ 0.0024 TARRANT ................................................................. 45910 

460017 ....................................................................... ............................ 0.0364 BOX ELDER .............................................................. 46010 

460039 ....................................................................... * 0.0364 BOX ELDER .............................................................. 46010 

490019 ....................................................................... * 0.1081 CULPEPER ............................................................... 49230 

490084 ....................................................................... ............................ 0.0145 ESSEX ...................................................................... 49280 

490110 ....................................................................... ............................ 0.0327 MONTGOMERY ........................................................ 49600 

500003 ....................................................................... * 0.0164 SKAGIT ..................................................................... 50280 

500007 ....................................................................... * 0.0164 SKAGIT ..................................................................... 50280 

500019 ....................................................................... ............................ 0.0140 LEWIS ....................................................................... 50200 

500039 ....................................................................... * 0.0101 KITSAP ...................................................................... 50170 

500041 ....................................................................... * 0.0020 COWLITZ .................................................................. 50070 

510018 ....................................................................... * 0.0187 JACKSON ................................................................. 51170 

510047 ....................................................................... * 0.0270 MARION .................................................................... 51240 

520028 ....................................................................... * 0.0297 GREEN ...................................................................... 52220 

520035 ....................................................................... ............................ 0.0083 SHEBOYGAN ............................................................ 52580 

520044 ....................................................................... ............................ 0.0083 SHEBOYGAN ............................................................ 52580 

520057 ....................................................................... ............................ 0.0184 SAUK ......................................................................... 52550 

520059 ....................................................................... * 0.0189 RACINE ..................................................................... 52500 

520060 ....................................................................... * 0.0048 GREEN LAKE ........................................................... 52230 

520071 ....................................................................... * 0.0174 JEFFERSON ............................................................. 52270 

520076 ....................................................................... * 0.0159 DODGE ..................................................................... 52130 

520095 ....................................................................... * 0.0184 SAUK ......................................................................... 52550 

520096 ....................................................................... ............................ 0.0189 RACINE ..................................................................... 52500 

520102 ....................................................................... * 0.0242 WALWORTH ............................................................. 52630 

520116 ....................................................................... * 0.0174 JEFFERSON ............................................................. 52270 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

1 ............ NO .............. NO .............. PRE SURG ......... Heart transplant or implant of heart assist system w MCC 23.6378 30.5 44.2 

2 ............ NO .............. NO .............. PRE SURG ......... Heart transplant or implant of heart assist system w/o 

MCC.

11.2998 16.0 22.8 

3 ............ YES ............ NO .............. PRE SURG ......... ECMO or trach w MV 96+ hrs or PDX exc face, mouth & 

neck w maj O.R.

18.6118 36.2 43.2 

4 ............ YES ............ NO .............. PRE SURG ......... Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o 

maj O.R.

11.5312 26.2 31.3 

5 ............ NO .............. NO .............. PRE SURG ......... Liver transplant w MCC or intestinal transplant .................. 10.3032 17.0 22.6 

6 ............ NO .............. NO .............. PRE SURG ......... Liver transplant w/o MCC .................................................... 4.7075 8.7 10.0 

7 ............ NO .............. NO .............. PRE SURG ......... Lung transplant .................................................................... 7.6379 14.6 17.3 

8 ............ NO .............. NO .............. PRE SURG ......... Simultaneous pancreas/kidney transplant ........................... 5.0633 10.2 11.9 

9 ............ NO .............. NO .............. PRE SURG ......... Bone marrow transplant ....................................................... 6.1059 18.1 21.6 

10 .......... NO .............. NO .............. PRE SURG ......... Pancreas transplant ............................................................. 3.6839 9.1 10.2 

11 .......... NO .............. NO .............. PRE SURG ......... Tracheostomy for face, mouth & neck diagnoses w MCC .. 4.8010 13.0 16.3 

12 .......... NO .............. NO .............. PRE SURG ......... Tracheostomy for face, mouth & neck diagnoses w CC ..... 2.9948 9.0 10.9 

13 .......... NO .............. NO .............. PRE SURG ......... Tracheostomy for face, mouth & neck diagnoses w/o CC/ 

MCC.

1.8882 6.1 7.3 

20 .......... NO .............. NO .............. 01 SURG ......... Intracranial vascular procedures w PDX hemorrhage w 

MCC.

8.2109 15.4 19.2 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24961 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

21 .......... NO .............. NO .............. 01 SURG ......... Intracranial vascular procedures w PDX hemorrhage w CC 6.1724 13.4 15.6 

22 .......... NO .............. NO .............. 01 SURG ......... Intracranial vascular procedures w PDX hemorrhage w/o 

CC/MCC.

4.1017 7.9 9.7 

23 .......... NO .............. NO .............. 01 SURG ......... Craniotomy w major device implant or acute complex CNS 

PDX w MCC.

5.1123 9.8 13.7 

24 .......... NO .............. NO .............. 01 SURG ......... Craniotomy w major device implant or acute complex CNS 

PDX w/o MCC.

3.4316 6.1 8.7 

25 .......... YES ............ NO .............. 01 SURG ......... Craniotomy & endovascular intracranial procedures w 

MCC.

4.9933 10.7 13.8 

26 .......... YES ............ NO .............. 01 SURG ......... Craniotomy & endovascular intracranial procedures w CC 2.9515 6.7 8.4 

27 .......... YES ............ NO .............. 01 SURG ......... Craniotomy & endovascular intracranial procedures w/o 

CC/MCC.

2.0380 3.6 4.7 

28 .......... NO .............. NO .............. 01 SURG ......... Spinal procedures w MCC ................................................... 4.9251 10.9 14.7 

29 .......... NO .............. NO .............. 01 SURG ......... Spinal procedures w CC ...................................................... 2.5965 5.7 7.7 

30 .......... NO .............. NO .............. 01 SURG ......... Spinal procedures w/o CC/MCC .......................................... 1.5278 2.7 3.7 

31 .......... NO .............. NO .............. 01 SURG ......... Ventricular shunt procedures w MCC .................................. 3.8505 9.2 13.2 

32 .......... NO .............. NO .............. 01 SURG ......... Ventricular shunt procedures w CC ..................................... 1.7502 3.9 5.8 

33 .......... NO .............. NO .............. 01 SURG ......... Ventricular shunt procedures w/o CC/MCC ........................ 1.2661 2.3 3.1 

34 .......... NO .............. NO .............. 01 SURG ......... Carotid artery stent procedure w MCC ................................ 3.2158 4.8 7.3 

35 .......... NO .............. NO .............. 01 SURG ......... Carotid artery stent procedure w CC ................................... 2.0186 2.0 3.0 

36 .......... NO .............. NO .............. 01 SURG ......... Carotid artery stent procedure w/o CC/MCC ...................... 1.5746 1.3 1.6 

37 .......... NO .............. NO .............. 01 SURG ......... Extracranial procedures w MCC .......................................... 3.0383 6.0 8.7 

38 .......... NO .............. NO .............. 01 SURG ......... Extracranial procedures w CC ............................................. 1.5518 2.6 3.8 

39 .......... NO .............. NO .............. 01 SURG ......... Extracranial procedures w/o CC/MCC ................................. 1.0172 1.5 1.9 

40 .......... YES ............ YES ............ 01 SURG ......... Periph & cranial nerve & other nerv syst proc w MCC ....... 3.8181 10.4 14.0 

41 .......... YES ............ YES ............ 01 SURG ......... Periph & cranial nerve & other nerv syst proc w CC .......... 2.1436 5.6 7.5 

42 .......... YES ............ YES ............ 01 SURG ......... Periph & cranial nerve & other nerv syst proc w/o CC/ 

MCC.

1.6878 2.5 3.7 

52 .......... NO .............. NO .............. 01 MED ........... Spinal disorders & injuries w CC/MCC ................................ 1.5118 4.9 6.8 

53 .......... NO .............. NO .............. 01 MED ........... Spinal disorders & injuries w/o CC/MCC ............................. 0.9105 3.2 4.0 

54 .......... YES ............ NO .............. 01 MED ........... Nervous system neoplasms w MCC ................................... 1.6182 5.5 7.4 

55 .......... YES ............ NO .............. 01 MED ........... Nervous system neoplasms w/o MCC ................................ 1.0567 3.9 5.1 

56 .......... YES ............ NO .............. 01 MED ........... Degenerative nervous system disorders w MCC ................ 1.6121 6.2 8.2 

57 .......... YES ............ NO .............. 01 MED ........... Degenerative nervous system disorders w/o MCC ............. 0.8403 4.0 5.0 

58 .......... NO .............. NO .............. 01 MED ........... Multiple sclerosis & cerebellar ataxia w MCC ..................... 1.6022 5.8 8.0 

59 .......... NO .............. NO .............. 01 MED ........... Multiple sclerosis & cerebellar ataxia w CC ........................ 0.9288 4.3 5.2 

60 .......... NO .............. NO .............. 01 MED ........... Multiple sclerosis & cerebellar ataxia w/o CC/MCC ............ 0.7126 3.4 4.1 

61 .......... NO .............. NO .............. 01 MED ........... Acute ischemic stroke w use of thrombolytic agent w MCC 2.9195 7.4 9.8 

62 .......... NO .............. NO .............. 01 MED ........... Acute ischemic stroke w use of thrombolytic agent w CC .. 1.9977 5.4 6.4 

63 .......... NO .............. NO .............. 01 MED ........... Acute ischemic stroke w use of thrombolytic agent w/o 

CC/MCC.

1.5581 4.0 4.6 

64 .......... YES ............ NO .............. 01 MED ........... Intracranial hemorrhage or cerebral infarction w MCC ....... 1.9072 5.9 7.9 

65 .......... YES ............ NO .............. 01 MED ........... Intracranial hemorrhage or cerebral infarction w CC .......... 1.1841 4.5 5.4 

66 .......... YES ............ NO .............. 01 MED ........... Intracranial hemorrhage or cerebral infarction w/o CC/ 

MCC.

0.8588 3.2 3.8 

67 .......... NO .............. NO .............. 01 MED ........... Nonspecific cva & precerebral occlusion w/o infarct w 

MCC.

1.5069 4.8 6.2 

68 .......... NO .............. NO .............. 01 MED ........... Nonspecific cva & precerebral occlusion w/o infarct w/o 

MCC.

0.8855 2.8 3.6 

69 .......... NO .............. NO .............. 01 MED ........... Transient ischemia ............................................................... 0.7372 2.5 3.1 

70 .......... YES ............ NO .............. 01 MED ........... Nonspecific cerebrovascular disorders w MCC ................... 1.8674 6.3 8.2 

71 .......... YES ............ NO .............. 01 MED ........... Nonspecific cerebrovascular disorders w CC ...................... 1.1698 4.6 5.8 

mmaher on DSK3CLS3C1PROD with $$_JOB

24962 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

72 .......... YES ............ NO .............. 01 MED ........... Nonspecific cerebrovascular disorders w/o CC/MCC ......... 0.8275 3.0 3.8 

73 .......... NO .............. NO .............. 01 MED ........... Cranial & peripheral nerve disorders w MCC ...................... 1.3298 4.8 6.4 

74 .......... NO .............. NO .............. 01 MED ........... Cranial & peripheral nerve disorders w/o MCC ................... 0.8482 3.4 4.4 

75 .......... NO .............. NO .............. 01 MED ........... Viral meningitis w CC/MCC ................................................. 1.7156 6.1 7.7 

76 .......... NO .............. NO .............. 01 MED ........... Viral meningitis w/o CC/MCC .............................................. 0.9367 3.5 4.2 

77 .......... NO .............. NO .............. 01 MED ........... Hypertensive encephalopathy w MCC ................................ 1.7374 5.6 7.2 

78 .......... NO .............. NO .............. 01 MED ........... Hypertensive encephalopathy w CC ................................... 1.0221 3.8 4.6 

79 .......... NO .............. NO .............. 01 MED ........... Hypertensive encephalopathy w/o CC/MCC ....................... 0.8041 2.9 3.5 

80 .......... NO .............. NO .............. 01 MED ........... Nontraumatic stupor & coma w MCC .................................. 1.0699 3.6 4.9 

81 .......... NO .............. NO .............. 01 MED ........... Nontraumatic stupor & coma w/o MCC ............................... 0.6932 2.7 3.4 

82 .......... NO .............. NO .............. 01 MED ........... Traumatic stupor & coma, coma ≤1 hr w MCC ................... 2.0060 3.9 6.4 

83 .......... NO .............. NO .............. 01 MED ........... Traumatic stupor & coma, coma ≤1 hr w CC ...................... 1.3451 3.8 5.3 

84 .......... NO .............. NO .............. 01 MED ........... Traumatic stupor & coma, coma ≤1 hr w/o CC/MCC ......... 0.8999 2.3 3.1 

85 .......... YES ............ NO .............. 01 MED ........... Traumatic stupor & coma, coma <1 hr w MCC .................. 2.0578 6.0 8.2 

86 .......... YES ............ NO .............. 01 MED ........... Traumatic stupor & coma, coma <1 hr w CC ..................... 1.1911 4.1 5.3 

87 .......... YES ............ NO .............. 01 MED ........... Traumatic stupor & coma, coma <1 hr w/o CC/MCC ......... 0.8097 2.7 3.4 

88 .......... NO .............. NO .............. 01 MED ........... Concussion w MCC ............................................................. 1.5966 4.3 6.1 

89 .......... NO .............. NO .............. 01 MED ........... Concussion w CC ................................................................ 0.9494 3.0 3.8 

90 .......... NO .............. NO .............. 01 MED ........... Concussion w/o CC/MCC .................................................... 0.6755 2.0 2.5 

91 .......... YES ............ NO .............. 01 MED ........... Other disorders of nervous system w MCC ........................ 1.6189 4.9 6.8 

92 .......... YES ............ NO .............. 01 MED ........... Other disorders of nervous system w CC ........................... 0.9082 3.6 4.5 

93 .......... YES ............ NO .............. 01 MED ........... Other disorders of nervous system w/o CC/MCC ............... 0.6805 2.6 3.2 

94 .......... NO .............. NO .............. 01 MED ........... Bacterial & tuberculous infections of nervous system w 

MCC.

3.5061 10.3 12.9 

95 .......... NO .............. NO .............. 01 MED ........... Bacterial & tuberculous infections of nervous system w CC 2.3341 7.7 9.4 

96 .......... NO .............. NO .............. 01 MED ........... Bacterial & tuberculous infections of nervous system w/o 

CC/MCC.

1.9369 5.1 6.3 

97 .......... NO .............. NO .............. 01 MED ........... Non-bacterial infect of nervous sys exc viral meningitis w 

MCC.

3.0776 9.6 12.0 

98 .......... NO .............. NO .............. 01 MED ........... Non-bacterial infect of nervous sys exc viral meningitis w 

CC.

1.8380 7.0 8.7 

99 .......... NO .............. NO .............. 01 MED ........... Non-bacterial infect of nervous sys exc viral meningitis w/o 

CC/MCC.

1.3644 5.2 6.4 

100 ........ YES ............ NO .............. 01 MED ........... Seizures w MCC .................................................................. 1.5034 4.8 6.4 

101 ........ YES ............ NO .............. 01 MED ........... Seizures w/o MCC ............................................................... 0.7674 3.0 3.7 

102 ........ NO .............. NO .............. 01 MED ........... Headaches w MCC .............................................................. 1.0425 3.6 5.1 

103 ........ NO .............. NO .............. 01 MED ........... Headaches w/o MCC ........................................................... 0.6534 2.5 3.2 

113 ........ NO .............. NO .............. 02 SURG ......... Orbital procedures w CC/MCC ............................................ 1.6088 3.9 5.6 

114 ........ NO .............. NO .............. 02 SURG ......... Orbital procedures w/o CC/MCC ......................................... 0.8349 2.0 2.7 

15 .......... NO .............. NO .............. 02 SURG ......... Extraocular procedures except orbit .................................... 1.0782 3.3 4.5 

116 ........ NO .............. NO .............. 02 SURG ......... Intraocular procedures w CC/MCC ...................................... 1.0167 2.2 3.5 

117 ........ NO .............. NO .............. 02 SURG ......... Intraocular procedures w/o CC/MCC ................................... 0.6329 1.5 2.0 

121 ........ NO .............. NO .............. 02 MED ........... Acute major eye infections w CC/MCC ............................... 1.0166 4.7 5.9 

122 ........ NO .............. NO .............. 02 MED ........... Acute major eye infections w/o CC/MCC ............................ 0.5585 3.4 4.1 

123 ........ NO .............. NO .............. 02 MED ........... Neurological eye disorders .................................................. 0.7168 2.4 2.9 

124 ........ NO .............. NO .............. 02 MED ........... Other disorders of the eye w MCC ...................................... 1.1057 4.0 5.3 

125 ........ NO .............. NO .............. 02 MED ........... Other disorders of the eye w/o MCC ................................... 0.6561 2.7 3.5 

129 ........ NO .............. NO .............. 03 SURG ......... Major head & neck procedures w CC/MCC or major device.1.9117 3.6 5.1 

130 ........ NO .............. NO .............. 03 SURG ......... Major head & neck procedures w/o CC/MCC ..................... 1.1754 2.5 3.2 

131 ........ NO .............. NO .............. 03 SURG ......... Cranial/facial procedures w CC/MCC .................................. 1.8374 3.9 5.6 

132 ........ NO .............. NO .............. 03 SURG ......... Cranial/facial procedures w/o CC/MCC ............................... 1.0808 2.1 2.6 

133 ........ NO .............. NO .............. 03 SURG ......... Other ear, nose, mouth & throat O.R. procedures w CC/ 

MCC.

1.7401 4.1 6.4 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24963 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

134 ........ NO .............. NO .............. 03 SURG ......... Other ear, nose, mouth & throat O.R. procedures w/o CC/ 

MCC.

0.7834 1.8 2.3 

135 ........ NO .............. NO .............. 03 SURG ......... Sinus & mastoid procedures w CC/MCC ............................ 1.8091 4.0 6.1 

136 ........ NO .............. NO .............. 03 SURG ......... Sinus & mastoid procedures w/o CC/MCC ......................... 0.9299 1.7 2.3 

137 ........ NO .............. NO .............. 03 SURG ......... Mouth procedures w CC/MCC ............................................. 1.3963 3.7 5.4 

138 ........ NO .............. NO .............. 03 SURG ......... Mouth procedures w/o CC/MCC .......................................... 0.7922 1.9 2.4 

139 ........ NO .............. NO .............. 03 SURG ......... Salivary gland procedures ................................................... 0.8585 1.5 1.9 

146 ........ NO .............. NO .............. 03 MED ........... Ear, nose, mouth & throat malignancy w MCC ................... 2.2573 7.1 10.2 

147 ........ NO .............. NO .............. 03 MED ........... Ear, nose, mouth & throat malignancy w CC ...................... 1.1662 4.2 5.8 

148 ........ NO .............. NO .............. 03 MED ........... Ear, nose, mouth & throat malignancy w/o CC/MCC .......... 0.7281 2.5 3.5 

149 ........ NO .............. NO .............. 03 MED ........... Dysequilibrium ...................................................................... 0.6154 2.2 2.7 

150 ........ NO .............. NO .............. 03 MED ........... Epistaxis w MCC .................................................................. 1.3003 4.0 5.5 

151 ........ NO .............. NO .............. 03 MED ........... Epistaxis w/o MCC ............................................................... 0.5760 2.3 2.9 

152 ........ NO .............. NO .............. 03 MED ........... Otitis media & URI w MCC .................................................. 0.9462 3.7 4.7 

153 ........ NO .............. NO .............. 03 MED ........... Otitis media & URI w/o MCC ............................................... 0.6048 2.8 3.4 

154 ........ NO .............. NO .............. 03 MED ........... Nasal trauma & deformity w MCC ....................................... 1.3989 4.9 6.5 

155 ........ NO .............. NO .............. 03 MED ........... Nasal trauma & deformity w CC .......................................... 0.8749 3.6 4.6 

156 ........ NO .............. NO .............. 03 MED ........... Nasal trauma & deformity w/o CC/MCC .............................. 0.6360 2.5 3.2 

157 ........ NO .............. NO .............. 03 MED ........... Dental & Oral Diseases w MCC .......................................... 1.4922 5.0 6.9 

158 ........ NO .............. NO .............. 03 MED ........... Dental & Oral Diseases w CC ............................................. 0.8634 3.4 4.5 

159 ........ NO .............. NO .............. 03 MED ........... Dental & Oral Diseases w/o CC/MCC ................................. 0.6046 2.4 3.1 

163 ........ YES ............ NO .............. 04 SURG ......... Major chest procedures w MCC .......................................... 5.0199 12.7 15.4 

164 ........ YES ............ NO .............. 04 SURG ......... Major chest procedures w CC ............................................. 2.5482 7.0 8.5 

165 ........ YES ............ NO .............. 04 SURG ......... Major chest procedures w/o CC/MCC ................................. 1.7780 4.5 5.4 

166 ........ YES ............ NO .............. 04 SURG ......... Other resp system O.R. procedures w MCC ...................... 3.7734 10.6 13.4 

167 ........ YES ............ NO .............. 04 SURG ......... Other resp system O.R. procedures w CC ......................... 2.0778 6.7 8.3 

168 ........ YES ............ NO .............. 04 SURG ......... Other resp system O.R. procedures w/o CC/MCC ............. 1.3566 4.1 5.5 

175 ........ YES ............ NO .............. 04 MED ........... Pulmonary embolism w MCC .............................................. 1.6160 6.4 7.6 

176 ........ YES ............ NO .............. 04 MED ........... Pulmonary embolism w/o MCC ........................................... 1.0969 4.9 5.6 

177 ........ YES ............ NO .............. 04 MED ........... Respiratory infections & inflammations w MCC .................. 2.0518 7.6 9.5 

178 ........ YES ............ NO .............. 04 MED ........... Respiratory infections & inflammations w CC ..................... 1.5058 6.3 7.7 

179 ........ YES ............ NO .............. 04 MED ........... Respiratory infections & inflammations w/o CC/MCC ......... 1.0484 4.8 5.8 

180 ........ NO .............. NO .............. 04 MED ........... Respiratory neoplasms w MCC ........................................... 1.7205 6.1 8.0 

181 ........ NO .............. NO .............. 04 MED ........... Respiratory neoplasms w CC .............................................. 1.2288 4.6 6.0 

182 ........ NO .............. NO .............. 04 MED ........... Respiratory neoplasms w/o CC/MCC .................................. 0.8973 3.3 4.3 

183 ........ NO .............. NO .............. 04 MED ........... Major chest trauma w MCC ................................................. 1.5059 5.7 7.2 

184 ........ NO .............. NO .............. 04 MED ........... Major chest trauma w CC .................................................... 0.9082 3.8 4.7 

185 ........ NO .............. NO .............. 04 MED ........... Major chest trauma w/o CC/MCC ........................................ 0.6322 2.7 3.3 

186 ........ YES ............ NO .............. 04 MED ........... Pleural effusion w MCC ....................................................... 1.6338 6.0 7.7 

187 ........ YES ............ NO .............. 04 MED ........... Pleural effusion w CC .......................................................... 1.1228 4.4 5.6 

188 ........ YES ............ NO .............. 04 MED ........... Pleural effusion w/o CC/MCC .............................................. 0.8350 3.3 4.2 

189 ........ NO .............. NO .............. 04 MED ........... Pulmonary edema & respiratory failure ............................... 1.3833 4.9 6.3 

190 ........ YES ............ NO .............. 04 MED ........... Chronic obstructive pulmonary disease w MCC ................. 1.3448 5.3 6.6 

191 ........ YES ............ NO .............. 04 MED ........... Chronic obstructive pulmonary disease w CC .................... 1.0024 4.3 5.2 

192 ........ YES ............ NO .............. 04 MED ........... Chronic obstructive pulmonary disease w/o CC/MCC ........ 0.7484 3.4 4.1 

193 ........ YES ............ NO .............. 04 MED ........... Simple pneumonia & pleurisy w MCC ................................. 1.4737 5.7 7.0 

194 ........ YES ............ NO .............. 04 MED ........... Simple pneumonia & pleurisy w CC .................................... 1.0280 4.5 5.4 

195 ........ YES ............ NO .............. 04 MED ........... Simple pneumonia & pleurisy w/o CC/MCC ........................ 0.7461 3.6 4.2 

196 ........ YES ............ NO .............. 04 MED ........... Interstitial lung disease w MCC ........................................... 1.5597 6.0 7.5 

197 ........ YES ............ NO .............. 04 MED ........... Interstitial lung disease w CC .............................................. 1.1041 4.5 5.5 

198 ........ YES ............ NO .............. 04 MED ........... Interstitial lung disease w/o CC/MCC .................................. 0.8423 3.5 4.3 

199 ........ NO .............. NO .............. 04 MED ........... Pneumothorax w MCC ......................................................... 1.7928 6.7 8.5 

200 ........ NO .............. NO .............. 04 MED ........... Pneumothorax w CC ............................................................ 1.0158 4.0 5.2 

201 ........ NO .............. NO .............. 04 MED ........... Pneumothorax w/o CC/MCC ............................................... 0.7356 3.2 4.1 

202 ........ NO .............. NO .............. 04 MED ........... Bronchitis & asthma w CC/MCC ......................................... 0.8324 3.6 4.5 

203 ........ NO .............. NO .............. 04 MED ........... Bronchitis & asthma w/o CC/MCC ...................................... 0.6040 2.9 3.5 

204 ........ NO .............. NO .............. 04 MED ........... Respiratory signs & symptoms ............................................ 0.6685 2.2 2.9 

mmaher on DSK3CLS3C1PROD with $$_JOB

24964 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

205 ........ YES ............ NO .............. 04 MED ........... Other respiratory system diagnoses w MCC ....................... 1.2260 4.4 5.8 

206 ........ YES ............ NO .............. 04 MED ........... Other respiratory system diagnoses w/o MCC .................... 0.7438 2.7 3.5 

207 ........ YES ............ NO .............. 04 MED ........... Respiratory system diagnosis w ventilator support 96+ 

hours.

5.1817 13.0 15.3 

208 ........ NO .............. NO .............. 04 MED ........... Respiratory system diagnosis w ventilator support <96 

hours.

2.2694 5.3 7.4 

215 ........ NO .............. NO .............. 05 SURG ......... Other heart assist system implant ....................................... 11.3007 6.3 12.2 

216 ........ YES ............ NO .............. 05 SURG ......... Cardiac valve & oth maj cardiothoracic proc w card cath w 

MCC.

10.1554 16.5 19.3 

217 ........ YES ............ NO .............. 05 SURG ......... Cardiac valve & oth maj cardiothoracic proc w card cath w 

CC.

6.7770 11.2 12.6 

218 ........ YES ............ NO .............. 05 SURG ......... Cardiac valve & oth maj cardiothoracic proc w card cath 

w/o CC/MCC.

5.3817 8.5 9.2 

219 ........ YES ............ YES ............ 05 SURG ......... Cardiac valve & oth maj cardiothoracic proc w/o card cath 

w MCC.

8.0521 12.0 14.7 

220 ........ YES ............ YES ............ 05 SURG ......... Cardiac valve & oth maj cardiothoracic proc w/o card cath 

w CC.

5.2148 7.7 8.8 

221 ........ YES ............ YES ............ 05 SURG ......... Cardiac valve & oth maj cardiothoracic proc w/o card cath 

w/o CC/MCC.

4.2664 6.1 6.5 

222 ........ NO .............. NO .............. 05 SURG ......... Cardiac defib implant w cardiac cath w AMI/HF/shock w 

MCC.

8.7087 10.8 13.3 

223 ........ NO .............. NO .............. 05 SURG ......... Cardiac defib implant w cardiac cath w AMI/HF/shock w/o 

MCC.

6.4941 5.0 6.6 

224 ........ NO .............. NO .............. 05 SURG ......... Cardiac defib implant w cardiac cath w/o AMI/HF/shock w 

MCC.

8.0293 9.2 11.5 

225 ........ NO .............. NO .............. 05 SURG ......... Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/ 

o MCC.

6.0000 4.6 5.8 

226 ........ NO .............. NO .............. 05 SURG ......... Cardiac defibrillator implant w/o cardiac cath w MCC ........ 6.6475 6.2 9.4 

227 ........ NO .............. NO .............. 05 SURG ......... Cardiac defibrillator implant w/o cardiac cath w/o MCC ..... 4.9179 1.8 2.8 

228 ........ YES ............ NO .............. 05 SURG ......... Other cardiothoracic procedures w MCC ............................ 7.6611 12.4 15.1 

229 ........ YES ............ NO .............. 05 SURG ......... Other cardiothoracic procedures w CC ............................... 4.9100 8.1 9.3 

230 ........ YES ............ NO .............. 05 SURG ......... Other cardiothoracic procedures w/o CC/MCC ................... 3.8738 5.8 6.7 

231 ........ NO .............. NO .............. 05 SURG ......... Coronary bypass w PTCA w MCC ...................................... 7.8839 10.8 13.2 

232 ........ NO .............. NO .............. 05 SURG ......... Coronary bypass w PTCA w/o MCC ................................... 5.7100 8.1 9.0 

233 ........ YES ............ NO .............. 05 SURG ......... Coronary bypass w cardiac cath w MCC ............................ 7.1576 12.9 14.7 

234 ........ YES ............ NO .............. 05 SURG ......... Coronary bypass w cardiac cath w/o MCC ......................... 4.6250 8.3 9.0 

235 ........ YES ............ NO .............. 05 SURG ......... Coronary bypass w/o cardiac cath w MCC ......................... 5.8085 10.0 11.9 

236 ........ YES ............ NO .............. 05 SURG ......... Coronary bypass w/o cardiac cath w/o MCC ...................... 3.5360 6.1 6.7 

237 ........ NO .............. NO .............. 05 SURG ......... Major cardiovascular procedures w MCC ........................... 5.1414 8.3 11.6 

238 ........ NO .............. NO .............. 05 SURG ......... Major cardiovascular procedures w/o MCC ........................ 2.8491 3.4 4.9 

239 ........ YES ............ NO .............. 05 SURG ......... Amputation for circ sys disorders exc upper limb & toe w 

MCC.

4.4948 13.6 16.9 

240 ........ YES ............ NO .............. 05 SURG ......... Amputation for circ sys disorders exc upper limb & toe w 

CC.

2.6343 9.4 11.4 

241 ........ YES ............ NO .............. 05 SURG ......... Amputation for circ sys disorders exc upper limb & toe w/o 

CC/MCC.

1.6041 6.2 7.4 

242 ........ YES ............ NO .............. 05 SURG ......... Permanent cardiac pacemaker implant w MCC .................. 3.7363 7.1 9.1 

243 ........ YES ............ NO .............. 05 SURG ......... Permanent cardiac pacemaker implant w CC ..................... 2.5922 3.9 5.2 

244 ........ YES ............ NO .............. 05 SURG ......... Permanent cardiac pacemaker implant w/o CC/MCC ......... 2.0181 2.2 3.0

245 ........ NO .............. NO .............. 05 SURG ......... AICD lead & generator procedures ..................................... 3.1597 2.1 3.3 

246 ........ NO .............. NO .............. 05 SURG ......... PercutAneous cardiovascular proc w drugeluting stent w 

MCC.

3.3910 4.4 6.3 

247 ........ NO .............. NO .............. 05 SURG ......... PercutAneous cardiovascular proc w drugeluting stent w/o 

MCC.

2.0829 1.7 2.2 

248 ........ NO .............. NO .............. 05 SURG ......... PercutAneous cardiovasc proc w non drugeluting stent w 

MCC.

2.9777 4.7 6.5 

249 ........ NO .............. NO .............. 05 SURG ......... PercutAneous cardiovasc proc w non drugeluting stent w/ 

o MCC.

1.7813 1.9 2.5 

250 ........ NO .............. NO .............. 05 SURG ......... Perc cardiovasc proc w/o coronary artery stent or AMI w 

MCC.

2.8561 5.3 7.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24965 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

251 ........ NO .............. NO .............. 05 SURG ......... Perc cardiovasc proc w/o coronary artery stent or AMI w/o 

MCC.

1.6341 2.1 3.0 

252 ........ NO .............. NO .............. 05 SURG ......... Other vascular procedures w MCC ..................................... 2.9234 5.7 8.8 

253 ........ NO .............. NO .............. 05 SURG ......... Other vascular procedures w CC ........................................ 2.2669 4.3 6.3 

254 ........ NO .............. NO .............. 05 SURG ......... Other vascular procedures w/o CC/MCC ............................ 1.5412 2.1 2.9 

255 ........ YES ............ NO .............. 05 SURG ......... Upper limb & toe amputation for circ system disorders w 

MCC.

2.4736 8.0 10.5 

256 ........ YES ............ NO .............. 05 SURG ......... Upper limb & toe amputation for circ system disorders w 

CC.

1.5502 6.2 7.9 

257 ........ YES ............ NO .............. 05 SURG ......... Upper limb & toe amputation for circ system disorders w/o 

CC/MCC.

0.9882 3.9 5.2 

258 ........ NO .............. NO .............. 05 SURG ......... Cardiac pacemaker device replacement w MCC ................ 2.9077 5.5 7.6 

259 ........ NO .............. NO .............. 05 SURG ......... Cardiac pacemaker device replacement w/o MCC ............. 1.6063 1.9 2.6 

260 ........ NO .............. NO .............. 05 SURG ......... Cardiac pacemaker revision except device replacement w 

MCC.

2.9653 7.3 10.3 

261 ........ NO .............. NO .............. 05 SURG ......... Cardiac pacemaker revision except device replacement w 

CC.

1.3133 2.8 4.0 

262 ........ NO .............. NO .............. 05 SURG ......... Cardiac pacemaker revision except device replacement w/ 

o CC/MCC.

0.9197 1.9 2.5 

263 ........ NO .............. NO .............. 05 SURG ......... Vein ligation & stripping ....................................................... 1.5146 3.5 5.5 

264 ........ YES ............ NO .............. 05 SURG ......... Other circulatory system O.R. procedures .......................... 2.4755 6.1 9.2 

280 ........ YES ............ NO .............. 05 MED ........... Acute myocardial infarction, discharged alive w MCC ........ 1.9690 6.4 7.8 

281 ........ YES ............ NO .............. 05 MED ........... Acute myocardial infarction, discharged alive w CC ........... 1.2675 4.2 5.1 

282 ........ YES ............ NO .............. 05 MED ........... Acute myocardial infarction, discharged alive w/o CC/MCC 0.9121 2.7 3.4 

283 ........ NO .............. NO .............. 05 MED ........... Acute myocardial infarction, expired w MCC ...................... 1.7404 3.4 5.5 

284 ........ NO .............. NO .............. 05 MED ........... Acute myocardial infarction, expired w CC ......................... 1.0037 2.3 3.5 

285 ........ NO .............. NO .............. 05 MED ........... Acute myocardial infarction, expired w/o CC/MCC ............. 0.6679 1.7 2.3 

286 ........ NO .............. NO .............. 05 MED ........... Circulatory disorders except AMI, w card cath w MCC ...... 2.0464 5.3 7.1 

287 ........ NO .............. NO .............. 05 MED ........... Circulatory disorders except AMI, w card cath w/o MCC ... 1.0939 2.5 3.2 

288 ........ YES ............ NO .............. 05 MED ........... Acute & subacute endocarditis w MCC ............................... 3.1146 10.4 12.8 

289 ........ YES ............ NO .............. 05 MED ........... Acute & subacute endocarditis w CC .................................. 1.9306 7.7 9.2 

290 ........ YES ............ NO .............. 05 MED ........... Acute & subacute endocarditis w/o CC/MCC ...................... 1.2534 5.6 6.9 

291 ........ YES ............ NO .............. 05 MED ........... Heart failure & shock w MCC .............................................. 1.4850 5.3 6.8 

292 ........ YES ............ NO .............. 05 MED ........... Heart failure & shock w CC ................................................. 1.0216 4.3 5.2 

293 ........ YES ............ NO .............. 05 MED ........... Heart failure & shock w/o CC/MCC ..................................... 0.7317 3.1 3.8 

294 ........ NO .............. NO .............. 05 MED ........... Deep vein thrombophlebitis w CC/MCC .............................. 0.9403 4.6 5.6 

295 ........ NO .............. NO .............. 05 MED ........... Deep vein thrombophlebitis w/o CC/MCC ........................... 0.5995 3.8 4.4 

296 ........ NO .............. NO .............. 05 MED ........... Cardiac arrest, unexplained w MCC .................................... 1.3021 2.0 3.3 

297 ........ NO .............. NO .............. 05 MED ........... Cardiac arrest, unexplained w CC ....................................... 0.7673 1.5 2.0 

298 ........ NO .............. NO .............. 05 MED ........... Cardiac arrest, unexplained w/o CC/MCC .......................... 0.4932 1.2 1.5 

299 ........ YES ............ NO .............. 05 MED ........... Peripheral vascular disorders w MCC ................................. 1.4537 5.4 7.1 

300 ........ YES ............ NO .............. 05 MED ........... Peripheral vascular disorders w CC .................................... 0.9234 4.3 5.3 

301 ........ YES ............ NO .............. 05 MED ........... Peripheral vascular disorders w/o CC/MCC ........................ 0.6535 3.1 3.8 

302 ........ NO .............. NO .............. 05 MED ........... Atherosclerosis w MCC ....................................................... 1.0240 3.3 4.4 

303 ........ NO .............. NO .............. 05 MED ........... Atherosclerosis w/o MCC .................................................... 0.5972 2.1 2.6 

304 ........ NO .............. NO .............. 05 MED ........... Hypertension w MCC ........................................................... 1.0693 4.0 5.3 

305 ........ NO .............. NO .............. 05 MED ........... Hypertension w/o MCC ........................................................ 0.5937 2.3 2.9 

306 ........ NO .............. NO .............. 05 MED ........... Cardiac congenital & valvular disorders w MCC ................. 1.4448 4.7 6.5 

307 ........ NO .............. NO .............. 05 MED ........... Cardiac congenital & valvular disorders w/o MCC .............. 0.7582 2.8 3.5 

308 ........ NO .............. NO .............. 05 MED ........... Cardiac arrhythmia & conduction disorders w MCC ........... 1.3406 4.3 5.8 

309 ........ NO .............. NO .............. 05 MED ........... Cardiac arrhythmia & conduction disorders w CC .............. 0.8421 3.2 4.0 

310 ........ NO .............. NO .............. 05 MED ........... Cardiac arrhythmia & conduction disorders w/o CC/MCC .. 0.5917 2.3 2.8 

311 ........ NO .............. NO .............. 05 MED ........... Angina pectoris .................................................................... 0.5209 1.9 2.3 

mmaher on DSK3CLS3C1PROD with $$_JOB

24966 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

312 ........ NO .............. NO .............. 05 MED ........... Syncope & collapse ............................................................. 0.7198 2.5 3.2 

313 ........ NO .............. NO .............. 05 MED ........... Chest pain ............................................................................ 0.5588 1.7 2.1 

314 ........ YES ............ NO .............. 05 MED ........... Other circulatory system diagnoses w MCC ....................... 1.7436 5.3 7.3 

315 ........ YES ............ NO .............. 05 MED ........... Other circulatory system diagnoses w CC .......................... 0.9947 3.7 4.8 

316 ........ YES ............ NO .............. 05 MED ........... Other circulatory system diagnoses w/o CC/MCC .............. 0.6650 2.4 3.1 

326 ........ YES ............ NO .............. 06 SURG ......... Stomach, esophageal & duodenal proc w MCC ................. 5.9079 13.9 17.7 

327 ........ YES ............ NO .............. 06 SURG ......... Stomach, esophageal & duodenal proc w CC .................... 2.8426 8.2 10.5 

328 ........ YES ............ NO .............. 06 SURG ......... Stomach, esophageal & duodenal proc w/o CC/MCC ........ 1.4776 3.4 4.6 

329 ........ YES ............ NO .............. 06 SURG ......... Major small & large bowel procedures w MCC ................... 5.1551 13.3 16.4 

330 ........ YES ............ NO .............. 06 SURG ......... Major small & large bowel procedures w CC ...................... 2.5597 8.6 10.0 

331 ........ YES ............ NO .............. 06 SURG ......... Major small & large bowel procedures w/o CC/MCC .......... 1.6155 5.5 6.1 

332 ........ YES ............ NO .............. 06 SURG ......... Rectal resection w MCC ...................................................... 4.6624 12.7 15.2 

333 ........ YES ............ NO .............. 06 SURG ......... Rectal resection w CC ......................................................... 2.4296 8.0 9.1 

334 ........ YES ............ NO .............. 06 SURG ......... Rectal resection w/o CC/MCC ............................................. 1.5965 5.0 5.7 

335 ........ YES ............ NO .............. 06 SURG ......... Peritoneal adhesiolysis w MCC ........................................... 4.2165 12.2 14.7 

336 ........ YES ............ NO .............. 06 SURG ......... Peritoneal adhesiolysis w CC .............................................. 2.2499 7.8 9.4 

337 ........ YES ............ NO .............. 06 SURG ......... Peritoneal adhesiolysis w/o CC/MCC .................................. 1.4712 4.5 5.7 

338 ........ NO .............. NO .............. 06 SURG ......... Appendectomy w complicated principal diag w MCC ......... 3.3316 9.1 10.9 

339 ........ NO .............. NO .............. 06 SURG ......... Appendectomy w complicated principal diag w CC ............ 1.8705 6.2 7.2 

340 ........ NO .............. NO .............. 06 SURG ......... Appendectomy w complicated principal diag w/o CC/MCC 1.2680 3.6 4.3 

341 ........ NO .............. NO .............. 06 SURG ......... Appendectomy w/o complicated principal diag w MCC ...... 2.3828 5.4 7.3 

342 ........ NO .............. NO .............. 06 SURG ......... Appendectomy w/o complicated principal diag w CC ......... 1.3623 3.4 4.4 

343 ........ NO .............. NO .............. 06 SURG ......... Appendectomy w/o complicated principal diag w/o CC/ 

MCC.

0.9442 1.9 2.3 

344 ........ NO .............. NO .............. 06 SURG ......... Minor small & large bowel procedures w MCC ................... 3.1864 9.4 12.1 

345 ........ NO .............. NO .............. 06 SURG ......... Minor small & large bowel procedures w CC ...................... 1.6018 6.3 7.3 

346 ........ NO .............. NO .............. 06 SURG ......... Minor small & large bowel procedures w/o CC/MCC .......... 1.1496 4.5 5.0 

347 ........ NO .............. NO .............. 06 SURG ......... Anal & stomal procedures w MCC ...................................... 2.1945 6.2 8.4 

348 ........ NO .............. NO .............. 06 SURG ......... Anal & stomal procedures w CC ......................................... 1.2723 4.2 5.6 

349 ........ NO .............. NO .............. 06 SURG ......... Anal & stomal procedures w/o CC/MCC ............................. 0.7728 2.4 3.1 

350 ........ NO .............. NO .............. 06 SURG ......... Inguinal & femoral hernia procedures w MCC .................... 2.3797 5.9 8.1 

351 ........ NO .............. NO .............. 06 SURG ......... Inguinal & femoral hernia procedures w CC ....................... 1.2299 3.5 4.7 

352 ........ NO .............. NO .............. 06 SURG ......... Inguinal & femoral hernia procedures w/o CC/MCC ........... 0.7910 1.9 2.5 

353 ........ NO .............. NO .............. 06 SURG ......... Hernia procedures except inguinal & femoral w MCC ........ 2.5720 6.6 8.7 

354 ........ NO .............. NO .............. 06 SURG ......... Hernia procedures except inguinal & femoral w CC ........... 1.3793 4.0 5.1 

355 ........ NO .............. NO .............. 06 SURG ......... Hernia procedures except inguinal & femoral w/o CC/MCC 0.9375 2.3 2.9 

356 ........ YES ............ NO .............. 06 SURG ......... Other digestive system O.R. procedures w MCC ............... 3.8336 10.0 13.7 

357 ........ YES ............ NO .............. 06 SURG ......... Other digestive system O.R. procedures w CC .................. 2.1324 6.3 8.3 

358 ........ YES ............ NO .............. 06 SURG ......... Other digestive system O.R. procedures w/o CC/MCC ...... 1.4045 3.6 4.7

368 ........ NO .............. NO .............. 06 MED ........... Major esophageal disorders w MCC ................................... 1.6379 5.1 6.7 

369 ........ NO .............. NO .............. 06 MED ........... Major esophageal disorders w CC ...................................... 1.0821 3.9 4.8 

370 ........ NO .............. NO .............. 06 MED ........... Major esophageal disorders w/o CC/MCC .......................... 0.8138 2.9 3.4 

371 ........ YES ............ NO .............. 06 MED ........... Major gastrointestinal disorders & peritoneal infections w 

MCC.

1.8831 6.9 9.0 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24967 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

372 ........ YES ............ NO .............. 06 MED ........... Major gastrointestinal disorders & peritoneal infections w 

CC.

1.2657 5.8 7.0 

373 ........ YES ............ NO .............. 06 MED ........... Major gastrointestinal disorders & peritoneal infections w/o 

CC/MCC.

0.8644 4.3 5.1 

374 ........ YES ............ NO .............. 06 MED ........... Digestive malignancy w MCC .............................................. 2.0243 6.7 9.0 

375 ........ YES ............ NO .............. 06 MED ........... Digestive malignancy w CC ................................................. 1.2489 4.7 6.1 

376 ........ YES ............ NO .............. 06 MED ........... Digestive malignancy w/o CC/MCC ..................................... 0.8688 3.2 4.1 

377 ........ YES ............ NO .............. 06 MED ........... G.I. hemorrhage w MCC ...................................................... 1.6119 5.2 6.6 

378 ........ YES ............ NO .............. 06 MED ........... G.I. hemorrhage w CC ......................................................... 1.0451 3.9 4.8 

379 ........ YES ............ NO .............. 06 MED ........... G.I. hemorrhage w/o CC/MCC ............................................ 0.7745 3.0 3.5 

380 ........ YES ............ NO .............. 06 MED ........... Complicated peptic ulcer w MCC ........................................ 1.7245 5.7 7.4 

381 ........ YES ............ NO .............. 06 MED ........... Complicated peptic ulcer w CC ........................................... 1.1612 4.4 5.4 

382 ........ YES ............ NO .............. 06 MED ........... Complicated peptic ulcer w/o CC/MCC ............................... 0.8139 3.1 3.7 

383 ........ NO .............. NO .............. 06 MED ........... Uncomplicated peptic ulcer w MCC .................................... 1.2971 4.6 5.9 

384 ........ NO .............. NO .............. 06 MED ........... Uncomplicated peptic ulcer w/o MCC ................................. 0.8274 3.2 3.9 

385 ........ NO .............. NO .............. 06 MED ........... Inflammatory bowel disease w MCC ................................... 1.8700 6.7 9.0 

386 ........ NO .............. NO .............. 06 MED ........... Inflammatory bowel disease w CC ...................................... 1.0592 4.6 5.8 

387 ........ NO .............. NO .............. 06 MED ........... Inflammatory bowel disease w/o CC/MCC .......................... 0.8063 3.6 4.4 

388 ........ YES ............ NO .............. 06 MED ........... G.I. obstruction w MCC ....................................................... 1.5834 5.7 7.6 

389 ........ YES ............ NO .............. 06 MED ........... G.I. obstruction w CC .......................................................... 0.9405 4.1 5.1 

390 ........ YES ............ NO .............. 06 MED ........... G.I. obstruction w/o CC/MCC .............................................. 0.6490 3.0 3.6 

391 ........ NO .............. NO .............. 06 MED ........... Esophagitis, gastroent & misc digest disorders w MCC ..... 1.1256 4.1 5.5 

392 ........ NO .............. NO .............. 06 MED ........... Esophagitis, gastroent & misc digest disorders w/o MCC .. 0.6920 2.8 3.6 

393 ........ NO .............. NO .............. 06 MED ........... Other digestive system diagnoses w MCC ......................... 1.5389 5.0 7.0 

394 ........ NO .............. NO .............. 06 MED ........... Other digestive system diagnoses w CC ............................ 0.9667 3.9 5.0 

395 ........ NO .............. NO .............. 06 MED ........... Other digestive system diagnoses w/o CC/MCC ................ 0.6878 2.7 3.4 

405 ........ YES ............ NO .............. 07 SURG ......... Pancreas, liver & shunt procedures w MCC ....................... 5.7069 13.3 17.8 

406 ........ YES ............ NO .............. 07 SURG ......... Pancreas, liver & shunt procedures w CC .......................... 2.7512 7.2 9.6 

407 ........ YES ............ NO .............. 07 SURG ......... Pancreas, liver & shunt procedures w/o CC/MCC .............. 1.7634 4.3 5.6 

408 ........ NO .............. NO .............. 07 SURG ......... Biliary tract proc except only cholecyst w or w/o c.d.e. w 

MCC.

4.2285 12.1 14.9 

409 ........ NO .............. NO .............. 07 SURG ......... Biliary tract proc except only cholecyst w or w/o c.d.e. w 

CC.

2.4974 8.3 10.0 

410 ........ NO .............. NO .............. 07 SURG ......... Biliary tract proc except only cholecyst w or w/o c.d.e. w/o 

CC/MCC.

1.7031 5.8 6.8 

411 ........ NO .............. NO .............. 07 SURG ......... Cholecystectomy w c.d.e. w MCC ....................................... 3.9469 10.9 13.1 

412 ........ NO .............. NO .............. 07 SURG ......... Cholecystectomy w c.d.e. w CC .......................................... 2.4190 7.6 8.9 

413 ........ NO .............. NO .............. 07 SURG ......... Cholecystectomy w c.d.e. w/o CC/MCC .............................. 1.7392 5.2 6.1 

414 ........ YES ............ NO .............. 07 SURG ......... Cholecystectomy except by laparoscope w/o c.d.e. w 

MCC.

3.6536 10.0 12.1 

415 ........ YES ............ NO .............. 07 SURG ......... Cholecystectomy except by laparoscope w/o c.d.e. w CC 2.0589 6.7 7.8 

416 ........ YES ............ NO .............. 07 SURG ......... Cholecystectomy except by laparoscope w/o c.d.e. w/o 

CC/MCC.

1.3309 4.2 4.9 

417 ........ NO .............. NO .............. 07 SURG ......... Laparoscopic cholecystectomy w/o c.d.e. w MCC .............. 2.5133 6.6 8.4 

418 ........ NO .............. NO .............. 07 SURG ......... Laparoscopic cholecystectomy w/o c.d.e. w CC ................. 1.6868 4.5 5.7 

419 ........ NO .............. NO .............. 07 SURG ......... Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC ..... 1.1458 2.5 3.2 

420 ........ NO .............. NO .............. 07 SURG ......... Hepatobiliary diagnostic procedures w MCC ...................... 4.1023 10.1 14.1 

421 ........ NO .............. NO .............. 07 SURG ......... Hepatobiliary diagnostic procedures w CC ......................... 1.9241 5.6 7.9 

422 ........ NO .............. NO .............. 07 SURG ......... Hepatobiliary diagnostic procedures w/o CC/MCC ............. 1.1906 3.4 4.5 

423 ........ NO .............. NO .............. 07 SURG ......... Other hepatobiliary or pancreas O.R. procedures w MCC 4.2038 11.4 15.4 

424 ........ NO .............. NO .............. 07 SURG ......... Other hepatobiliary or pancreas O.R. procedures w CC .... 2.4168 7.8 10.3 

425 ........ NO .............. NO .............. 07 SURG ......... Other hepatobiliary or pancreas O.R. procedures w/o CC/ 

MCC.

1.6595 4.7 5.9 

432 ........ NO .............. NO .............. 07 MED ........... Cirrhosis & alcoholic hepatitis w MCC ................................ 1.6308 5.2 6.9 

433 ........ NO .............. NO .............. 07 MED ........... Cirrhosis & alcoholic hepatitis w CC ................................... 0.9191 3.8 4.9 

434 ........ NO .............. NO .............. 07 MED ........... Cirrhosis & alcoholic hepatitis w/o CC/MCC ....................... 0.6679 2.8 3.6 

mmaher on DSK3CLS3C1PROD with $$_JOB

24968 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

435 ........ NO .............. NO .............. 07 MED ........... Malignancy of hepatobiliary system or pancreas w MCC ... 1.7244 5.8 7.7 

436 ........ NO .............. NO .............. 07 MED ........... Malignancy of hepatobiliary system or pancreas w CC ...... 1.1881 4.6 5.9 

437 ........ NO .............. NO .............. 07 MED ........... Malignancy of hepatobiliary system or pancreas w/o CC/ 

MCC.

0.9486 3.3 4.4 

438 ........ NO .............. NO .............. 07 MED ........... Disorders of pancreas except malignancy w MCC ............. 1.7775 5.7 7.8 

439 ........ NO .............. NO .............. 07 MED ........... Disorders of pancreas except malignancy w CC ................ 1.0709 4.3 5.5 

440 ........ NO .............. NO .............. 07 MED ........... Disorders of pancreas except malignancy w/o CC/MCC .... 0.7280 3.2 3.9 

441 ........ YES ............ NO .............. 07 MED ........... Disorders of liver except malig,cirr,alc hepa w MCC .......... 1.5813 5.2 7.1 

442 ........ YES ............ NO .............. 07 MED ........... Disorders of liver except malig,cirr,alc hepa w CC ............. 0.9918 4.1 5.2 

443 ........ YES ............ NO .............. 07 MED ........... Disorders of liver except malig,cirr,alc hepa w/o CC/MCC 0.7215 3.1 3.9 

444 ........ NO .............. NO .............. 07 MED ........... Disorders of the biliary tract w MCC ................................... 1.5675 5.2 6.7 

445 ........ NO .............. NO .............. 07 MED ........... Disorders of the biliary tract w CC ...................................... 1.0589 3.9 4.9 

446 ........ NO .............. NO .............. 07 MED ........... Disorders of the biliary tract w/o CC/MCC .......................... 0.7631 2.7 3.3 

453 ........ NO .............. NO .............. 08 SURG ......... Combined anterior/posterior spinal fusion w MCC .............. 10.1153 12.7 15.9 

454 ........ NO .............. NO .............. 08 SURG ......... Combined anterior/posterior spinal fusion w CC ................. 6.5111 7.0 8.7 

455 ........ NO .............. NO .............. 08 SURG ......... Combined anterior/posterior spinal fusion w/o CC/MCC ..... 4.8831 4.2 4.9 

456 ........ NO .............. NO .............. 08 SURG ......... Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w 

MCC.

8.2061 12.2 15.7 

457 ........ NO .............. NO .............. 08 SURG ......... Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w 

CC.

5.5526 6.8 8.3 

458 ........ NO .............. NO .............. 08 SURG ......... Spinal fusion exc cerv w spinal curv, malig or 9+ fusions 

w/o CC/MCC.

4.5646 4.2 4.8 

459 ........ YES ............ NO .............. 08 SURG ......... Spinal fusion except cervical w MCC .................................. 5.8259 8.2 10.0 

460 ........ YES ............ NO .............. 08 SURG ......... Spinal fusion except cervical w/o MCC ............................... 3.4246 3.8 4.4 

461 ........ NO .............. NO .............. 08 SURG ......... Bilateral or multiple major joint procs of lower extremity w 

MCC.

4.4292 7.0 8.4 

462 ........ NO .............. NO .............. 08 SURG ......... Bilateral or multiple major joint procs of lower extremity w/ 

o MCC.

3.0007 3.9 4.3 

463 ........ YES ............ NO .............. 08 SURG ......... Wnd debrid & skn grft exc hand, for musculoconn tiss dis 

w MCC.

4.6953 14.0 18.3 

464 ........ YES ............ NO .............. 08 SURG ......... Wnd debrid & skn grft exc hand, for musculoconn tiss dis 

w CC.

2.5929 8.4 11.0 

465 ........ YES ............ NO .............. 08 SURG ......... Wnd debrid & skn grft exc hand, for musculo-conn tiss dis 

w/o CC/MCC.

1.5985 4.9 6.5 

466 ........ YES ............ NO .............. 08 SURG ......... Revision of hip or knee replacement w MCC ...................... 4.3570 8.2 10.2 

467 ........ YES ............ NO .............. 08 SURG ......... Revision of hip or knee replacement w CC ......................... 2.9233 5.3 6.3 

468 ........ YES ............ NO .............. 08 SURG ......... Revision of hip or knee replacement w/o CC/MCC ............ 2.2405 3.7 4.1 

469 ........ YES ............ NO .............. 08 SURG ......... Major joint replacement or reattachment of lower extremity 

w MCC.

3.2932 7.5 8.9 

470 ........ YES ............ NO .............. 08 SURG ......... Major joint replacement or reattachment of lower extremity 

w/o MCC.

1.9422 3.8 4.0 

471 ........ NO .............. NO .............. 08 SURG ......... Cervical spinal fusion w MCC .............................................. 4.3150 7.0 10.1 

472 ........ NO .............. NO .............. 08 SURG ......... Cervical spinal fusion w CC ................................................. 2.5303 2.9 4.4 

473 ........ NO .............. NO .............. 08 SURG ......... Cervical spinal fusion w/o CC/MCC .................................... 1.8721 1.6 2.0 

474 ........ YES ............ NO .............. 08 SURG ......... Amputation for musculoskeletal sys & conn tissue dis w 

MCC.

3.3888 10.6 13.5 

475 ........ YES ............ NO .............. 08 SURG ......... Amputation for musculoskeletal sys & conn tissue dis w 

CC.

1.9833 7.2 9.2 

476 ........ YES ............ NO .............. 08 SURG ......... Amputation for musculoskeletal sys & conn tissue dis w/o 

CC/MCC.

1.1111 4.0 5.2 

477 ........ YES ............ YES ............ 08 SURG ......... Biopsies of musculoskeletal system & connective tissue w 

MCC.

3.3833 9.9 12.8 

478 ........ YES ............ YES ............ 08 SURG ......... Biopsies of musculoskeletal system & connective tissue w 

CC.

2.0553 4.9 7.0 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24969 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

479 ........ YES ............ YES ............ 08 SURG ......... Biopsies of musculoskeletal system & connective tissue w/ 

o CC/MCC.

1.4543 1.9 2.9 

480 ........ YES ............ YES ............ 08 SURG ......... Hip & femur procedures except major joint w MCC ............ 2.8506 8.2 9.7 

481 ........ YES ............ YES ............ 08 SURG ......... Hip & femur procedures except major joint w CC ............... 1.8267 5.7 6.3 

482 ........ YES ............ YES ............ 08 SURG ......... Hip & femur procedures except major joint w/o CC/MCC .. 1.4721 4.6 5.0 

483 ........ NO .............. NO .............. 08 SURG ......... Major joint & limb reattachment proc of upper extremity w 

CC/MCC.

2.1725 3.6 4.6 

484 ........ NO .............. NO .............. 08 SURG ......... Major joint & limb reattachment proc of upper extremity w/ 

o CC/MCC.

1.6673 2.2 2.5 

485 ........ NO .............. NO .............. 08 SURG ......... Knee procedures w pdx of infection w MCC ....................... 3.2946 10.4 12.7 

486 ........ NO .............. NO .............. 08 SURG ......... Knee procedures w pdx of infection w CC .......................... 2.1122 7.0 8.4 

487 ........ NO .............. NO .............. 08 SURG ......... Knee procedures w pdx of infection w/o CC/MCC .............. 1.5140 5.1 5.8 

488 ........ NO .............. NO .............. 08 SURG ......... Knee procedures w/o pdx of infection w CC/MCC .............. 1.6962 4.3 5.7 

489 ........ NO .............. NO .............. 08 SURG ......... Knee procedures w/o pdx of infection w/o CC/MCC ........... 1.0796 2.6 3.1 

490 ........ NO .............. NO .............. 08 SURG ......... Back & neck procedures except spinal fusion w CC/MCC 

or disc devices.

1.6543 3.4 4.9 

491 ........ NO .............. NO .............. 08 SURG ......... Back & neck procedures except spinal fusion w/o CC/ 

MCC.

0.9538 1.8 2.3 

492 ........ YES ............ YES ............ 08 SURG ......... Lower extrem & humer proc except hip,foot,femur w MCC 2.7254 7.1 8.9 

493 ........ YES ............ YES ............ 08 SURG ......... Lower extrem & humer proc except hip, foot, femur w CC 1.7402 4.5 5.5 

494 ........ YES ............ YES ............ 08 SURG ......... Lower extrem & humer proc except hip, foot, femur w/o 

CC/MCC.

1.2067 2.9 3.4 

495 ........ YES ............ NO .............. 08 SURG ......... Local excision & removal int fix devices exc hip & femur w 

MCC.

3.2333 9.0 11.7 

496 ........ YES ............ NO .............. 08 SURG ......... Local excision & removal int fix devices exc hip & femur w 

CC.

1.7033 4.7 6.2 

497 ........ YES ............ NO .............. 08 SURG ......... Local excision & removal int fix devices exc hip & femur 

w/o CC/MCC.

1.1384 2.4 3.3 

498 ........ NO .............. NO .............. 08 SURG ......... Local excision & removal int fix devices of hip & femur w 

CC/MCC.

2.0669 6.0 8.4 

499 ........ NO .............. NO .............. 08 SURG ......... Local excision & removal int fix devices of hip & femur w/o 

CC/MCC.

0.9152 2.4 3.3 

500 ........ YES ............ YES ............ 08 SURG ......... Soft tissue procedures w MCC ............................................ 3.0695 8.4 11.5 

501 ........ YES ............ YES ............ 08 SURG ......... Soft tissue procedures w CC ............................................... 1.4828 4.6 6.1 

502 ........ YES ............ YES ............ 08 SURG ......... Soft tissue procedures w/o CC/MCC ................................... 0.9295 2.3 3.0 

503 ........ NO .............. NO .............. 08 SURG ......... Foot procedures w MCC ...................................................... 2.1343 6.9 8.9 

504 ........ NO .............. NO .............. 08 SURG ......... Foot procedures w CC ......................................................... 1.4821 5.1 6.5 

505 ........ NO .............. NO .............. 08 SURG ......... Foot procedures w/o CC/MCC ............................................ 0.9794 2.6 3.4 

506 ........ NO .............. NO .............. 08 SURG ......... Major thumb or joint procedures .......................................... 0.9900 2.3 3.2 

507 ........ NO .............. NO .............. 08 SURG ......... Major shoulder or elbow joint procedures w CC/MCC ........ 1.6307 3.8 5.3 

508 ........ NO .............. NO .............. 08 SURG ......... Major shoulder or elbow joint procedures w/o CC/MCC ..... 1.0467 1.7 2.1 

509 ........ NO .............. NO .............. 08 SURG ......... Arthroscopy .......................................................................... 1.0441 2.0 2.9 

510 ........ NO .............. NO .............. 08 SURG ......... Shoulder, elbow or forearm proc, exc major joint proc w 

MCC.

2.0281 5.0 6.6 

511 ........ NO .............. NO .............. 08 SURG ......... Shoulder, elbow or forearm proc, exc major joint proc w 

CC.

1.2889 3.1 3.9 

512 ........ NO .............. NO .............. 08 SURG ......... Shoulder, elbow or forearm proc, exc major joint proc w/o 

CC/MCC.

0.9269 1.7 2.1 

513 ........ NO .............. NO .............. 08 SURG ......... Hand or wrist proc, except major thumb or joint proc w 

CC/MCC.

1.3544 3.7 5.1 

514 ........ NO .............. NO .............. 08 SURG ......... Hand or wrist proc, except major thumb or joint proc w/o 

CC/MCC.

0.8233 2.0 2.6 

515 ........ YES ............ YES ............ 08 SURG ......... Other musculoskelet sys & conn tiss O.R. proc w MCC .... 3.0667 8.4 11.1

516 ........ YES ............ YES ............ 08 SURG ......... Other musculoskelet sys & conn tiss O.R. proc w CC ....... 1.8221 4.5 6.1 

mmaher on DSK3CLS3C1PROD with $$_JOB

24970 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

517 ........ YES ............ YES ............ 08 SURG ......... Other musculoskelet sys & conn tiss O.R. proc w/o CC/ 

MCC.

1.3195 2.1 2.9 

533 ........ YES ............ NO .............. 08 MED ........... Fractures of femur w MCC .................................................. 1.4317 5.5 7.2 

534 ........ YES ............ NO .............. 08 MED ........... Fractures of femur w/o MCC ............................................... 0.6905 3.4 4.2 

535 ........ YES ............ NO .............. 08 MED ........... Fractures of hip & pelvis w MCC ......................................... 1.3683 5.1 6.6 

536 ........ YES ............ NO .............. 08 MED ........... Fractures of hip & pelvis w/o MCC ...................................... 0.6743 3.5 4.1 

537 ........ NO .............. NO .............. 08 MED ........... Sprains, strains, & dislocations of hip, pelvis & thigh w 

CC/MCC.

0.8451 3.9 4.7 

538 ........ NO .............. NO .............. 08 MED ........... Sprains, strains, & dislocations of hip, pelvis & thigh w/o 

CC/MCC.

0.5424 2.6 3.1 

539 ........ YES ............ NO .............. 08 MED ........... Osteomyelitis w MCC .......................................................... 2.0095 8.4 10.8 

540 ........ YES ............ NO .............. 08 MED ........... Osteomyelitis w CC ............................................................. 1.3085 6.2 7.6 

541 ........ YES ............ NO .............. 08 MED ........... Osteomyelitis w/o CC/MCC ................................................. 0.9229 4.6 5.8 

542 ........ YES ............ NO .............. 08 MED ........... Pathological fractures & musculoskelet & conn tiss malig 

w MCC.

1.8245 7.1 9.0 

543 ........ YES ............ NO .............. 08 MED ........... Pathological fractures & musculoskelet & conn tiss malig 

w CC.

1.1004 5.0 6.2 

544 ........ YES ............ NO .............. 08 MED ........... Pathological fractures & musculoskelet & conn tiss malig 

w/o CC/MCC.

0.7580 3.9 4.6 

545 ........ YES ............ NO .............. 08 MED ........... Connective tissue disorders w MCC ................................... 2.2353 6.7 9.2 

546 ........ YES ............ NO .............. 08 MED ........... Connective tissue disorders w CC ...................................... 1.0595 4.4 5.6 

547 ........ YES ............ NO .............. 08 MED ........... Connective tissue disorders w/o CC/MCC .......................... 0.7387 3.2 4.0 

548 ........ NO .............. NO .............. 08 MED ........... Septic arthritis w MCC ......................................................... 1.8774 7.2 9.5 

549 ........ NO .............. NO .............. 08 MED ........... Septic arthritis w CC ............................................................ 1.1402 5.2 6.4 

550 ........ NO .............. NO .............. 08 MED ........... Septic arthritis w/o CC/MCC ................................................ 0.7637 3.7 4.6 

551 ........ YES ............ NO .............. 08 MED ........... Medical back problems w MCC ........................................... 1.5024 5.8 7.5 

552 ........ YES ............ NO .............. 08 MED ........... Medical back problems w/o MCC ........................................ 0.7526 3.5 4.2 

553 ........ NO .............. NO .............. 08 MED ........... Bone diseases & arthropathies w MCC .............................. 1.0922 4.8 6.1 

554 ........ NO .............. NO .............. 08 MED ........... Bone diseases & arthropathies w/o MCC ........................... 0.6166 3.0 3.7 

555 ........ NO .............. NO .............. 08 MED ........... Signs & symptoms of musculoskeletal system & conn tissue w MCC.0.9488 3.6 4.9 

556 ........ NO .............. NO .............. 08 MED ........... Signs & symptoms of musculoskeletal system & conn tissue w/o MCC.0.5771 2.5 3.2 

557 ........ YES ............ NO .............. 08 MED ........... Tendonitis, myositis & bursitis w MCC ................................ 1.5172 5.7 7.2 

558 ........ YES ............ NO .............. 08 MED ........... Tendonitis, myositis & bursitis w/o MCC ............................. 0.7900 3.6 4.3 

559 ........ YES ............ NO .............. 08 MED ........... Aftercare, musculoskeletal system & connective tissue w 

MCC.

1.6221 5.6 7.7 

560 ........ YES ............ NO .............. 08 MED ........... Aftercare, musculoskeletal system & connective tissue w 

CC.

0.9149 3.8 4.9 

561 ........ YES ............ NO .............. 08 MED ........... Aftercare, musculoskeletal system & connective tissue w/o 

CC/MCC.

0.5701 2.2 2.8 

562 ........ YES ............ NO .............. 08 MED ........... Fx, sprn, strn & disl except femur, hip, pelvis & thigh w 

MCC.

1.3859 5.3 6.8 

563 ........ YES ............ NO .............. 08 MED ........... Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o 

MCC.

0.6597 3.2 3.8 

564 ........ NO .............. NO .............. 08 MED ........... Other musculoskeletal sys & connective tissue diagnoses 

w MCC.

1.4031 5.4 7.2 

565 ........ NO .............. NO .............. 08 MED ........... Other musculoskeletal sys & connective tissue diagnoses 

w CC.

0.8829 4.0 5.1 

566 ........ NO .............. NO .............. 08 MED ........... Other musculoskeletal sys & connective tissue diagnoses 

w/o CC/MCC.

0.6423 3.0 3.8 

573 ........ YES ............ NO .............. 09 SURG ......... Skin graft &/or debrid for skn ulcer or cellulitis w MCC ...... 3.2955 11.3 14.9 

574 ........ YES ............ NO .............. 09 SURG ......... Skin graft &/or debrid for skn ulcer or cellulitis w CC ......... 1.9279 7.9 10.1 

575 ........ YES ............ NO .............. 09 SURG ......... Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/ 

MCC.

1.1628 5.0 6.2 

576 ........ NO .............. NO .............. 09 SURG ......... Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC 3.2274 7.8 12.2 

577 ........ NO .............. NO .............. 09 SURG ......... Skin graft &/or debrid exc for skin ulcer or cellulitis w CC .. 1.5681 4.1 6.0 

578 ........ NO .............. NO .............. 09 SURG ......... Skin graft &/or debrid exc for skin ulcer or cellulitis w/o 

CC/MCC.

0.9412 2.5 3.5 

579 ........ YES ............ NO .............. 09 SURG ......... Other skin, subcut tiss & breast proc w MCC ..................... 2.9032 9.1 12.0 

580 ........ YES ............ NO .............. 09 SURG ......... Other skin, subcut tiss & breast proc w CC ........................ 1.6213 5.7 7.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24971 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

581 ........ YES ............ NO .............. 09 SURG ......... Other skin, subcut tiss & breast proc w/o CC/MCC ............ 0.9588 3.0 4.1 

582 ........ NO .............. NO .............. 09 SURG ......... Mastectomy for malignancy w CC/MCC .............................. 0.9881 2.1 2.8 

583 ........ NO .............. NO .............. 09 SURG ......... Mastectomy for malignancy w/o CC/MCC ........................... 0.7441 1.5 1.8 

584 ........ NO .............. NO .............. 09 SURG ......... Breast biopsy, local excision & other breast procedures w 

CC/MCC.

1.2819 2.7 4.5 

585 ........ NO .............. NO .............. 09 SURG ......... Breast biopsy, local excision & other breast procedures w/ 

o CC/MCC.

0.7975 1.5 1.9 

592 ........ YES ............ NO .............. 09 MED ........... Skin ulcers w MCC .............................................................. 1.7628 7.1 9.3 

593 ........ YES ............ NO .............. 09 MED ........... Skin ulcers w CC ................................................................. 1.0687 5.5 6.7 

594 ........ YES ............ NO .............. 09 MED ........... Skin ulcers w/o CC/MCC ..................................................... 0.7221 4.1 5.0 

595 ........ NO .............. NO .............. 09 MED ........... Major skin disorders w MCC ............................................... 1.7504 6.1 8.3 

596 ........ NO .............. NO .............. 09 MED ........... Major skin disorders w/o MCC ............................................ 0.8037 3.8 4.8 

597 ........ NO .............. NO .............. 09 MED ........... Malignant breast disorders w MCC ..................................... 1.6544 5.9 8.1 

598 ........ NO .............. NO .............. 09 MED ........... Malignant breast disorders w CC ........................................ 1.0084 4.3 5.6 

599 ........ NO .............. NO .............. 09 MED ........... Malignant breast disorders w/o CC/MCC ............................ 0.6089 2.6 3.6 

600 ........ NO .............. NO .............. 09 MED ........... Non-malignant breast disorders w CC/MCC ....................... 0.9421 4.2 5.4 

601 ........ NO .............. NO .............. 09 MED ........... Non-malignant breast disorders w/o CC/MCC .................... 0.6207 3.1 3.8 

602 ........ YES ............ NO .............. 09 MED ........... Cellulitis w MCC ................................................................... 1.3689 5.7 7.2 

603 ........ YES ............ NO .............. 09 MED ........... Cellulitis w/o MCC ................................................................ 0.7698 4.0 4.8 

604 ........ NO .............. NO .............. 09 MED ........... Trauma to the skin, subcut tiss & breast w MCC ............... 1.1521 4.2 5.4 

605 ........ NO .............. NO .............. 09 MED ........... Trauma to the skin, subcut tiss & breast w/o MCC ............ 0.6584 2.8 3.5 

606 ........ NO .............. NO .............. 09 MED ........... Minor skin disorders w MCC ............................................... 1.0928 4.2 5.9 

607 ........ NO .............. NO .............. 09 MED ........... Minor skin disorders w/o MCC ............................................ 0.6163 2.9 3.8 

614 ........ NO .............. NO .............. 10 SURG ......... Adrenal & pituitary procedures w CC/MCC ......................... 2.4677 5.3 7.4 

615 ........ NO .............. NO .............. 10 SURG ......... Adrenal & pituitary procedures w/o CC/MCC ...................... 1.3907 2.8 3.4 

616 ........ YES ............ NO .............. 10 SURG ......... Amputat of lower limb for endocrine, nutrit, & metabol dis 

w MCC.

3.9552 13.8 16.6 

617 ........ YES ............ NO .............. 10 SURG ......... Amputat of lower limb for endocrine, nutrit, & metabol dis 

w CC.

2.0973 7.7 9.4 

618 ........ YES ............ NO .............. 10 SURG ......... Amputat of lower limb for endocrine, nutrit, & metabol dis 

w/o CC/MCC.

1.3024 5.4 6.7 

619 ........ NO .............. NO .............. 10 SURG ......... O.R. procedures for obesity w MCC ................................... 3.7048 6.4 9.3 

620 ........ NO .............. NO .............. 10 SURG ......... O.R. procedures for obesity w CC ...................................... 2.0768 3.4 4.3 

621 ........ NO .............. NO .............. 10 SURG ......... O.R. procedures for obesity w/o CC/MCC .......................... 1.5791 2.1 2.4 

622 ........ YES ............ NO .............. 10 SURG ......... Skin grafts & wound debrid for endoc, nutrit & metab dis w 

MCC.

3.2426 10.8 14.2 

623 ........ YES ............ NO .............. 10 SURG ......... Skin grafts & wound debrid for endoc, nutrit & metab dis w 

CC.

1.8784 7.3 9.2 

624 ........ YES ............ NO .............. 10 SURG ......... Skin grafts & wound debrid for endoc, nutrit & metab dis 

w/o CC/MCC.

1.1114 4.8 6.1 

625 ........ NO .............. NO .............. 10 SURG ......... Thyroid, parathyroid & thyroglossal procedures w MCC ..... 2.2742 5.0 7.5 

626 ........ NO .............. NO .............. 10 SURG ......... Thyroid, parathyroid & thyroglossal procedures w CC ........ 1.1509 2.2 3.3 

627 ........ NO .............. NO .............. 10 SURG ......... Thyroid, parathyroid & thyroglossal procedures w/o CC/ 

MCC.

0.7404 1.3 1.6 

628 ........ YES ............ NO .............. 10 SURG ......... Other endocrine, nutrit & metab O.R. proc w MCC ............ 3.3711 8.0 12.0 

629 ........ YES ............ NO .............. 10 SURG ......... Other endocrine, nutrit & metab O.R. proc w CC ............... 2.2663 7.4 9.2 

630 ........ YES ............ NO .............. 10 SURG ......... Other endocrine, nutrit & metab O.R. proc w/o CC/MCC ... 1.5036 4.0 5.5

637 ........ YES ............ NO .............. 10 MED ........... Diabetes w MCC .................................................................. 1.3914 4.8 6.3 

638 ........ YES ............ NO .............. 10 MED ........... Diabetes w CC ..................................................................... 0.8349 3.5 4.5 

639 ........ YES ............ NO .............. 10 MED ........... Diabetes w/o CC/MCC ......................................................... 0.5768 2.5 3.1 

640 ........ YES ............ NO .............. 10 MED ........... Nutritional & misc metabolic disorders w MCC ................... 1.1366 4.2 5.7 

641 ........ YES ............ NO .............. 10 MED ........... Nutritional & misc metabolic disorders w/o MCC ................ 0.6856 3.1 3.9 

642 ........ NO .............. NO .............. 10 MED ........... Inborn errors of metabolism ................................................. 1.0612 3.8 5.2 

643 ........ YES ............ NO .............. 10 MED ........... Endocrine disorders w MCC ................................................ 1.6611 6.2 8.0 

644 ........ YES ............ NO .............. 10 MED ........... Endocrine disorders w CC ................................................... 1.0256 4.5 5.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

24972 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

645 ........ YES ............ NO .............. 10 MED ........... Endocrine disorders w/o CC/MCC ....................................... 0.7361 3.2 3.9 

652 ........ NO .............. NO .............. 11 SURG ......... Kidney transplant ................................................................. 2.9875 6.7 7.9 

653 ........ YES ............ NO .............. 11 SURG ......... Major bladder procedures w MCC ....................................... 5.6554 14.1 17.5 

654 ........ YES ............ NO .............. 11 SURG ......... Major bladder procedures w CC .......................................... 2.9409 9.0 10.3 

655 ........ YES ............ NO .............. 11 SURG ......... Major bladder procedures w/o CC/MCC ............................. 1.9932 6.0 6.7 

656 ........ NO .............. NO .............. 11 SURG ......... Kidney & ureter procedures for neoplasm w MCC ............. 3.3280 8.4 10.8 

657 ........ NO .............. NO .............. 11 SURG ......... Kidney & ureter procedures forneoplasm w CC .................. 1.8514 5.2 6.2 

658 ........ NO .............. NO .............. 11 SURG ......... Kidney & ureter procedures for neoplasm w/o CC/MCC .... 1.3628 3.4 3.9

659 ........ YES ............ NO .............. 11 SURG ......... Kidney & ureter procedures for non-neoplasm w MCC ...... 3.2759 8.5 11.6 

660 ........ YES ............ NO .............. 11 SURG ......... Kidney & ureter procedures for non-neoplasm w CC ......... 1.8525 5.0 6.7 

661 ........ YES ............ NO .............. 11 SURG ......... Kidney & ureter procedures for non-neoplasm w/o CC/ 

MCC.

1.2497 2.8 3.6 

662 ........ NO .............. NO .............. 11 SURG ......... Minor bladder procedures w MCC ....................................... 2.5929 7.3 10.5 

663 ........ NO .............. NO .............. 11 SURG ......... Minor bladder procedures w CC .......................................... 1.3800 3.6 5.2 

664 ........ NO .............. NO .............. 11 SURG ......... Minor bladder procedures w/o CC/MCC ............................. 0.9462 1.7 2.2 

665 ........ NO .............. NO .............. 11 SURG ......... Prostatectomy w MCC ......................................................... 2.8312 9.3 12.2 

666 ........ NO .............. NO .............. 11 SURG ......... Prostatectomy w CC ............................................................ 1.5177 4.2 6.4 

667 ........ NO .............. NO .............. 11 SURG ......... Prostatectomy w/o CC/MCC ................................................ 0.8075 2.1 2.9 

668 ........ NO .............. NO .............. 11 SURG ......... Transurethral procedures w MCC ....................................... 2.1963 6.3 8.6 

669 ........ NO .............. NO .............. 11 SURG ......... Transurethral procedures w CC .......................................... 1.1980 3.1 4.4 

670 ........ NO .............. NO .............. 11 SURG ......... Transurethral procedures w/o CC/MCC .............................. 0.7731 1.9 2.6 

671 ........ NO .............. NO .............. 11 SURG ......... Urethral procedures w CC/MCC .......................................... 1.4041 4.0 5.8 

672 ........ NO .............. NO .............. 11 SURG ......... Urethral procedures w/o CC/MCC ....................................... 0.7515 1.9 2.6 

673 ........ NO .............. NO .............. 11 SURG ......... Other kidney & urinary tract procedures w MCC ................ 2.8645 6.0 10.1 

674 ........ NO .............. NO .............. 11 SURG ......... Other kidney & urinary tract procedures w CC ................... 2.1903 4.5 7.3 

675 ........ NO .............. NO .............. 11 SURG ......... Other kidney & urinary tract procedures w/o CC/MCC ....... 1.3402 1.7 2.6 

682 ........ YES ............ NO .............. 11 MED ........... Renal failure w MCC ............................................................ 1.6772 5.5 7.4 

683 ........ YES ............ NO .............. 11 MED ........... Renal failure w CC ............................................................... 1.1655 4.8 6.0 

684 ........ YES ............ NO .............. 11 MED ........... Renal failure w/o CC/MCC .................................................. 0.7764 3.3 4.1 

685 ........ NO .............. NO .............. 11 MED ........... Admit for renal dialysis ........................................................ 0.8496 2.4 3.5 

686 ........ NO .............. NO .............. 11 MED ........... Kidney & urinary tract neoplasms w MCC .......................... 1.7101 6.0 8.1 

687 ........ NO .............. NO .............. 11 MED ........... Kidney & urinary tract neoplasms w CC ............................. 1.0483 4.0 5.3 

688 ........ NO .............. NO .............. 11 MED ........... Kidney & urinary tract neoplasms w/o CC/MCC ................. 0.7032 2.6 3.3 

689 ........ YES ............ NO .............. 11 MED ........... Kidney & urinary tract infections w MCC ............................. 1.2389 5.2 6.6 

690 ........ YES ............ NO .............. 11 MED ........... Kidney & urinary tract infections w/o MCC .......................... 0.7621 3.6 4.4 

691 ........ NO .............. NO .............. 11 MED ........... Urinary stones w esw lithotripsy w CC/MCC ....................... 1.4666 3.0 4.2 

692 ........ NO .............. NO .............. 11 MED ........... Urinary stones w esw lithotripsy w/o CC/MCC .................... 1.0647 1.8 2.3 

693 ........ NO .............. NO .............. 11 MED ........... Urinary stones w/o esw lithotripsy w MCC .......................... 1.2714 3.9 5.2 

694 ........ NO .............. NO .............. 11 MED ........... Urinary stones w/o esw lithotripsy w/o MCC ....................... 0.6729 2.0 2.6 

695 ........ NO .............. NO .............. 11 MED ........... Kidney & urinary tract signs & symptoms w MCC .............. 1.1689 4.3 5.7 

696 ........ NO .............. NO .............. 11 MED ........... Kidney & urinary tract signs & symptoms w/o MCC ........... 0.6054 2.6 3.2 

697 ........ NO .............. NO .............. 11 MED ........... Urethral stricture .................................................................. 0.7231 2.4 3.3 

698 ........ YES ............ NO .............. 11 MED ........... Other kidney & urinary tract diagnoses w MCC .................. 1.4706 5.3 6.9 

699 ........ YES ............ NO .............. 11 MED ........... Other kidney & urinary tract diagnoses w CC ..................... 0.9845 4.0 5.1 

700 ........ YES ............ NO .............. 11 MED ........... Other kidney & urinary tract diagnoses w/o CC/MCC ......... 0.7059 2.9 3.6 

707 ........ NO .............. NO .............. 12 SURG ......... Major male pelvic procedures w CC/MCC .......................... 1.7114 3.8 4.9 

708 ........ NO .............. NO .............. 12 SURG ......... Major male pelvic procedures w/o CC/MCC ....................... 1.1515 2.1 2.4 

709 ........ NO .............. NO .............. 12 SURG ......... Penis procedures w CC/MCC .............................................. 1.9087 3.8 6.7 

710 ........ NO .............. NO .............. 12 SURG ......... Penis procedures w/o CC/MCC ........................................... 1.2258 1.5 1.9 

711 ........ NO .............. NO .............. 12 SURG ......... Testes procedures w CC/MCC ............................................ 1.9149 5.4 8.0 

712 ........ NO .............. NO .............. 12 SURG ......... Testes procedures w/o CC/MCC ......................................... 0.8141 2.2 3.0 

713 ........ NO .............. NO .............. 12 SURG ......... Transurethral prostatectomy w CC/MCC ............................. 1.1007 2.9 4.1 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24973 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

714 ........ NO .............. NO .............. 12 SURG ......... Transurethral prostatectomy w/o CC/MCC .......................... 0.6342 1.7 2.0 

715 ........ NO .............. NO .............. 12 SURG ......... Other male reproductive system O.R. proc for malignancy 

w CC/MCC.

1.8234 3.9 6.2 

716 ........ NO .............. NO .............. 12 SURG ......... Other male reproductive system O.R. proc for malignancy 

w/o CC/MCC.

1.0017 1.3 1.5 

717 ........ NO .............. NO .............. 12 SURG ......... Other male reproductive system O.R. proc exc malignancy 

w CC/MCC.

1.8454 5.2 7.7 

718 ........ NO .............. NO .............. 12 SURG ......... Other male reproductive system O.R. proc exc malignancy 

w/o CC/MCC.

0.7902 2.1 2.8 

722 ........ NO .............. NO .............. 12 MED ........... Malignancy, male reproductive system w MCC .................. 1.4829 5.6 7.5 

723 ........ NO .............. NO .............. 12 MED ........... Malignancy, male reproductive system w CC ..................... 1.0428 4.2 5.5 

724 ........ NO .............. NO .............. 12 MED ........... Malignancy, male reproductive system w/o CC/MCC ......... 0.6146 2.5 3.4 

725 ........ NO .............. NO .............. 12 MED ........... Benign prostatic hypertrophy w MCC .................................. 1.0622 4.3 5.6 

726 ........ NO .............. NO .............. 12 MED ........... Benign prostatic hypertrophy w/o MCC ............................... 0.6648 2.8 3.5 

727 ........ NO .............. NO .............. 12 MED ........... Inflammation of the male reproductive system w MCC ...... 1.2681 5.1 6.6 

728 ........ NO .............. NO .............. 12 MED ........... Inflammation of the male reproductive system w/o MCC ... 0.6875 3.3 4.1 

729 ........ NO .............. NO .............. 12 MED ........... Other male reproductive system diagnoses w CC/MCC ..... 1.0808 3.8 5.2 

730 ........ NO .............. NO .............. 12 MED ........... Other male reproductive system diagnoses w/o CC/MCC .. 0.5860 2.5 3.3

734 ........ NO .............. NO .............. 13 SURG ......... Pelvic evisceration, rad hysterectomy & rad vulvectomy w 

CC/MCC.

2.2946 5.9 7.7 

735 ........ NO .............. NO .............. 13 SURG ......... Pelvic evisceration, rad hysterectomy & rad vulvectomy w/ 

o CC/MCC.

1.0226 3.0 3.5 

736 ........ NO .............. NO .............. 13 SURG ......... Uterine & adnexa proc for ovarian or adnexal malignancy 

w MCC.

4.1656 11.6 13.9 

737 ........ NO .............. NO .............. 13 SURG ......... Uterine & adnexa proc for ovarian or adnexal malignancy 

w CC.

1.9738 6.3 7.4 

738 ........ NO .............. NO .............. 13 SURG ......... Uterine & adnexa proc for ovarian or adnexal malignancy 

w/o CC/MCC.

1.1607 3.6 4.0 

739 ........ NO .............. NO .............. 13 SURG ......... Uterine, adnexa proc for non-ovarian/adnexal malig w 

MCC.

2.8464 7.9 10.2 

740 ........ NO .............. NO .............. 13 SURG ......... Uterine, adnexa proc for non-ovarian/adnexal malig w CC 1.3873 4.4 5.2 

741 ........ NO .............. NO .............. 13 SURG ......... Uterine, adnexa proc for non-ovarian/adnexal malig w/o 

CC/MCC.

0.9624 2.8 3.2 

742 ........ NO .............. NO .............. 13 SURG ......... Uterine & adnexa proc for non-malignancy w CC/MCC ..... 1.3758 3.6 4.7

743 ........ NO .............. NO .............. 13 SURG ......... Uterine & adnexa proc for non-malignancy w/o CC/MCC .. 0.8461 2.1 2.4 

744 ........ NO .............. NO .............. 13 SURG ......... D&C, conization, laparascopy & tubal interruption w CC/ 

MCC.

1.4153 4.1 5.9 

745 ........ NO .............. NO .............. 13 SURG ......... D&C, conization, laparascopy & tubal interruption w/o CC/ 

MCC.

0.7416 2.1 2.6 

746 ........ NO .............. NO .............. 13 SURG ......... Vagina, cervix & vulva procedures w CC/MCC ................... 1.2205 3.0 4.2 

747 ........ NO .............. NO .............. 13 SURG ......... Vagina, cervix & vulva procedures w/o CC/MCC ................ 0.8192 1.7 1.9 

748 ........ NO .............. NO .............. 13 SURG ......... Female reproductive system reconstructive procedures ..... 0.7966 1.5 1.8 

749 ........ NO .............. NO .............. 13 SURG ......... Other female reproductive system O.R. procedures w CC/ 

MCC.

2.5201 7.1 9.9 

750 ........ NO .............. NO .............. 13 SURG ......... Other female reproductive system O.R. procedures w/o 

CC/MCC.

0.9713 2.6 3.3 

754 ........ NO .............. NO .............. 13 MED ........... Malignancy, female reproductive system w MCC ............... 1.8553 6.4 8.9 

755 ........ NO .............. NO .............. 13 MED ........... Malignancy, female reproductive system w CC .................. 1.0847 4.2 5.7 

756 ........ NO .............. NO .............. 13 MED ........... Malignancy, female reproductive system w/o CC/MCC ...... 0.6339 2.5 3.3 

757 ........ NO .............. NO .............. 13 MED ........... Infections, female reproductive system w MCC .................. 1.6992 6.8 8.9 

mmaher on DSK3CLS3C1PROD with $$_JOB

24974 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

758 ........ NO .............. NO .............. 13 MED ........... Infections, female reproductive system w CC ..................... 1.0758 4.9 6.2 

759 ........ NO .............. NO .............. 13 MED ........... Infections, female reproductive system w/o CC/MCC ......... 0.7668 3.8 4.6 

760 ........ NO .............. NO .............. 13 MED ........... Menstrual & other female reproductive system disorders w 

CC/MCC.

0.7794 3.0 3.8 

761 ........ NO .............. NO .............. 13 MED ........... Menstrual & other female reproductive system disorders 

w/o CC/MCC.

0.5041 2.0 2.5 

765 ........ NO .............. NO .............. 14 SURG ......... Cesarean section w CC/MCC .............................................. 0.9644 4.1 5.3 

766 ........ NO .............. NO .............. 14 SURG ......... Cesarean section w/o CC/MCC ........................................... 0.6422 3.0 3.2 

767 ........ NO .............. NO .............. 14 SURG ......... Vaginal delivery w sterilization &/or D&C ............................ 0.6419 2.5 2.9 

768 ........ NO .............. NO .............. 14 SURG ......... Vaginal delivery w O.R. proc except steril &/or D&C .......... 1.6334 4.7 5.8 

769 ........ NO .............. NO .............. 14 SURG ......... Postpartum & post abortion diagnoses w O.R. procedure .. 1.9655 3.3 5.7 

770 ........ NO .............. NO .............. 14 SURG ......... Abortion w D&C, aspiration curettage or hysterotomy ........ 0.7598 1.6 2.7 

774 ........ NO .............. NO .............. 14 MED ........... Vaginal delivery w complicating diagnoses ......................... 0.5412 2.6 3.2 

775 ........ NO .............. NO .............. 14 MED ........... Vaginal delivery w/o complicating diagnoses ...................... 0.3953 2.1 2.3 

776 ........ NO .............. NO .............. 14 MED ........... Postpartum & post abortion diagnoses w/o O.R. procedure 0.6480 2.6 3.6 

777 ........ NO .............. NO .............. 14 MED ........... Ectopic pregnancy ............................................................... 0.7237 1.8 2.1 

778 ........ NO .............. NO .............. 14 MED ........... Threatened abortion ............................................................. 0.3775 2.0 2.8 

779 ........ NO .............. NO .............. 14 MED ........... Abortion w/o D&C ................................................................ 0.6006 1.7 2.6 

780 ........ NO .............. NO .............. 14 MED ........... False labor ........................................................................... 0.2935 1.3 2.7 

781 ........ NO .............. NO .............. 14 MED ........... Other antepartum diagnoses w medical complications ....... 0.5771 2.7 3.8 

782 ........ NO .............. NO .............. 14 MED ........... Other antepartum diagnoses w/o medical complications .... 0.4359 1.7 2.8 

789 ........ NO .............. NO .............. 15 MED ........... Neonates, died or transferred to another acute care facility 1.4246 * * 

790 ........ NO .............. NO .............. 15 MED ........... Extreme immaturity or respiratory distress syndrome, 

neonate.

4.6977 * * 

791 ........ NO .............. NO .............. 15 MED ........... Prematurity w major problems ............................................. 3.2084 * * 

792 ........ NO .............. NO .............. 15 MED ........... Prematurity w/o major problems .......................................... 1.9359 * * 

793 ........ NO .............. NO .............. 15 MED ........... Full term neonate w major problems ................................... 3.2957 * * 

794 ........ NO .............. NO .............. 15 MED ........... Neonate w other significant problems ................................. 1.1665 * * 

795 ........ NO .............. NO .............. 15 MED ........... Normal newborn ................................................................... 0.1579 * * 

799 ........ NO .............. NO .............. 16 SURG ......... Splenectomy w MCC ........................................................... 4.8444 10.8 14.3 

800 ........ NO .............. NO .............. 16 SURG ......... Splenectomy w CC .............................................................. 2.5219 6.5 8.4 

801 ........ NO .............. NO .............. 16 SURG ......... Splenectomy w/o CC/MCC .................................................. 1.6365 3.8 4.9 

802 ........ NO .............. NO .............. 16 SURG ......... Other O.R. proc of the blood & blood forming organs w 

MCC.

3.6564 9.2 12.8 

803 ........ NO .............. NO .............. 16 SURG ......... Other O.R. proc of the blood & blood forming organs w 

CC.

1.6759 4.8 6.6 

804 ........ NO .............. NO .............. 16 SURG ......... Other O.R. proc of the blood & blood forming organs w/o 

CC/MCC.

0.9952 2.4 3.3 

808 ........ YES ............ NO .............. 16 MED ........... Major hematol/immun diag exc sickle cell crisis & coagul 

w MCC.

1.9239 6.2 8.1 

809 ........ YES ............ NO .............. 16 MED ........... Major hematol/immun diag exc sickle cell crisis & coagul 

w CC.

1.0868 4.0 5.1 

810 ........ YES ............ NO .............. 16 MED ........... Major hematol/immun diag exc sickle cell crisis & coagul 

w/o CC/MCC.

0.8426 3.1 4.0 

811 ........ NO .............. NO .............. 16 MED ........... Red blood cell disorders w MCC ......................................... 1.1761 4.0 5.6 

812 ........ NO .............. NO .............. 16 MED ........... Red blood cell disorders w/o MCC ...................................... 0.7332 2.8 3.7 

813 ........ NO .............. NO .............. 16 MED ........... Coagulation disorders .......................................................... 1.3307 3.8 5.2 

814 ........ NO .............. NO .............. 16 MED ........... Reticuloendothelial & immunity disorders w MCC .............. 1.5585 5.4 7.2 

815 ........ NO .............. NO .............. 16 MED ........... Reticuloendothelial & immunity disorders w CC ................. 0.9778 3.9 4.9 

816 ........ NO .............. NO .............. 16 MED ........... Reticuloendothelial & immunity disorders w/o CC/MCC ..... 0.7021 2.7 3.4 

820 ........ NO .............. NO .............. 17 SURG ......... Lymphoma & leukemia w major O.R. procedure w MCC ... 5.6599 13.8 18.4 

821 ........ NO .............. NO .............. 17 SURG ......... Lymphoma & leukemia w major O.R. procedure w CC ...... 2.2223 5.4 7.8 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24975 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

822 ........ NO .............. NO .............. 17 SURG ......... Lymphoma & leukemia w major O.R. procedure w/o CC/ 

MCC.

1.2363 2.7 3.7 

823 ........ NO .............. NO .............. 17 SURG ......... Lymphoma & non-acute leukemia w other O.R. proc w 

MCC.

4.0550 12.1 15.4 

824 ........ NO .............. NO .............. 17 SURG ......... Lymphoma & non-acute leukemia w other O.R. proc w CC 2.1337 6.6 8.9 

825 ........ NO .............. NO .............. 17 SURG ......... Lymphoma & non-acute leukemia w other O.R. proc w/o 

CC/MCC.

1.3321 3.3 4.8 

826 ........ NO .............. NO .............. 17 SURG ......... Myeloprolif disord or poorly diff neopl w maj O.R. proc w 

MCC.

5.0473 13.2 17.4 

827 ........ NO .............. NO .............. 17 SURG ......... Myeloprolif disord or poorly diff neopl w maj O.R. proc w 

CC.

2.0842 5.8 7.6 

828 ........ NO .............. NO .............. 17 SURG ......... Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o 

CC/MCC.

1.2241 3.0 3.8 

829 ........ NO .............. NO .............. 17 SURG ......... Myeloprolif disord or poorly diff neopl w other O.R. proc w 

CC/MCC.

2.6852 6.9 10.5 

830 ........ NO .............. NO .............. 17 SURG ......... Myeloprolif disord or poorly diff neopl w other O.R. proc w/ 

o CC/MCC.

1.0340 2.5 3.7 

834 ........ NO .............. NO .............. 17 MED ........... Acute leukemia w/o major O.R. procedure w MCC ............ 3.9520 9.2 15.0 

835 ........ NO .............. NO .............. 17 MED ........... Acute leukemia w/o major O.R. procedure w CC ............... 1.8790 5.4 8.4 

836 ........ NO .............. NO .............. 17 MED ........... Acute leukemia w/o major O.R. procedure w/o CC/MCC ... 1.1326 3.4 5.1

837 ........ NO .............. NO .............. 17 MED ........... Chemo w acute leukemia as sdx or w high dose chemo 

agent w MCC.

5.7668 17.2 22.7 

838 ........ NO .............. NO .............. 17 MED ........... Chemo w acute leukemia as sdx or w high dose chemo 

agent w CC.

2.3625 6.3 9.2 

839 ........ NO .............. NO .............. 17 MED ........... Chemo w acute leukemia as sdx or w high dose chemo 

agent w/o CC/MCC.

1.2331 4.8 6.0 

840 ........ YES ............ NO .............. 17 MED ........... Lymphoma & non-acute leukemia w MCC .......................... 2.3808 7.1 9.8 

841 ........ YES ............ NO .............. 17 MED ........... Lymphoma & non-acute leukemia w CC ............................. 1.4326 5.1 6.7 

842 ........ YES ............ NO .............. 17 MED ........... Lymphoma & non-acute leukemia w/o CC/MCC ................. 0.9558 3.3 4.3 

843 ........ NO .............. NO .............. 17 MED ........... Other myeloprolif dis or poorly diff neopl diag w MCC ....... 1.9072 6.3 8.8 

844 ........ NO .............. NO .............. 17 MED ........... Other myeloprolif dis or poorly diff neopl diag w CC .......... 1.1252 4.5 6.0 

845 ........ NO .............. NO .............. 17 MED ........... Other myeloprolif dis or poorly diff neopl diag w/o CC/ 

MCC.

0.8433 3.3 4.3 

846 ........ NO .............. NO .............. 17 MED ........... Chemotherapy w/o acute leukemia as secondary diagnosis w MCC.2.1956 5.8 8.5 

847 ........ NO .............. NO .............. 17 MED ........... Chemotherapy w/o acute leukemia as secondary diagnosis w CC.0.9758 2.7 3.3 

848 ........ NO .............. NO .............. 17 MED ........... Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC.0.7495 2.3 2.9 

849 ........ NO .............. NO .............. 17 MED ........... Radiotherapy ........................................................................ 1.2491 4.3 6.0 

853 ........ YES ............ NO .............. 18 SURG ......... Infectious & parasitic diseases w O.R. procedure w MCC 5.4321 13.4 17.4 

854 ........ YES ............ NO .............. 18 SURG ......... Infectious & parasitic diseases w O.R. procedure w CC .... 2.9346 9.5 11.5 

855 ........ YES ............ NO .............. 18 SURG ......... Infectious & parasitic diseases w O.R. procedure w/o CC/ 

MCC.

1.8472 5.8 7.6 

856 ........ YES ............ NO .............. 18 SURG ......... Postoperative or post-traumatic infections w O.R. proc w 

MCC.

4.9141 13.4 17.4 

857 ........ YES ............ NO .............. 18 SURG ......... Postoperative or post-traumatic infections w O.R. proc w 

CC.

2.0895 7.3 9.3 

858 ........ YES ............ NO .............. 18 SURG ......... Postoperative or post-traumatic infections w O.R. proc w/o 

CC/MCC.

1.3418 5.0 6.3 

862 ........ YES ............ NO .............. 18 MED ........... Postoperative & post-traumatic infections w MCC .............. 1.8740 6.6 8.6 

863 ........ YES ............ NO .............. 18 MED ........... Postoperative & post-traumatic infections w/o MCC ........... 0.9224 4.4 5.4 

864 ........ NO .............. NO .............. 18 MED ........... Fever of unknown origin ...................................................... 0.8171 3.2 4.1 

865 ........ NO .............. NO .............. 18 MED ........... Viral illness w MCC .............................................................. 1.5687 4.9 6.8 

866 ........ NO .............. NO .............. 18 MED ........... Viral illness w/o MCC ........................................................... 0.6691 2.8 3.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

24976 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

867 ........ YES ............ NO .............. 18 MED ........... Other infectious & parasitic diseases diagnoses w MCC ... 2.5039 7.5 10.2 

868 ........ YES ............ NO .............. 18 MED ........... Other infectious & parasitic diseases diagnoses w CC ...... 1.1589 4.7 6.1 

869 ........ YES ............ NO .............. 18 MED ........... Other infectious & parasitic diseases diagnoses w/o CC/ 

MCC.

0.8295 3.6 4.4 

870 ........ YES ............ NO .............. 18 MED ........... Septicemia w MV 96+ hours ............................................... 5.8269 13.0 15.7 

871 ........ YES ............ NO .............. 18 MED ........... Septicemia w/o MV 96+ hours w MCC ............................... 1.8811 5.8 7.8 

872 ........ YES ............ NO .............. 18 MED ........... Septicemia w/o MV 96+ hours w/o MCC ............................ 1.1304 4.8 5.9 

876 ........ NO .............. NO .............. 19 SURG ......... O.R. procedure w principal diagnoses of mental illness ..... 2.4818 6.8 11.2 

880 ........ NO .............. NO .............. 19 MED ........... Acute adjustment reaction & psychosocial dysfunction ...... 0.6104 2.4 3.2 

881 ........ NO .............. NO .............. 19 MED ........... Depressive neuroses ........................................................... 0.5320 3.1 4.2 

882 ........ NO .............. NO .............. 19 MED ........... Neuroses except depressive ............................................... 0.5791 3.1 4.5 

883 ........ NO .............. NO .............. 19 MED ........... Disorders of personality & impulse control .......................... 0.8908 4.6 7.4 

884 ........ YES ............ NO .............. 19 MED ........... Organic disturbances & mental retardation ......................... 0.8407 4.2 5.5 

885 ........ NO .............. NO .............. 19 MED ........... Psychoses ............................................................................ 0.8183 5.6 7.6 

886 ........ NO .............. NO .............. 19 MED ........... Behavioral & developmental disorders ................................ 0.7095 4.0 5.9 

887 ........ NO .............. NO .............. 19 MED ........... Other mental disorder diagnoses ........................................ 0.8075 3.1 4.6 

894 ........ NO .............. NO .............. 20 MED ........... Alcohol/drug abuse or dependence, left ama ...................... 0.3712 2.1 2.9 

895 ........ NO .............. NO .............. 20 MED ........... Alcohol/drug abuse or dependence w rehabilitation therapy..7771 8.2 10.5 

896 ........ YES ............ NO .............. 20 MED ........... Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC.1.2975 5.0 6.8 

897 ........ YES ............ NO .............. 20 MED ........... Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC.0.5935 3.3 4.1 

901 ........ NO .............. NO .............. 21 SURG ......... Wound debridements for injuries w MCC ............................ 3.6765 9.3 14.5 

902 ........ NO .............. NO .............. 21 SURG ......... Wound debridements for injuries w CC ............................... 1.7433 5.7 8.0 

903 ........ NO .............. NO .............. 21 SURG ......... Wound debridements for injuries w/o CC/MCC .................. 1.0239 3.5 4.9 

904 ........ NO .............. NO .............. 21 SURG ......... Skin grafts for injuries w CC/MCC ....................................... 2.9545 7.3 12.4 

905 ........ NO .............. NO .............. 21 SURG ......... Skin grafts for injuries w/o CC/MCC .................................... 1.0711 3.6 4.8 

906 ........ NO .............. NO .............. 21 SURG ......... Hand procedures for injuries ............................................... 0.9899 2.2 3.3 

907 ........ YES ............ NO .............. 21 SURG ......... Other O.R. procedures for injuries w MCC ......................... 3.6201 8.4 12.0 

908 ........ YES ............ NO .............. 21 SURG ......... Other O.R. procedures for injuries w CC ............................ 1.8922 5.3 7.2 

909 ........ YES ............ NO .............. 21 SURG ......... Other O.R. procedures for injuries w/o CC/MCC ................ 1.1253 2.8 3.7 

913 ........ NO .............. NO .............. 21 MED ........... Traumatic injury w MCC ...................................................... 1.3122 4.5 6.1 

914 ........ NO .............. NO .............. 21 MED ........... Traumatic injury w/o MCC ................................................... 0.6590 2.7 3.4 

915 ........ NO .............. NO .............. 21 MED ........... Allergic reactions w MCC .................................................... 1.1882 3.3 4.6 

916 ........ NO .............. NO .............. 21 MED ........... Allergic reactions w/o MCC ................................................. 0.4531 1.7 2.1 

917 ........ YES ............ NO .............. 21 MED ........... Poisoning & toxic effects of drugs w MCC .......................... 1.4901 3.9 5.4 

918 ........ YES ............ NO .............. 21 MED ........... Poisoning & toxic effects of drugs w/o MCC ....................... 0.5940 2.1 2.7 

919 ........ NO .............. NO .............. 21 MED ........... Complications of treatment w MCC ..................................... 1.4806 4.5 6.3 

920 ........ NO .............. NO .............. 21 MED ........... Complications of treatment w CC ........................................ 0.9200 3.4 4.5 

921 ........ NO .............. NO .............. 21 MED ........... Complications of treatment w/o CC/MCC ............................ 0.6150 2.4 3.0 

922 ........ NO .............. NO .............. 21 MED ........... Other injury, poisoning & toxic effect diag w MCC ............. 1.4653 4.2 6.1 

923 ........ NO .............. NO .............. 21 MED ........... Other injury, poisoning & toxic effect diag w/o MCC .......... 0.6493 2.4 3.3 

927 ........ NO .............. NO .............. 22 SURG ......... Extensive burns or full thickness burns w MV 96+ hrs w 

skin graft.

12.7968 23.1 29.0 

928 ........ NO .............. NO .............. 22 SURG ......... Full thickness burn w skin graft or inhal inj w CC/MCC ...... 4.7844 12.2 16.2 

929 ........ NO .............. NO .............. 22 SURG ......... Full thickness burn w skin graft or inhal inj w/o CC/MCC ... 1.8538 5.6 7.8 

933 ........ NO .............. NO .............. 22 MED ........... Extensive burns or full thickness burns w MV 96+ hrs w/o 

skin graft.

2.6367 2.7 5.9 

934 ........ NO .............. NO .............. 22 MED ........... Full thickness burn w/o skin grft or inhal inj ........................ 1.3929 4.8 7.0 

935 ........ NO .............. NO .............. 22 MED ........... Non-extensive burns ............................................................ 1.2000 3.7 5.6 

939 ........ NO .............. NO .............. 23 SURG ......... O.R. proc w diagnoses of other contact w health services 

w MCC.

2.6958 7.5 11.0 

940 ........ NO .............. NO .............. 23 SURG ......... O.R. proc w diagnoses of other contact w health services 

w CC.

1.7409 4.5 6.5 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24977 

TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING

FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued 

MS– 

DRG 

FY 2008 

proposed 

rule postacute DRG 

FY 2008 

proposed 

rule special pay 

DRG 

MDC TYPE MS–DRG title Weights 

Geometric 

mean 

length of 

stay 

Arithmetic 

mean 

length of 

stay 

941 ........ NO .............. NO .............. 23 SURG ......... O.R. proc w diagnoses of other contact w health services 

w/o CC/MCC.

1.0979 2.4 3.1 

945 ........ YES ............ NO .............. 23 MED ........... Rehabilitation w CC/MCC .................................................... 1.1456 9.3 11.1 

946 ........ YES ............ NO .............. 23 MED ........... Rehabilitation w/o CC/MCC ................................................. 0.9009 7.3 8.1 

947 ........ YES ............ NO .............. 23 MED ........... Signs & symptoms w MCC .................................................. 1.0303 3.9 5.1 

948 ........ YES ............ NO .............. 23 MED ........... Signs & symptoms w/o MCC ............................................... 0.6298 2.8 3.4 

949 ........ NO .............. NO .............. 23 MED ........... Aftercare w CC/MCC ........................................................... 0.7746 2.5 4.2 

950 ........ NO .............. NO .............. 23 MED ........... Aftercare w/o CC/MCC ........................................................ 0.5018 2.4 3.4 

951 ........ NO .............. NO .............. 23 MED ........... Other factors influencing health status ................................ 0.6104 2.1 3.7 

955 ........ NO .............. NO .............. 24 SURG ......... Craniotomy for multiple significant trauma .......................... 5.1127 8.6 12.3 

956 ........ YES ............ YES ............ 24 SURG ......... Limb reattachment, hip & femur proc for multiple significant trauma.3.3955 7.9 9.7 

957 ........ NO .............. NO .............. 24 SURG ......... Other O.R. procedures for multiple significant trauma w 

MCC.

6.8026 11.6 16.9 

958 ........ NO .............. NO .............. 24 SURG ......... Other O.R. procedures for multiple significant trauma w 

CC.

4.3582 8.8 11.6 

959 ........ NO .............. NO .............. 24 SURG ......... Other O.R. procedures for multiple significant trauma w/o 

CC/MCC.

3.1511 5.8 7.8 

963 ........ NO .............. NO .............. 24 MED ........... Other multiple significant trauma w MCC ............................ 2.7874 6.7 9.6 

964 ........ NO .............. NO .............. 24 MED ........... Other multiple significant trauma w CC ............................... 1.6288 5.5 6.9 

965 ........ NO .............. NO .............. 24 MED ........... Other multiple significant trauma w/o CC/MCC ................... 1.2426 3.8 4.7 

969 ........ NO .............. NO .............. 25 SURG ......... HIV w extensive O.R. procedure w MCC ............................ 5.6577 13.6 19.0 

970 ........ NO .............. NO .............. 25 SURG ......... HIV w extensive O.R. procedure w/o MCC ......................... 3.0430 8.2 11.8 

974 ........ NO .............. NO .............. 25 MED ........... HIV w major related condition w MCC ................................ 2.2553 6.5 9.4 

975 ........ NO .............. NO .............. 25 MED ........... HIV w major related condition w CC ................................... 1.5844 5.8 8.0 

976 ........ NO .............. NO .............. 25 MED ........... HIV w major related condition w/o CC/MCC ....................... 1.0710 4.2 5.6 

977 ........ NO .............. NO .............. 25 MED ........... HIV w or w/o other related condition ................................... 1.0477 3.8 5.2 

981 ........ YES ............ NO .............. .......... SURG ......... Extensive O.R. procedure unrelated to principal diagnosis 

w MCC.

5.0683 12.5 15.8 

982 ........ YES ............ NO .............. .......... SURG ......... Extensive O.R. procedure unrelated to principal diagnosis 

w CC.

3.1457 8.2 10.3 

983 ........ YES ............ NO .............. .......... SURG ......... Extensive O.R. procedure unrelated to principal diagnosis 

w/o CC/MCC.

2.0435 4.1 5.6 

984 ........ NO .............. NO .............. .......... SURG ......... Prostatic O.R. procedure unrelated to principal diagnosis 

w MCC.

3.3812 11.8 14.6 

985 ........ NO .............. NO .............. .......... SURG ......... Prostatic O.R. procedure unrelated to principal diagnosis 

w CC.

2.1002 7.5 9.9 

986 ........ NO .............. NO .............. .......... SURG ......... Prostatic O.R. procedure unrelated to principal diagnosis 

w/o CC/MCC.

1.2417 3.6 5.2 

987 ........ YES ............ NO .............. .......... SURG ......... Non-extensive O.R. proc unrelated to principal diagnosis 

w MCC.

3.5163 10.4 13.6 

988 ........ YES ............ NO .............. .......... SURG ......... Non-extensive O.R. proc unrelated to principal diagnosis 

w CC.

1.8823 6.1 8.1 

989 ........ YES ............ NO .............. .......... SURG ......... Non-extensive O.R. proc unrelated to principal diagnosis 

w/o CC/MCC.

1.1151 3.0 4.3 

998 ........ NO .............. NO .............. .......... ** ................ Principal diagnosis invalid as discharge diagnosis ............. 0.0000 0.0 0.0 

999 ........ NO .............. NO .............. .......... ** ................ Ungroupable ......................................................................... 0.0000 0.0 0.0 

MS–DRGs 998 and 999 contain cases that could not be assigned to valid DRGs. 

Note: If there is no value or asterisk 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. 

TABLE 6A.—NEW DIAGNOSIS CODES

Diagnosis 

code Description CC MDC MS–DRG 

040.41 ........ Infant botulism ....................................................................................................................................................... Y 15 791 1, 793 1

CC 18 867, 868, 869 

040.42 ........ Wound botulism .................................................................................................................................................... Y 18 867, 868, 869 

CC 

058.10 ........ Roseola infantum, unspecified .............................................................................................................................. N 15 791 1, 793 1

18 865, 866 

058.11 ........ Roseola infantum due to human herpes virus 6 .................................................................................................. N 15 791 1, 793 1

18 865, 866 

058.12 ........ Roseola infantum due to human herpes virus 7 .................................................................................................. N 15 791 1, 793 1

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24978 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6A.—NEW DIAGNOSIS CODES—Continued 

Diagnosis 

code Description CC MDC MS–DRG 

18 865, 866 

058.21 ........ Human herpes virus 6 encephalitis ...................................................................................................................... Y 

MCC 

1 23, 24, 97, 98, 

99 

15 791 1, 793 1

25 974, 975, 976 

058.29 ........ Other human herpes virus encephalitis ................................................................................................................ Y 

MCC 

1 23, 24,97, 98, 99 

15 791 1, 793 1

25 974, 975, 976 

058.81 ........ Human herpes virus 6 infection ............................................................................................................................ N 9 606, 607 

058.82 ........ Human herpes virus 7 infection ............................................................................................................................ N 9 606, 607 

058.89 ........ Other human herpes virus infection ...................................................................................................................... N 9 606, 607 

079.83 ........ Parvovirus B19 ...................................................................................................................................................... Y 

CC 

18 865, 866 

200.30 ........ Marginal zone lymphoma, unspecified site, extranodal and solid organ sites ..................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.31 ........ Marginal zone lymphoma, lymph nodes of head, face, and neck ........................................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.32 ........ Marginal zone lymphoma, intrathoracic lymph nodes .......................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.33 ........ Marginal zone lymphoma, intraabdominal lymph nodes ...................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.34 ........ Marginal zone lymphoma, lymph nodes of axilla and upper limb ........................................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.35 ........ Marginal zone lymphoma, lymph nodes of inguinal region and lower limb ......................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.36 ........ Marginal zone lymphoma, intrapelvic lymph nodes .............................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.37 ........ Marginal zone lymphoma, spleen ......................................................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.38 ........ Marginal zone lymphoma, lymph nodes of multiple sites ..................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.40 ........ Mantle cell lymphoma, unspecified site, extranodal and solid organ sites .......................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.41 ........ Mantle cell lymphoma, lymph nodes of head, face, and neck ............................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.42 ........ Mantle cell lymphoma, intrathoracic lymph nodes ................................................................................................ Y 

CC 

17 820, 821,822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.43 ........ Mantle cell lymphoma, intra-abdominal lymph nodes .......................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.44 ........ Mantle cell lymphoma, lymph nodes of axilla and upper limb ............................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24979 

TABLE 6A.—NEW DIAGNOSIS CODES—Continued 

Diagnosis 

code Description CC MDC MS–DRG 

200.45 ........ Mantle cell lymphoma, lymph nodes of inguinal region and lower limb ............................................................... Y 17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.46 ........ Mantle cell lymphoma, intrapelvic lymph nodes ................................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.47 ........ Mantle cell lymphoma, spleen .............................................................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.48 ........ Mantle cell lymphoma, lymph nodes of multiple sites .......................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.50 ........ Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sites ......................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.51 ........ Primary central nervous system lymphoma, lymph nodes of head, face, and neck ........................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.52 ........ Primary central nervous system lymphoma, intrathoracic lymph nodes .............................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.53 ........ Primary central nervous system lymphoma, intra-abdominal lymph nodes ......................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.54 ........ Primary central nervous system lymphoma, lymph nodes of axilla and upper limb ............................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.55 ........ Primary central nervous system lymphoma, lymph nodes of inguinal region and lower limb ............................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.56 ........ Primary central nervous system lymphoma, intrapelvic lymph nodes ................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.57 ........ Primary central nervous system lymphoma, spleen ............................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.58 ........ Primary central nervous system lymphoma, lymph nodes of multiple sites ........................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.60 ........ Anaplastic large cell lymphoma, unspecified site, extranodal and solid organ sites ........................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.61 ........ Anaplastic large cell lymphoma, lymph nodes of head, face, and neck .............................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.62 ........ Anaplastic large cell lymphoma, intrathoracic lymph nodes ................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.63 ........ Anaplastic large cell lymphoma, intra-abdominal lymph nodes ........................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.64 ........ Anaplastic large cell lymphoma, lymph nodes of axilla and upper limb .............................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

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24980 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6A.—NEW DIAGNOSIS CODES—Continued 

Diagnosis 

code Description CC MDC MS–DRG 

25 974, 975, 976 

200.65 ........ Anaplastic large cell lymphoma, lymph nodes of inguinal region and lower limb ................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.66 ........ Anaplastic large cell lymphoma, intrapelvic lymph nodes .................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.67 ........ Anaplastic large cell lymphoma, spleen ............................................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.68 ........ Anaplastic large cell lymphoma, lymph nodes of multiple sites ........................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.70 ........ Large cell lymphoma, unspecified site, extranodal and solid organ sites ............................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.71 ........ Large cell lymphoma, lymph nodes of head, face, and neck ............................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.72 ........ Large cell lymphoma, intrathoracic lymph nodes ................................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.73 ........ Large cell lymphoma, intra- abdominal lymph nodes ........................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.74 ........ Large cell lymphoma, lymph nodes of axilla and upper limb ............................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.75 ........ Large cell lymphoma, lymph nodes of inguinal region and lower limb ................................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.76 ........ Large cell lymphoma, intrapelvic lymph nodes ..................................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.77 ........ Large cell lymphoma, spleen ................................................................................................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

200.78 ........ Large cell lymphoma, lymph nodes of multiple sites ............................................................................................ Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.70 ........ Peripheral T cell lymphoma, unspecified site, extranodal and solid organ sites ................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.71 ........ Peripheral T cell lymphoma, lymph nodes of head, face, and neck .................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.72 ........ Peripheral T cell lymphoma, intrathoracic lymph nodes ....................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.73 ........ Peripheral T cell lymphoma, intra-abdominal lymph nodes ................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24981 

TABLE 6A.—NEW DIAGNOSIS CODES—Continued 

Diagnosis 

code Description CC MDC MS–DRG 

202.74 ........ Peripheral T cell lymphoma, lymph nodes of axilla and upper limb .................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.75 ........ Peripheral T cell lymphoma, lymph nodes of inguinal region and lower limb ...................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.76 ........ Peripheral T cell lymphoma, intrapelvic lymph nodes .......................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.77 ........ Peripheral T cell lymphoma, spleen ..................................................................................................................... Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

202.78 ........ Peripheral T cell lymphoma, lymph nodes of multiple sites ................................................................................. Y 

CC 

17 820, 821, 822, 

823, 824, 825, 

840, 841, 842 

25 974, 975, 976 

233.30 ........ Carcinoma in situ, unspecified female genital organ ............................................................................................ N 13 739, 740, 741, 

744, 745, 754, 

755, 756 

233.31 ........ Carcinoma in situ,vagina ....................................................................................................................................... N 13 739, 740, 741, 

744, 745, 754, 

755, 756 

233.32 ........ Carcinoma in situ,vulva ......................................................................................................................................... N 13 739, 740, 741, 

744, 745, 754, 

755, 756 

233.39 ........ Carcinoma in situ, other female genital organ ...................................................................................................... N 13 739, 740, 741, 

744, 745, 754, 

755, 756 

255.41 ........ Glucocorticoid deficiency ...................................................................................................................................... Y 10 643, 644, 645 

CC 

255.42 ........ Mineralocorticoid deficiency .................................................................................................................................. Y 10 643, 644, 645 

CC 

258.01 ........ Multiple endocrine neoplasia [MEN] type I ........................................................................................................... N 10 643, 644, 645 

258.02 ........ Multiple endocrine neoplasia [MEN] type IIA ........................................................................................................ N 10 643, 644, 645 

258.03 ........ Multiple endocrine neoplasia [MEN] type IIB ........................................................................................................ N 10 643, 644, 645 

284.81 ........ Red cell aplasia (acquired)(adult)(with thymoma) ................................................................................................ Y 16 808, 809, 810 

MCC 25 977 

284.89 ........ Other specified aplastic anemias .......................................................................................................................... Y 16 808, 809, 810 

MCC 25 977 

288.66 ........ Bandemia .............................................................................................................................................................. N 16 814, 815, 816 

315.34 ........ Speech and language developmental delay due to hearing loss ........................................................................ N 19 886 

331.5 .......... Idiopathic normal pressure hydrocephalus (INPH) ............................................................................................... Y 

CC 

1 56, 57 

359.21 ........ Myotonic muscular dystrophy ............................................................................................................................... N 1 91, 92, 93 

359.22 ........ Myotonia congenital .............................................................................................................................................. N 1 91, 92, 93 

359.23 ........ Myotonic chondrodystrophy .................................................................................................................................. N 1 91, 92, 93 

359.24 ........ Drug induced myotonia ......................................................................................................................................... N 1 91, 92, 93 

359.29 ........ Other specified myotonic disorder ........................................................................................................................ N 1 91, 92, 93 

364.81 ........ Floppy iris syndrome ............................................................................................................................................. N 2 124, 125 

364.89 ........ Other disorders of iris and ciliary body ................................................................................................................. N 2 124, 125 

388.45 ........ Acquired auditory processing disorder ................................................................................................................. N 19 886 

389.05 ........ Conductive hearing loss, unilateral ....................................................................................................................... N 3 154, 155, 156 

389.06 ........ Conductive hearing loss, bilateral ......................................................................................................................... N 3 154, 155, 156 

389.13 ........ Neural hearing loss, unilateral .............................................................................................................................. N 3 154, 155, 156 

389.17 ........ Sensory hearing loss, unilateral ............................................................................................................................ N 3 154, 155, 156 

389.20 ........ Mixed hearing loss, unspecified ............................................................................................................................ N 3 154, 155, 156 

389.21 ........ Mixed hearing loss, unilateral ............................................................................................................................... N 3 154, 155, 156 

389.22 ........ Mixed hearing loss, bilateral ................................................................................................................................. N 3 154, 155, 156 

414.2 .......... Chronic total occlusion of coronary artery ............................................................................................................ N 5 302, 303 

415.12 ........ Septic pulmonary embolism .................................................................................................................................. Y 4 175,176 

MCC 15 791 1, 793 1

423.3 .......... Cardiac tamponade ............................................................................................................................................... Y 

CC 

5 314, 315, 316 

440.4 .......... Chronic total occlusion of artery of the extremities .............................................................................................. N 5 299, 300, 301 

449 ............. Septic arterial embolism ........................................................................................................................................ Y 5 299, 300, 301 

CC 15 791 1, 793 1

488 ............. Influenza due to identified avian influenza virus ................................................................................................... N 3 152, 153 

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TABLE 6A.—NEW DIAGNOSIS CODES—Continued 

Diagnosis 

code Description CC MDC MS–DRG 

525.71 ........ Osseointegration failure of dental implant ............................................................................................................ N PRE3 11, 12, 13, 

157, 158, 159 

525.72 ........ Post-osseointegration biological failure of dental implant .................................................................................... N PRE3 11, 12, 13, 

157, 158, 159 

525.73 ........ Post-osseointegration mechanical failure of dental implant ................................................................................. N PRE3 11, 12, 13, 

157, 158, 159 

525.79 ........ Other endosseous dental implant failure .............................................................................................................. N PRE3 11, 12, 13, 

157, 158, 159 

569.43 ........ Anal sphincter tear (healed) (old) ......................................................................................................................... N 6 393, 394, 395 

624.01 ........ Vulvar intraepithelial neoplasia I [VIN I] ................................................................................................................ N 13 742, 743, 760, 

761 

624.02 ........ Vulvar intraepithelial neoplasia II [VIN II] .............................................................................................................. N 13 742, 743, 760, 

761 

624.09 ........ Other dystrophy of vulva ....................................................................................................................................... N 13 742, 743, 760, 

761 

629.82 ........ Acquired absence of both uterus and cervix ........................................................................................................ N 13 742, 743, 760, 

761 

629.83 ........ Acquired absence of uterus, with remaining cervical stump ................................................................................ N 13 742, 743, 760, 

761 

629.84 ........ Acquired absence of cervix with remaining uterus ............................................................................................... N 13 742, 743, 760, 

761 

664.60 ........ Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, unspecified as 

to episode of care or not applicable.

N 14 765, 766, 767, 

768, 774, 775 

664.61 ........ Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, delivered, with 

or without mention of antepartum condition.

Y 

CC 

14 765, 766, 767, 

768, 774, 775 

664.64 ........ Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, postpartum 

condition or complication.

Y 

CC 

14 769, 776 

733.45 ........ Aseptic necrosis of bone, jaw ............................................................................................................................... Y 8 553, 554 

CC 

787.20 ........ Dysphagia, unspecified ......................................................................................................................................... N 6 391, 392 

787.21 ........ Dysphagia, oral phase .......................................................................................................................................... N 6 391, 392 

787.22 ........ Dysphagia, oropharyngeal phase ......................................................................................................................... N 6 391, 392 

787.23 ........ Dysphagia, pharyngeal phase .............................................................................................................................. N 6 391, 392 

787.24 ........ Dysphagia, pharyngoesophageal phase ............................................................................................................... N 6 391, 392 

787.29 ........ Other dysphagia .................................................................................................................................................... N 6 391, 392 

789.51 ........ Malignant ascites .................................................................................................................................................. Y 23 947, 948 

789.59 ........ Other ascites ......................................................................................................................................................... Y 23 947, 948 

CC 

V12.53 ........ Personal history of sudden cardiac arrest ............................................................................................................ N 23 951 

V12.54 ........ Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits ................. N 23 951 

V13.22 ........ Personal history of cervical dysplasia ................................................................................................................... N 17 843, 844, 845 

V16.52 ........ Family history of malignant neoplasm, bladder .................................................................................................... N 23 951 

V17.40 ........ Family history of cardiovascular diseases, unspecified ........................................................................................ N 23 951 

V17.41 ........ Family history of sudden cardiac death (SCD) ..................................................................................................... N 23 951 

V17.49 ........ Family history of other cardiovascular diseases ................................................................................................... N 23 951 

V18.11 ........ Family history of multiple endocrine neoplasia [MEN] syndrome ........................................................................ N 23 951 

V18.19 ........ Family history of other endocrine and metabolic diseases .................................................................................. N 23 951 

V25.04 ........ Counseling and instruction in natural family planning to avoid pregnancy .......................................................... N 23 951 

V26.41 ........ Procreative counseling and advice using natural family planning ........................................................................ N 23 951 

V26.49 ........ Other procreative management, counseling and advice ...................................................................................... N 23 951 

V26.81 ........ Encounter for assisted reproductive fertility procedure cycle ............................................................................... N 23 951 

V26.89 ........ Other specified procreative management ............................................................................................................. N 23 951 

V49.85 ........ Dual sensory impairment ...................................................................................................................................... N 23 951 

V68.01 ........ Disability examination ........................................................................................................................................... N 23 951 

V68.09 ........ Other issue of medical certificates ........................................................................................................................ N 23 951 

V72.12 ........ Encounter for hearing conservation and treatment .............................................................................................. N 15 795 2

23 951 

V73.81 ........ Special screening examination, Human papilloma virus (HPV) ........................................................................... N 23 951 

V84.81 ........ Genetic susceptibility to multiple endocrine neoplasia [MEN] .............................................................................. N 23 951 

V84.89 ........ Genetic susceptibility to other disease ................................................................................................................. N 23 951 

MCC—Major Complication or Comorbidity in MS–DRGs. 

1 Secondary diagnosis of major problem. 

2 On ‘‘Only secondary diagnosis’’ list. 

TABLE 6B.—NEW PROCEDURE CODES

Procedure 

code Description O.R. MDC MS–DRG 

00.19 .......... Disruption of blood brain barrier via infusion [BBBD] ........................................................................................... N 

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TABLE 6B.—NEW PROCEDURE CODES—Continued 

Procedure 

code Description O.R. MDC MS–DRG 

01.10 .......... Intracranial pressure monitoring ........................................................................................................................... N 

01.16 .......... Intracranial oxygen monitoring .............................................................................................................................. N 

01.17 .......... Brain temperature monitoring ............................................................................................................................... N 

32.41 .......... Thoracoscopic lobectomy of lung ......................................................................................................................... Y 4 163, 164, 165 

21 907, 908, 909 

24 957, 958, 959 

32.49 .......... Other lobectomy of lung ........................................................................................................................................ Y 4 163, 164, 165 

21 907, 908, 909 

24 957, 958, 959 

33.20 .......... Thoracoscopic lung biopsy ................................................................................................................................... Y 4 166, 167, 168 

5 264 

8 515, 516, 517 

11 673, 674, 675 

17 823, 824, 825, 

829, 830 

34.06 .......... Thoracoscopic drainage of pleural cavity ............................................................................................................. Y 4 166, 167, 168 

34.20 .......... Thoracoscopic pleural biopsy ............................................................................................................................... Y 4 166, 167, 168 

34.52 .......... Thoracoscopic decortication of lung ..................................................................................................................... Y 4 163, 164, 165 

17 820, 821, 822, 

826, 827, 828 

21 907, 908, 909 

............................................................................................................................................................................... 24 957, 958, 959 

70.53 .......... Repair of cystocele and rectocele with graft or prosthesis .................................................................................. Y 6 329, 330, 331 

11 653, 654, 655 

13 748 

70.54 .......... Repair of cystocele with graft or prosthesis ......................................................................................................... Y 11 662, 663, 664 

13 748 

70.55 .......... Repair of rectocele with graft or prosthesis .......................................................................................................... Y 6 329, 330, 331 

13 748 

70.63 .......... Vaginal construction with graft or prosthesis ........................................................................................................ Y 13 748 

70.64 .......... Vaginal reconstruction with graft or prosthesis ..................................................................................................... Y 13 748 

21 907, 908, 909 

24 957, 958, 959 

70.78 .......... Vaginal suspension and fixation with graft or prosthesis ..................................................................................... Y 11 662, 663, 664 

............................................................................................................................................................................... 13 748 

70.93 .......... Other operations on cul-de-sac with graft or prosthesis ...................................................................................... Y 13 746, 747 

70.94 .......... Insertion of biological graft .................................................................................................................................... N 

70.95 .......... Insertion of synthetic graft or prosthesis ............................................................................................................... N 

88.59 .......... Intra-operative fluorescence vascular angiography .............................................................................................. N 

TABLE 6C.—INVALID DIAGNOSIS CODES

Diagnosis 

code Description CC MDC CMS DRG 

233.3 .......... Carcinoma in situ,other and unspecified female genital organs .......................................................................... N 13 354, 355, 363, 

366, 367 

255.4 .......... Corticoadrenal insufficiency .................................................................................................................................. Y 10 300, 301 

258.0 .......... Polyglandular activity in multiple endocrine adenomatosis .................................................................................. N 10 300, 301 

284.8 .......... Other specified aplastic anemias .......................................................................................................................... Y 16 574 

............................................................................................................................................................................... 25 490 

359.2 .......... Myotonic disorders ................................................................................................................................................ N 1 34, 35 

364.8 .......... Other disorders of iris and ciliary body ................................................................................................................. N 2 46, 47, 48 

389.2 .......... Mixed conductive and sensorineural hearing loss ................................................................................................ N 3 73, 74 

624.0 .......... Dystrophy of vulva ................................................................................................................................................ N 13 358, 359, 369 

787.2 .......... Dysphagia ............................................................................................................................................................. N 6 182, 183, 184 

789.5 .......... Ascites ................................................................................................................................................................... Y 23 463, 464 

V17.4 .......... Family history of other cardiovascular diseases ................................................................................................... N 23 467 

V18.1 .......... Family history of other endocrine and metabolic diseases .................................................................................. N 23 467 

V26.4 .......... Procreative management, general counseling and advice ................................................................................... N 23 467 

V26.8 .......... Other specified procreative management ............................................................................................................. N 23 467 

V68.0 .......... Issue of medical certificates .................................................................................................................................. N 23 467 

V84.8 .......... Genetic susceptibility to other disease ................................................................................................................. N 23 467 

The DRG assignments listed are based 

on the current code assignment in the 

CMS DRGs. 

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TABLE 6D.—INVALID PROCEDURE CODES

Procedure 

code Description OR MDC CMS DRG 

32.4 ........ Lobectomy of lung ....................................................................................................................... Y 4 

21 

24 

75 

442,443 

486 

The DRG assignments listed are based 

on the current code assignment in the 

CMS DRGs. 

TABLE 6E.—REVISED DIAGNOSIS CODE TITLES

Diagnosis 

code Description CC MDC MS–DRG 

005.1 ......... Botulism food poisoning ........................................................................................................................................ Y 

CC 

18 867, 868, 869 

359.3 ......... Periodic paralysis .................................................................................................................................................. N 1 91, 92, 93 

389.14 ....... Central hearing loss .............................................................................................................................................. N 3 154, 155, 156 

389.18 ........ Sensorineural hearing loss, bilateral ..................................................................................................................... N 3 154, 155,156 

389.7 ......... Deaf, nonspeaking, not elsewhere classifiable ..................................................................................................... N 3 154, 155, 156 

TABLE 6F.—REVISED PROCEDURE CODE TITLES

Procedure 

code Description OR MDC MS–DRG 

00.74 ........ Hip bearing surface, metal-on-polyethylene ................................................................................ N 

00.75 ........ Hip bearing surface, metal-on-metal ........................................................................................... N 

00.76 ........ Hip bearing surface, ceramic-on-ceramic .................................................................................... N 

00.77 ........ Hip bearing surface, ceramic-on-polyethylene ............................................................................ N 

34.24 ........ Other pleural biopsy ..................................................................................................................... N 

53.41 ........ Repair of umbilical hernia with graft or prosthesis ...................................................................... Y 6 353, 354, 355 

987, 988, 989 

53.61 ........ Incisional hernia repair with graft or prosthesis ........................................................................... Y 6 

21 

24 

353, 354, 355 

907, 908, 909 

957, 958, 959 

987, 988, 989 

53.69 ........ Repair of other hernia of anterior abdominal wall with graft or prosthesis ................................. Y 06 353, 354, 355 

987, 988, 989 

99.14 ........ Injection or infusion of gamma globulin ....................................................................................... N 

Note: Diagnoses codes 42741 (Ventricular 

fibrillation), 4275 (Cardiac arrest), 78551 

(Cardiogenic shock), 78559 (Other shock 

without mention of trauma) and 7991 

(Respiratory arrest) are assigned as a major 

CC only for patients discharged alive, 

otherwise they will be assigned as a non CC. 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST

Diagnosis code Code title 

0031 ................................................. Salmonella septicemia. 

00321 ............................................... Salmonella meningitis. 

00322 ............................................... Salmonella pneumonia. 

0063 ................................................. Amebic liver abscess. 

0064 ................................................. Amebic lung abscess. 

0065 ................................................. Amebic brain abscess. 

01160 ............................................... Tuberculous pneumonia (any form), unspecified examination. 

01161 ............................................... Tuberculous pneumonia (any form), bacteriological or histological examination not done. 

01162 ............................................... Tuberculous pneumonia (any form), bacteriological or histological examination results unknown (at present). 

01163 ............................................... Tuberculous pneumonia (any form), tubercle bacilli found (in sputum) by microscopy. 

01164 ............................................... Tuberculous pneumonia (any form), tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01165 ............................................... Tuberculous pneumonia (any form), tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01166 ............................................... Tuberculous pneumonia (any form), tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01300 ............................................... Tuberculous meningitis, unspecified examination. 

01301 ............................................... Tuberculous meningitis, bacteriological or histological examination not done. 

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TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

01302 ............................................... Tuberculous meningitis, bacteriological or histological examination results unknown (at present). 

01303 ............................................... Tuberculous meningitis, tubercle bacilli found (in sputum) by microscopy. 

01304 ............................................... Tuberculous meningitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01305 ............................................... Tuberculous meningitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01306 ............................................... Tuberculous meningitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01310 ............................................... Tuberculoma of meninges, unspecified examination. 

01311 ............................................... Tuberculoma of meninges, bacteriological or histological examination not done. 

01312 ............................................... Tuberculoma of meninges, bacteriological or histological examination results unknown (at present). 

01313 ............................................... Tuberculoma of meninges, tubercle bacilli found (in sputum) by microscopy. 

01314 ............................................... Tuberculoma of meninges, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01315 ............................................... Tuberculoma of meninges, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01316 ............................................... Tuberculoma of meninges, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01320 ............................................... Tuberculoma of brain, unspecified examination. 

01321 ............................................... Tuberculoma of brain, bacteriological or histological examination not done.

01322 ............................................... Tuberculoma of brain, bacteriological or histological examination results unknown (at present). 

01323 ............................................... Tuberculoma of brain, tubercle bacilli found (in sputum) by microscopy. 

01324 ............................................... Tuberculoma of brain, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01325 ............................................... Tuberculoma of brain, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01326 ............................................... Tuberculoma of brain, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01330 ............................................... Tuberculous abscess of brain, unspecified examination. 

01331 ............................................... Tuberculous abscess of brain, bacteriological or histological examination not done. 

01332 ............................................... Tuberculous abscess of brain, bacteriological or histological examination results unknown (at present). 

01333 ............................................... Tuberculous abscess of brain, tubercle bacilli found (in sputum) by microscopy. 

01334 ............................................... Tuberculous abscess of brain, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01335 ............................................... Tuberculous abscess of brain, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01336 ............................................... Tuberculous abscess of brain, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01340 ............................................... Tuberculoma of spinal cord, unspecified examination. 

01341 ............................................... Tuberculoma of spinal cord, bacteriological or histological examination not done. 

01342 ............................................... Tuberculoma of spinal cord, bacteriological or histological examination results unknown (at present). 

01343 ............................................... Tuberculoma of spinal cord, tubercle bacilli found (in sputum) by microscopy. 

01344 ............................................... Tuberculoma of spinal cord, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01345 ............................................... Tuberculoma of spinal cord, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01346 ............................................... Tuberculoma of spinal cord, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01350 ............................................... Tuberculous abscess of spinal cord, unspecified examination. 

01351 ............................................... Tuberculous abscess of spinal cord, bacteriological or histological examination not done. 

01352 ............................................... Tuberculous abscess of spinal cord, bacteriological or histological examination results unknown (at present). 

01353 ............................................... Tuberculous abscess of spinal cord, tubercle bacilli found (in sputum) by microscopy. 

01354 ............................................... Tuberculous abscess of spinal cord, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01355 ............................................... Tuberculous abscess of spinal cord, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01356 ............................................... Tuberculous abscess of spinal cord, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01360 ............................................... Tuberculous encephalitis or myelitis, unspecified examination. 

01361 ............................................... Tuberculous encephalitis or myelitis, bacteriological or histological examination not done. 

01362 ............................................... Tuberculous encephalitis or myelitis, bacteriological or histological examination results unknown (at present). 

01363 ............................................... Tuberculous encephalitis or myelitis, tubercle bacilli found (in sputum) by microscopy. 

01364 ............................................... Tuberculous encephalitis or myelitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01365 ............................................... Tuberculous encephalitis or myelitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01366 ............................................... Tuberculous encephalitis or myelitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01380 ............................................... Other specified tuberculosis of central nervous system, unspecified examination. 

01381 ............................................... Other specified tuberculosis of central nervous system, bacteriological or histological examination not done. 

01382 ............................................... Other specified tuberculosis of central nervous system, bacteriological or histological examination results unknown (at present). 

01383 ............................................... Other specified tuberculosis of central nervous system, tubercle bacilli found (in sputum) by microscopy. 

01384 ............................................... Other specified tuberculosis of central nervous system, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

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TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

01385 ............................................... Other specified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01386 ............................................... Other specified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological or histological examination, 

but tuberculosis confirmed by other methods (inoculation of animals). 

01390 ............................................... Unspecified tuberculosis of central nervous system, unspecified examination. 

01391 ............................................... Unspecified tuberculosis of central nervous system, bacteriological or histological examination not done. 

01392 ............................................... Unspecified tuberculosis of central nervous system, bacteriological or histological examination results unknown (at present). 

01393 ............................................... Unspecified tuberculosis of central nervous system, tubercle bacilli found (in sputum) by microscopy. 

01394 ............................................... Unspecified tuberculosis of central nervous system, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial 

culture. 

01395 ............................................... Unspecified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological examination, but tuberculosis 

confirmed histologically. 

01396 ............................................... Unspecified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological or histological examination, but 

tuberculosis confirmed by other methods (inoculation of animals). 

01400 ............................................... Tuberculous peritonitis, unspecified examination. 

01401 ............................................... Tuberculous peritonitis, bacteriological or histological examination not done. 

01402 ............................................... Tuberculous peritonitis, bacteriological or histological examination results unknown (at present). 

01403 ............................................... Tuberculous peritonitis, tubercle bacilli found (in sputum) by microscopy. 

01404 ............................................... Tuberculous peritonitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01405 ............................................... Tuberculous peritonitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01406 ............................................... Tuberculous peritonitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01800 ............................................... Acute miliary tuberculosis, unspecified examination. 

01801 ............................................... Acute miliary tuberculosis, bacteriological or histological examination not done. 

01802 ............................................... Acute miliary tuberculosis, bacteriological or histological examination results unknown (at present). 

01803 ............................................... Acute miliary tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01804 ............................................... Acute miliary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01805 ............................................... Acute miliary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01806 ............................................... Acute miliary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01880 ............................................... Other specified miliary tuberculosis, unspecified examination. 

01881 ............................................... Other specified miliary tuberculosis, bacteriological or histological examination not done. 

01882 ............................................... Other specified miliary tuberculosis, bacteriological or histological examination results unknown (at present). 

01883 ............................................... Other specified miliary tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01884 ............................................... Other specified miliary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01885 ............................................... Other specified miliary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01886 ............................................... Other specified miliary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01890 ............................................... Unspecified miliary tuberculosis, unspecified examination. 

01891 ............................................... Unspecified miliary tuberculosis, bacteriological or histological examination not done. 

01892 ............................................... Unspecified miliary tuberculosis, bacteriological or histological examination results unknown (at present). 

01893 ............................................... Unspecified miliary tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01894 ............................................... Unspecified miliary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01895 ............................................... Unspecified miliary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01896 ............................................... Unspecified miliary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

0200 ................................................. Bubonic plague. 

0201 ................................................. Cellulocutaneous plague. 

0202 ................................................. Septicemic plague. 

0203 ................................................. Primary pneumonic plague. 

0204 ................................................. Secondary pneumonic plague. 

0205 ................................................. Pneumonic plague, unspecified. 

0208 ................................................. Other specified types of plague. 

0209 ................................................. Plague, unspecified. 

0221 ................................................. Pulmonary anthrax. 

0223 ................................................. Anthrax septicemia. 

0360 ................................................. Meningococcal meningitis. 

0361 ................................................. Meningococcal encephalitis. 

0362 ................................................. Meningococcemia. 

0363 ................................................. Waterhouse-friderichsen syndrome, meningococcal. 

03640 ............................................... Meningococcal carditis, unspecified. 

03641 ............................................... Meningococcal pericarditis. 

03642 ............................................... Meningococcal endocarditis. 

03643 ............................................... Meningococcal myocarditis. 

037 ................................................... Tetanus. 

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TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

0380 ................................................. Streptococcal septicemia. 

03810 ............................................... Staphylococcal septicemia, unspecified. 

03811 ............................................... Staphylococcus aureus septicemia. 

03819 ............................................... Other staphylococcal septicemia. 

0382 ................................................. Pneumococcal septicemia. 

0383 ................................................. Septicemia due to anaerobes. 

03840 ............................................... Septicemia due to gram-negative organism, unspecified. 

03841 ............................................... Septicemia due to hemophilus influenzae (h. influenzae). 

03842 ............................................... Septicemia due to escherichia coli (e. coli). 

03843 ............................................... Septicemia due to pseudomonas. 

03844 ............................................... Septicemia due to serratia. 

03849 ............................................... Other septicemia due to gram-negative organisms. 

0388 ................................................. Other specified septicemias. 

0389 ................................................. Unspecified septicemia. 

0400 ................................................. Gas gangrene. 

04082 ............................................... Toxic shock syndrome. 

042 ................................................... Human immunodeficiency virus (hiv) disease. 

04500 ............................................... Acute paralytic poliomyelitis specified as bulbar, unspecified type of poliovirus. 

04501 ............................................... Acute paralytic poliomyelitis specified as bulbar, poliovirus type i. 

04502 ............................................... Acute paralytic poliomyelitis specified as bulbar, poliovirus type ii. 

04503 ............................................... Acute paralytic poliomyelitis specified as bulbar, poliovirus type iii. 

04510 ............................................... Acute poliomyelitis with other paralysis, unspecified type of poliovirus. 

04511 ............................................... Acute poliomyelitis with other paralysis, poliovirus type i. 

04512 ............................................... Acute poliomyelitis with other paralysis, poliovirus type ii. 

04513 ............................................... Acute poliomyelitis with other paralysis, poliovirus type iii. 

0520 ................................................. Postvaricella encephalitis. 

0521 ................................................. Varicella (hemorrhagic) pneumonitis. 

0522 ................................................. Postvaricella myelitis. 

0530 ................................................. Herpes zoster with meningitis. 

05314 ............................................... Herpes zoster myelitis. 

0543 ................................................. Herpetic meningoencephalitis. 

0545 ................................................. Herpetic septicemia. 

05472 ............................................... Herpes simplex meningitis. 

05474 ............................................... Herpes simplex myelitis. 

0550 ................................................. Postmeasles encephalitis. 

0551 ................................................. Postmeasles pneumonia. 

05601 ............................................... Encephalomyelitis due to rubella. 

05821 ............................................... Human herpes virus 6 encephalitis. 

05829 ............................................... Other human herpes virus encephalitis. 

0620 ................................................. Japanese encephalitis. 

0621 ................................................. Western equine encephalitis. 

0622 ................................................. Eastern equine encephalitis. 

0623 ................................................. St. Louis encephalitis. 

0624 ................................................. Australian encephalitis. 

0625 ................................................. California virus encephalitis. 

0628 ................................................. Other specified mosquito-borne viral encephalitis. 

0629 ................................................. Mosquito-borne viral encephalitis, unspecified. 

0630 ................................................. Russian spring-summer (taiga) encephalitis. 

0631 ................................................. Louping ill. 

0632 ................................................. Central european encephalitis. 

0638 ................................................. Other specified tick-borne viral encephalitis. 

0639 ................................................. Tick-borne viral encephalitis, unspecified. 

064 ................................................... Viral encephalitis transmitted by other and unspecified arthropods. 

06640 ............................................... West Nile Fever, unspecified. 

06641 ............................................... West Nile Fever with encephalitis. 

06642 ............................................... West Nile Fever with other neurologic manifestation. 

06649 ............................................... West Nile Fever with other complications. 

0700 ................................................. Viral hepatitis a with hepatic coma. 

07020 ............................................... Viral hepatitis b with hepatic coma, acute or unspecified, without mention of hepatitis delta. 

07021 ............................................... Viral hepatitis b with hepatic coma, acute or unspecified, with hepatitis delta. 

07022 ............................................... Chronic viral hepatitis b with hepatic coma without hepatitis delta. 

07023 ............................................... Chronic viral hepatitis b with hepatic coma with hepatitis delta. 

07041 ............................................... Acute hepatitis C with hepatic coma. 

07042 ............................................... Hepatitis delta without mention of active hepatitis b disease, with hepatic coma, hepatitis delta with hepatitis b carrier state. 

07043 ............................................... Hepatitis e with hepatic coma. 

07044 ............................................... Chronic hepatitis c with hepatic coma. 

07049 ............................................... Other specified viral hepatitis with hepatic coma. 

0706 ................................................. Unspecified viral hepatitis with hepatic coma. 

07071 ............................................... Unspecified viral hepatitis C with hepatic coma. 

0721 ................................................. Mumps meningitis. 

0722 ................................................. Mumps encephalitis. 

mmaher on DSK3CLS3C1PROD with $$_JOB

24988 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

0730 ................................................. Ornithosis with pneumonia. 

0840 ................................................. Falciparum malaria (malignant tertian). 

09041 ............................................... Congenital syphilitic encephalitis. 

09042 ............................................... Congenital syphilitic meningitis. 

09181 ............................................... Acute syphilitic meningitis (secondary). 

0942 ................................................. Syphilitic meningitis. 

09481 ............................................... Syphilitic encephalitis. 

09487 ............................................... Syphilitic ruptured cerebral aneurysm. 

09882 ............................................... Gonococcal meningitis. 

09883 ............................................... Gonococcal pericarditis. 

09884 ............................................... Gonococcal endocarditis. 

10081 ............................................... Leptospiral meningitis (aseptic). 

1124 ................................................. Candidiasis of lung. 

1125 ................................................. Disseminated candidiasis. 

11281 ............................................... Candidal endocarditis. 

11283 ............................................... Candidal meningitis. 

1142 ................................................. Coccidioidal meningitis. 

11501 ............................................... Histoplasma capsulatum meningitis. 

11503 ............................................... Histoplasma capsulatum pericarditis. 

11504 ............................................... Histoplasma capsulatum endocarditis. 

11505 ............................................... Histoplasma capsulatum pneumonia. 

11511 ............................................... Histoplasma duboisii meningitis. 

11513 ............................................... Histoplasma duboisii pericarditis. 

11514 ............................................... Histoplasma duboisii endocarditis. 

11515 ............................................... Histoplasma duboisii pneumonia. 

11591 ............................................... Histoplasmosis meningitis, unspecified. 

11593 ............................................... Histoplasmosis pericarditis, unspecified. 

11594 ............................................... Histoplasmosis endocarditis. 

11595 ............................................... Histoplasmosis pneumonia, unspecified. 

1177 ................................................. Zygomycosis (phycomycosis or mucormycosis). 

1300 ................................................. Meningoencephalitis due to toxoplasmosis. 

1303 ................................................. Myocarditis due to toxoplasmosis. 

1304 ................................................. Pneumonitis due to toxoplasmosis. 

1308 ................................................. Multisystemic disseminated toxoplasmosis. 

1362 ................................................. Specific infections by free-living amebae. 

1363 ................................................. Pneumocystosis. 

24201 ............................................... Toxic diffuse goiter with mention of thyrotoxic crisis or storm. 

24211 ............................................... Toxic uninodular goiter with mention of thyrotoxic crisis or storm. 

24221 ............................................... Toxic multinodular goiter with mention of thyrotoxic crisis or storm. 

24231 ............................................... Toxic nodular goiter, unspecified type, with mention of thyrotoxic crisis or storm. 

24241 ............................................... Thyrotoxicosis from ectopic thyroid nodule with mention of thyrotoxic crisis or storm. 

24281 ............................................... Thyrotoxicosis of other specified origin with mention of thyrotoxic crisis or storm. 

24291 ............................................... Thyrotoxicosis without mention of goiter or other cause, with mention of thyrotoxic crisis or storm. 

25010 ............................................... Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled. 

25011 ............................................... Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled. 

25012 ............................................... Diabetes with ketoacidosis, type II or unspecified type, uncontrolled. 

25013 ............................................... Diabetes with ketoacidosis, type I [juvenile type], uncontrolled. 

25020 ............................................... Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled. 

25021 ............................................... Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled. 

25022 ............................................... Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled. 

25023 ............................................... Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled. 

25030 ............................................... Diabetes with other coma, type II or unspecified type, not stated as uncontrolled. 

25031 ............................................... Diabetes with other coma, type I [juvenile type], not stated as uncontrolled. 

25032 ............................................... Diabetes with other coma, type II or unspecified type, uncontrolled. 

25033 ............................................... Diabetes with other coma, type I [juvenile type], uncontrolled. 

260 ................................................... Kwashiorkor. 

261 ................................................... Nutritional marasmus. 

262 ................................................... Other severe protein-calorie malnutrition. 

27701 ............................................... Cystic fibrosis with meconium ileus. 

27702 ............................................... Cystic fibrosis with pulmonary manifestations. 

28242 ............................................... Sickle-Cell thalassemia with crisis. 

28262 ............................................... Hb-ss disease with crisis. 

28264 ............................................... Sickle-Cell/Hb-C disease with crisis. 

28311 ............................................... Hemolytic-uremic syndrome. 

28481 ............................................... Red cell aplasia (acquired)(adult)(with thymoma). 

28489 ............................................... Other specified aplastic anemias. 

2860 ................................................. Congenital factor viii disorder. 

2861 ................................................. Congenital factor ix disorder. 

2866 ................................................. Defibrination syndrome. 

3200 ................................................. Hemophilus meningitis. 

3201 ................................................. Pneumococcal meningitis. 

3202 ................................................. Streptococcal meningitis. 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24989 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

3203 ................................................. Staphylococcal meningitis. 

3207 ................................................. Meningitis in other bacterial diseases classified elsewhere. 

32081 ............................................... Anaerobic meningitis. 

32082 ............................................... Meningitis due to gram-negative bacteria, not elsewhere classified. 

32089 ............................................... Meningitis due to other specified bacteria. 

3209 ................................................. Meningitis due to unspecified bacterium. 

3210 ................................................. Cryptococcal meningitis. 

3211 ................................................. Meningitis in other fungal diseases. 

3212 ................................................. Meningitis due to viruses not elsewhere classified. 

3213 ................................................. Meningitis due to trypanosomiasis. 

3214 ................................................. Meningitis in sarcoidosis. 

3218 ................................................. Meningitis due to other nonbacterial organisms classified elsewhere. 

3220 ................................................. Nonpyogenic meningitis. 

3221 ................................................. Eosinophilic meningitis. 

3229 ................................................. Meningitis, unspecified. 

32301 ............................................... Encephalitis and encephalomyelitis in viral diseases classified elsewhere. 

32302 ............................................... Myelitis in viral diseases classified elsewhere. 

3231 ................................................. Encephalitis, myelitis, and encephalomyelitis in rickettsial diseases classified elsewhere. 

3232 ................................................. Encephalitis, myelitis, and encephalomyelitis in protozoal diseases classified elsewhere. 

32341 ............................................... Other encephalitis and encephalomyelitis due to infection classified elsewhere. 

32342 ............................................... Other myelitis due to infection classified elsewhere. 

32351 ............................................... Encephalitis and encephalomyelitis following immunization procedures. 

32352 ............................................... Myelitis following immunization procedures. 

32361 ............................................... Infectious acute disseminated encephalomyelitis (ADEM). 

32362 ............................................... Other postinfectious encephalitis and encephalomyelitis. 

32363 ............................................... Postinfectious myelitis. 

32371 ............................................... Toxic encephalitis and encephalomyelitis. 

32372 ............................................... Toxic myelitis. 

32381 ............................................... Other causes of encephalitis and encephalomyelitis. 

32382 ............................................... Other causes of myelitis. 

3239 ................................................. Unspecified causes of encephalitis, myelitis, and encephalomyelitis. 

3240 ................................................. Intracranial abscess. 

3241 ................................................. Intraspinal abscess. 

3249 ................................................. Intracranial and intraspinal abscess of unspecified site. 

325 ................................................... Phlebitis and thrombophlebitis of intracranial venous sinuses. 

33181 ............................................... Reye’s syndrome. 

33392 ............................................... Neuroleptic malignant syndrome. 

3361 ................................................. Vascular myelopathies. 

3432 ................................................. Congenital quadriplegia. 

34400 ............................................... Quadriplegia, unspecified. 

34401 ............................................... Quadriplegia, C1–C4, complete. 

34402 ............................................... Quadriplegia, C1–C4, incomplete. 

34403 ............................................... Quadriplegia, C5–C7, complete. 

34404 ............................................... Quadriplegia, C5–C7, incomplete. 

34409 ............................................... Other quadriplegia. 

34481 ............................................... Locked-in state. 

3453 ................................................. Grand mal status, epileptic. 

34830 ............................................... Encephalopathy, unspecified. 

34831 ............................................... Metabolic encephalopathy. 

34839 ............................................... Other encephalopathy. 

3484 ................................................. Compression of brain. 

3485 ................................................. Cerebral edema. 

34982 ............................................... Toxic encephalopathy. 

35801 ............................................... Myasthenia gravis with (acute) exacerbation. 

41001 ............................................... Acute myocardial infarction of anterolateral wall, initial episode of care.

41011 ............................................... Acute myocardial infarction of other anterior wall, initial episode of care. 

41021 ............................................... Acute myocardial infarction of inferolateral wall, initial episode of care.

41031 ............................................... Acute myocardial infarction of inferoposterior wall, initial episode of care. 

41041 ............................................... Acute myocardial infarction of other inferior wall, initial episode of care. 

41051 ............................................... Acute myocardial infarction of other lateral wall, initial episode of care.

41061 ............................................... True posterior wall infarction, initial episode of care. 

41071 ............................................... Subendocardial infarction, initial episode of care. 

41081 ............................................... Acute myocardial infarction of other specified sites, initial episode of care. 

41091 ............................................... Acute myocardial infarction of unspecified site, initial episode of care. 

41412 ............................................... Dissection of coronary artery. 

4150 ................................................. Acute cor pulmonale. 

41511 ............................................... Iatrogenic pulmonary embolism and infarction. 

41512 ............................................... Septic pulmonary embolism. 

41519 ............................................... Other pulmonary embolism and infarction. 

4210 ................................................. Acute and subacute bacterial endocarditis. 

4211 ................................................. Acute and subacute infective endocarditis in diseases classified elsewhere. 

4219 ................................................. Acute endocarditis, unspecified. 

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24990 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

4220 ................................................. Acute myocarditis in diseases classified elsewhere. 

42290 ............................................... Acute myocarditis, unspecified. 

42291 ............................................... Idiopathic myocarditis. 

42292 ............................................... Septic myocarditis. 

42293 ............................................... Toxic myocarditis. 

42299 ............................................... Other acute myocarditis. 

42741 ............................................... Ventricular fibrillation. 

42742 ............................................... Ventricular flutter. 

4275 ................................................. Cardiac arrest. 

42821 ............................................... Acute systolic heart failure. 

42823 ............................................... Acute on chronic systolic heart failure. 

42831 ............................................... Acute diastolic heart failure. 

42833 ............................................... Acute on chronic diastolic heart failure. 

42841 ............................................... Acute combined systolic and diastolic heart failure. 

42843 ............................................... Acute on chronic combined systolic and diastolic heart failure. 

4295 ................................................. Rupture of chordae tendineae. 

4296 ................................................. Rupture of papillary muscle. 

430 ................................................... Subarachnoid hemorrhage. 

431 ................................................... Intracerebral hemorrhage. 

4320 ................................................. Nontraumatic extradural hemorrhage. 

4321 ................................................. Subdural hemorrhage. 

43301 ............................................... Occlusion and stenosis of basilar artery with cerebral infarction. 

43311 ............................................... Occlusion and stenosis of carotid artery with cerebral infarction. 

43321 ............................................... Occlusion and stenosis of vertebral artery with cerebral infarction. 

43331 ............................................... Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction. 

43381 ............................................... Occlusion and stenosis of other specified precerebral artery with cerebral infarction. 

43391 ............................................... Occlusion and stenosis of unspecified precerebral artery with cerebral infarction. 

43401 ............................................... Cerebral thrombosis with cerebral infarction. 

43411 ............................................... Cerebral embolism with cerebral infarction. 

43491 ............................................... Cerebral artery occlusion, unspecified with cerebral infarction. 

44100 ............................................... Dissection of aorta, unspecified site. 

44101 ............................................... Dissection of aorta, thoracic. 

44102 ............................................... Dissection of aorta, abdominal. 

44103 ............................................... Dissection of aorta, thoracoabdominal. 

4411 ................................................. Thoracic aneurysm, ruptured. 

4413 ................................................. Abdominal aneurysm, ruptured. 

4415 ................................................. Aortic aneurysm of unspecified site, ruptured. 

4416 ................................................. Thoracoabdominal aneurysm, ruptured. 

44321 ............................................... Dissection of carotid artery. 

44322 ............................................... Dissection of iliac artery. 

44323 ............................................... Dissection of renal artery. 

44324 ............................................... Dissection of vertebral artery. 

44329 ............................................... Dissection of other artery. 

4466 ................................................. Thrombotic microangiopathy. 

452 ................................................... Portal vein thrombosis. 

4530 ................................................. Budd-chiari syndrome. 

4532 ................................................. Embolism and thrombosis of vena cava. 

4560 ................................................. Esophageal varices with bleeding. 

45620 ............................................... Esophageal varices in diseases classified elsewhere, with bleeding. 

46401 ............................................... Acute laryngitis with obstruction. 

46411 ............................................... Acute tracheitis with obstruction. 

46421 ............................................... Acute laryngotracheitis with obstruction. 

46431 ............................................... Acute epiglottitis with obstruction. 

46451 ............................................... Supraglottitis unspecified with obstruction. 

4800 ................................................. Pneumonia due to adenovirus. 

4801 ................................................. Pneumonia due to respiratory syncytial virus. 

4802 ................................................. Pneumonia due to parainfluenza virus. 

4803 ................................................. Pneumonia due to sars-associated coronavirus. 

4808 ................................................. Pneumonia due to other virus not elsewhere classified. 

4809 ................................................. Viral pneumonia, unspecified. 

481 ................................................... Pneumococcal pneumonia [streptococcus pneumoniae pneumonia]. 

4820 ................................................. Pneumonia due to klebsiella pneumoniae. 

4821 ................................................. Pneumonia due to pseudomonas. 

4822 ................................................. Pneumonia due to hemophilus influenzae (h. influenzae). 

48230 ............................................... Pneumonia due to streptococcus, unspecified. 

48231 ............................................... Pneumonia due to streptococcus, group a. 

48232 ............................................... Pneumonia due to streptococcus, group b. 

48239 ............................................... Pneumonia due to other streptococcus. 

48240 ............................................... Pneumonia due to staphylococcus, unspecified. 

48241 ............................................... Pneumonia due to staphylococcus aureus. 

48249 ............................................... Other staphylococcus pneumonia. 

48281 ............................................... Pneumonia due to anaerobes. 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24991 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

48282 ............................................... Pneumonia due to escherichia coli [e.coli]. 

48283 ............................................... Pneumonia due to other gram-negative bacteria. 

48284 ............................................... Pneumonia due to legionnaires’ disease. 

48289 ............................................... Pneumonia due to other specified bacteria. 

4829 ................................................. Bacterial pneumonia, unspecified. 

4830 ................................................. Pneumonia due to mycoplasma pneumoniae. 

4831 ................................................. Pneumonia due to chlamydia. 

4838 ................................................. Pneumonia due to other specified organism. 

4841 ................................................. Pneumonia in cytomegalic inclusion disease. 

4843 ................................................. Pneumonia in whooping cough. 

4845 ................................................. Pneumonia in anthrax. 

4846 ................................................. Pneumonia in aspergillosis. 

4847 ................................................. Pneumonia in other systemic mycoses. 

4848 ................................................. Pneumonia in other infectious diseases classified elsewhere. 

485 ................................................... Bronchopneumonia, organism unspecified. 

486 ................................................... Pneumonia, organism unspecified. 

4870 ................................................. Influenza with pneumonia. 

5061 ................................................. Acute pulmonary edema due to fumes and vapors. 

5070 ................................................. Pneumonitis due to inhalation of food or vomitus. 

5071 ................................................. Pneumonitis due to inhalation of oils and essences. 

5078 ................................................. Pneumonitis due to other solids and liquids. 

5100 ................................................. Empyema with fistula. 

5109 ................................................. Empyema without mention of fistula. 

5111 ................................................. Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis. 

5118 ................................................. Other specified forms of pleural effusion, except tuberculous. 

5120 ................................................. Spontaneous tension pneumothorax. 

5130 ................................................. Abscess of lung. 

5131 ................................................. Abscess of mediastinum. 

5184 ................................................. Acute edema of lung, unspecified. 

5185 ................................................. Pulmonary insufficiency following trauma and surgery. 

51881 ............................................... Acute respiratory failure. 

51884 ............................................... Acute and chronic respiratory failure. 

5192 ................................................. Mediastinitis. 

53021 ............................................... Ulcer of esophagus with bleeding. 

5304 ................................................. Perforation of esophagus. 

5307 ................................................. Gastroesophageal laceration-hemorrhage syndrome. 

53082 ............................................... Esophageal hemorrhage. 

53084 ............................................... Tracheoesophageal fistula. 

53100 ............................................... Acute gastric ulcer with hemorrhage, without mention of obstruction. 

53101 ............................................... Acute gastric ulcer with hemorrhage, with obstruction. 

53110 ............................................... Acute gastric ulcer with perforation, without mention of obstruction. 

53111 ............................................... Acute gastric ulcer with perforation, with obstruction. 

53120 ............................................... Acute gastric ulcer with hemorrhage and perforation, without mention of obstruction. 

53121 ............................................... Acute gastric ulcer with hemorrhage and perforation, with obstruction. 

53131 ............................................... Acute gastric ulcer without mention of hemorrhage or perforation, with obstruction. 

53140 ............................................... Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction. 

53141 ............................................... Chronic or unspecified gastric ulcer with hemorrhage, with obstruction. 

53150 ............................................... Chronic or unspecified gastric ulcer with perforation, without mention of obstruction. 

53151 ............................................... Chronic or unspecified gastric ulcer with perforation, with obstruction. 

53160 ............................................... Chronic or unspecified gastric ulcer with hemorrhage and perforation, without mention of obstruction. 

53161 ............................................... Chronic or unspecified gastric ulcer with hemorrhage and perforation, with obstruction. 

53171 ............................................... Chronic gastric ulcer without mention of hemorrhage or perforation, with obstruction. 

53191 ............................................... Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. 

53200 ............................................... Acute duodenal ulcer with hemorrhage, without mention of obstruction. 

53201 ............................................... Acute duodenal ulcer with hemorrhage, with obstruction. 

53210 ............................................... Acute duodenal ulcer with perforation, without mention of obstruction. 

53211 ............................................... Acute duodenal ulcer with perforation, with obstruction. 

53220 ............................................... Acute duodenal ulcer with hemorrhage and perforation, without mention of obstruction. 

53221 ............................................... Acute duodenal ulcer with hemorrhage and perforation, with obstruction. 

53231 ............................................... Acute duodenal ulcer without mention of hemorrhage or perforation, with obstruction. 

53240 ............................................... Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction. 

53241 ............................................... Chronic or unspecified duodenal ulcer with hemorrhage, with obstruction. 

53250 ............................................... Chronic or unspecified duodenal ulcer with perforation, without mention of obstruction. 

53251 ............................................... Chronic or unspecified duodenal ulcer with perforation, with obstruction. 

53260 ............................................... Chronic or unspecified duodenal ulcer with hemorrhage and perforation, without mention of obstruction. 

53261 ............................................... Chronic or unspecified duodenal ulcer with hemorrhage and perforation, with obstruction. 

53271 ............................................... Chronic duodenal ulcer without mention of hemorrhage or perforation, with obstruction. 

53291 ............................................... Duodenal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. 

53300 ............................................... Acute peptic ulcer of unspecified site with hemorrhage, without mention of obstruction. 

53301 ............................................... Acute peptic ulcer of unspecified site with hemorrhage, with obstruction. 

53310 ............................................... Acute peptic ulcer of unspecified site with perforation, without mention of obstruction. 

mmaher on DSK3CLS3C1PROD with $$_JOB

24992 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

53311 ............................................... Acute peptic ulcer of unspecified site with perforation, with obstruction. 

53320 ............................................... Acute peptic ulcer of unspecified site with hemorrhage and perforation, without mention of obstruction. 

53321 ............................................... Acute peptic ulcer of unspecified site with hemorrhage and perforation, with obstruction. 

53331 ............................................... Acute peptic ulcer of unspecified site without mention of hemorrhage and perforation, with obstruction. 

53340 ............................................... Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, without mention of obstruction. 

53341 ............................................... Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, with obstruction. 

53350 ............................................... Chronic or unspecified peptic ulcer of unspecified site with perforation, without mention of obstruction. 

53351 ............................................... Chronic or unspecified peptic ulcer of unspecified site with perforation, with obstruction. 

53360 ............................................... Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation, without mention of obstruction. 

53361 ............................................... Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation, with obstruction. 

53371 ............................................... Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation, with obstruction. 

53391 ............................................... Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. 

53400 ............................................... Acute gastrojejunal ulcer with hemorrhage, without mention of obstruction. 

53401 ............................................... Acute gastrojejunal ulcer, with hemorrhage, with obstruction. 

53410 ............................................... Acute gastrojejunal ulcer with perforation, without mention of obstruction.

53411 ............................................... Acute gastrojejunal ulcer with perforation, with obstruction. 

53420 ............................................... Acute gastrojejunal ulcer with hemorrhage and perforation, without mention of obstruction. 

53421 ............................................... Acute gastrojejunal ulcer with hemorrhage and perforation, with obstruction. 

53431 ............................................... Acute gastrojejunal ulcer without mention of hemorrhage or perforation, with obstruction. 

53440 ............................................... Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction. 

53441 ............................................... Chronic or unspecified gastrojejunal ulcer, with hemorrhage, with obstruction. 

53450 ............................................... Chronic or unspecified gastrojejunal ulcer with perforation, without mention of obstruction. 

53451 ............................................... Chronic or unspecified gastrojejunal ulcer with perforation, with obstruction. 

53460 ............................................... Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation, without mention of obstruction. 

53461 ............................................... Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation, with obstruction. 

53471 ............................................... Chronic gastrojejunal ulcer without mention of hemorrhage or perforation, with obstruction. 

53491 ............................................... Gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. 

53501 ............................................... Acute gastritis with hemorrhage. 

53511 ............................................... Atrophic gastritis with hemorrhage. 

53521 ............................................... Gastric mucosal hypertrophy with hemorrhage. 

53531 ............................................... Alcoholic gastritis with hemorrhage. 

53541 ............................................... Other specified gastritis with hemorrhage. 

53551 ............................................... Unspecified gastritis and gastroduodenitis with hemorrhage. 

53561 ............................................... Duodenitis with hemorrhage. 

53783 ............................................... Angiodysplasia of stomach and duodenum with hemorrhage. 

53784 ............................................... Dielulafoy lesion (hemorrhagic) of stomach and duodenum. 

5400 ................................................. Acute appendicitis with generalized peritonitis. 

5401 ................................................. Acute appendicitis with peritoneal abscess. 

55000 ............................................... Unilateral or unspecified inguinal hernia, with gangrene. 

55001 ............................................... Recurrent unilateral or unspecified inguinal hernia, with gangrene. 

55002 ............................................... Bilateral inguinal hernia, with gangrene. 

55003 ............................................... Recurrent bilateral inguinal hernia, with gangrene. 

55100 ............................................... Unilateral or unspecified femoral hernia with gangrene. 

55101 ............................................... Recurrent unilateral or unspecified femoral hernia with gangrene. 

55102 ............................................... Bilateral femoral hernia with gangrene. 

55103 ............................................... Recurrent bilateral femoral hernia with gangrene. 

5511 ................................................. Umbilical hernia with gangrene. 

55120 ............................................... Unspecified ventral hernia with gangrene. 

55121 ............................................... Incisional ventral hernia, with gangrene. 

55129 ............................................... Other ventral hernia with gangrene. 

5513 ................................................. Diaphragmatic hernia with gangrene. 

5518 ................................................. Hernia of other specified sites, with gangrene. 

5519 ................................................. Hernia of unspecified site, with gangrene. 

5570 ................................................. Acute vascular insufficiency of intestine. 

5602 ................................................. Volvulus. 

56202 ............................................... Diverticulosis of small intestine with hemorrhage. 

56203 ............................................... Diverticulitis of small intestine with hemorrhage. 

56212 ............................................... Diverticulosis of colon with hemorrhage. 

56213 ............................................... Diverticulitis of colon with hemorrhage. 

5670 ................................................. Peritonitis in infectious diseases classified elsewhere. 

5671 ................................................. Pneumococcal peritonitis. 

56721 ............................................... Peritonitis (acute) generalized. 

56722 ............................................... Peritoneal abscess. 

56723 ............................................... Spontaneous bacterial peritonitis. 

56729 ............................................... Other suppurative peritonitis. 

56731 ............................................... Psoas muscle abscess. 

56738 ............................................... Other retroperitoneal abscess. 

56739 ............................................... Other retroperitoneal infections. 

56781 ............................................... Choleperitonitis. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24993 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

56789 ............................................... Other specified peritonitis. 

5679 ................................................. Unspecified peritonitis. 

56881 ............................................... Hemoperitoneum (nontraumatic). 

56983 ............................................... Perforation of intestine. 

56985 ............................................... Angiodysplasia of intestine with hemorrhage. 

56986 ............................................... Dieulafoy lesion (hemorrhagic) of intestine. 

570 ................................................... Acute and subacute necrosis of liver. 

5720 ................................................. Abscess of liver. 

5721 ................................................. Portal pyemia. 

5722 ................................................. Hepatic coma. 

5724 ................................................. Hepatorenal syndrome. 

5734 ................................................. Hepatic infarction. 

57481 ............................................... Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction. 

5754 ................................................. Perforation of gallbladder. 

5762 ................................................. Obstruction of bile duct. 

5763 ................................................. Perforation of bile duct. 

5770 ................................................. Acute pancreatitis. 

5800 ................................................. Acute glomerulonephritis with lesion of proliferative glomerulonephritis. 

5804 ................................................. Acute glomerulonephritis with lesion of rapidly progressive glomerulonephritis. 

58081 ............................................... Acute glomerulonephritis in diseases classified elsewhere. 

58089 ............................................... Acute glomerulonephritis with other specified pathological lesion in kidney. 

5809 ................................................. Acute glomerulonephritis with unspecified pathological lesion in kidney. 

5834 ................................................. Nephritis and nephropathy, not specified as acute or chronic, with lesion of rapidly progressive glomerulonephritis. 

5836 ................................................. Nephritis and nephropathy, not specified as acute or chronic, with lesion of renal cortical necrosis. 

5845 ................................................. Acute renal failure with lesion of tubular necrosis. 

5846 ................................................. Acute renal failure with lesion of renal cortical necrosis. 

5847 ................................................. Acute renal failure with lesion of renal medullary (papillary) necrosis. 

5848 ................................................. Acute renal failure with other specified pathological lesion in kidney. 

5849 ................................................. Acute renal failure, unspecified. 

5856 ................................................. End stage renal disease. 

59011 ............................................... Acute pyelonephritis with lesion of renal medullary necrosis. 

5902 ................................................. Renal and perinephric abscess. 

5966 ................................................. Rupture of bladder, nontraumatic. 

6145 ................................................. Acute or unspecified pelvic peritonitis, female. 

63430 ............................................... Spontaneous abortion, unspecified, complicated by renal failure. 

63431 ............................................... Spontaneous abortion, incomplete, complicated by renal failure. 

63432 ............................................... Spontaneous abortion, complete, complicated by renal failure. 

63450 ............................................... Spontaneous abortion, unspecified, complicated by shock. 

63451 ............................................... Spontaneous abortion, incomplete, complicated by shock. 

63452 ............................................... Spontaneous abortion, complete, complicated by shock. 

63461 ............................................... Spontaneous abortion, incomplete, complicated by embolism. 

63462 ............................................... Spontaneous abortion, complete, complicated by embolism. 

63530 ............................................... Legally induced abortion, unspecified, complicated by renal failure. 

63531 ............................................... Legally induced abortion, incomplete, complicated by renal failure. 

63532 ............................................... Legally induced abortion, complete, complicated by renal failure. 

63550 ............................................... Legally induced abortion, unspecified, complicated by shock. 

63551 ............................................... Legally induced abortion, incomplete, complicated by shock. 

63552 ............................................... Legally induced abortion, complete, complicated by shock. 

63560 ............................................... Legally induced abortion, unspecified, complicated by embolism. 

63561 ............................................... Legally induced abortion, incomplete, complicated by embolism. 

63562 ............................................... Legally induced abortion, complete, complicated by embolism. 

63630 ............................................... Illegal abortion, unspecified, complicated by renal failure. 

63631 ............................................... Illegal abortion, incomplete, complicated by renal failure. 

63632 ............................................... Illegal abortion, complete, complicated by renal failure. 

63650 ............................................... Illegal abortion, unspecified, complicated by shock. 

63651 ............................................... Illegal abortion, incomplete, complicated by shock. 

63652 ............................................... Illegal abortion, complete, complicated by shock. 

63660 ............................................... Illegal abortion, unspecified, complicated by embolism. 

63661 ............................................... Illegal abortion, incomplete, complicated by embolism. 

63662 ............................................... Illegal abortion, complete, complicated by embolism. 

63730 ............................................... Legally unspecified type of abortion, unspecified, complicated by renal failure. 

63731 ............................................... Legally unspecified abortion, incomplete, complicated by renal failure. 

63732 ............................................... Legally unspecified abortion, complete, complicated by renal failure. 

63750 ............................................... Legally unspecified type of abortion, unspecified, complicated by shock. 

63751 ............................................... Legally unspecified abortion, incomplete, complicated by shock. 

63752 ............................................... Legally unspecified abortion, complete, complicated by shock. 

63760 ............................................... Legally unspecified type of abortion, unspecified, complicated by embolism.

63761 ............................................... Legally unspecified abortion, incomplete, complicated by embolism. 

63762 ............................................... Legally unspecified abortion, complete, complicated by embolism. 

6383 ................................................. Failed attempted abortion complicated by renal failure. 

6385 ................................................. Failed attempted abortion complicated by shock. 

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24994 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

6386 ................................................. Failed attempted abortion complicated by embolism. 

6393 ................................................. Renal failure following abortion or ectopic and molar pregnancies. 

6395 ................................................. Shock following abortion or ectopic and molar pregnancies. 

6396 ................................................. Embolism following abortion or ectopic and molar pregnancies. 

64111 ............................................... Hemorrhage from placenta previa, with delivery. 

64113 ............................................... Hemorrhage from placenta previa, antepartum. 

64121 ............................................... Premature separation of placenta, with delivery. 

64131 ............................................... Antepartum hemorrhage associated with coagulation defects, with delivery. 

64133 ............................................... Antepartum hemorrhage associated with coagulation defects. 

64211 ............................................... Hypertension secondary to renal disease, with delivery. 

64212 ............................................... Hypertension secondary to renal disease, with delivery, with mention of postpartum complication. 

64242 ............................................... Mild or unspecified pre-eclampsia, with delivery, with mention of postpartum complication. 

64251 ............................................... Severe pre-eclampsia, with delivery. 

64252 ............................................... Severe pre-eclampsia, with delivery, with mention of postpartum complication. 

64253 ............................................... Severe pre-eclampsia, antepartum. 

64254 ............................................... Severe pre-eclampsia, postpartum. 

64261 ............................................... Eclampsia, with delivery. 

64262 ............................................... Eclampsia, with delivery, with mention of postpartum complication. 

64263 ............................................... Eclampsia, antepartum. 

64264 ............................................... Eclampsia, postpartum. 

64271 ............................................... Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, with delivery. 

64272 ............................................... Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, with delivery, with mention of postpartum complication. 

64273 ............................................... Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, antepartum. 

64274 ............................................... Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, postpartum. 

64403 ............................................... Threatened premature labor, antepartum. 

64421 ............................................... Early onset of delivery, delivered, with or without mention of antepartum condition. 

64801 ............................................... Diabetes mellitus of mother, with delivery. 

64802 ............................................... Diabetes mellitus of mother, with delivery, with mention of postpartum complication. 

65451 ............................................... Cervical incompetence, with delivery. 

65452 ............................................... Cervical incompetence, delivered, with mention of postpartum complication. 

65453 ............................................... Cervical incompetence, antepartum condition or complication. 

65454 ............................................... Cervical incompetence, postpartum condition or complication. 

65841 ............................................... Infection of amniotic cavity, delivered. 

65843 ............................................... Infection of amniotic cavity, antepartum. 

65931 ............................................... Generalized infection during labor, delivered. 

65933 ............................................... Generalized infection during labor, antepartum. 

66501 ............................................... Rupture of uterus before onset of labor, with delivery. 

66503 ............................................... Rupture of uterus before onset of labor, antepartum. 

66511 ............................................... Rupture of uterus, with delivery. 

66911 ............................................... Obstetric shock, with delivery, with or without mention of antepartum condition. 

66912 ............................................... Obstetric shock, with delivery, with mention of postpartum complication. 

66913 ............................................... Antepartum obstetric shock. 

66914 ............................................... Postpartum obstetric shock. 

66921 ............................................... Maternal hypotension syndrome, with delivery, with or without mention of antepartum condition. 

66922 ............................................... Maternal hypotension syndrome, with delivery, with mention of postpartum complication. 

66932 ............................................... Acute renal failure with delivery, with mention of postpartum complication.

66934 ............................................... Acute renal failure following labor and delivery, postpartum condition or complication. 

67002 ............................................... Major puerperal infection, delivered, with mention of postpartum complication. 

67004 ............................................... Major puerperal infection, postpartum. 

67131 ............................................... Deep phlebothrombosis, antepartum, with delivery. 

67133 ............................................... Deep phlebothrombosis, antepartum. 

67142 ............................................... Deep phlebothrombosis, postpartum, with delivery. 

67144 ............................................... Deep phlebothrombosis, postpartum. 

67301 ............................................... Obstetrical air embolism, with delivery, with or without mention of antepartum condition. 

67302 ............................................... Obstetrical air embolism, with delivery, with mention of postpartum complication. 

67303 ............................................... Obstetrical air embolism, antepartum condition or complication. 

67304 ............................................... Obstetrical air embolism, postpartum condition or complication. 

67311 ............................................... Amniotic fluid embolism, with delivery, with or without mention of antepartum condition. 

67312 ............................................... Amniotic fluid embolism, with delivery, with mention of postpartum complication. 

67313 ............................................... Amniotic fluid embolism, antepartum condition or complication. 

67314 ............................................... Amniotic fluid embolism, postpartum condition or complication. 

67321 ............................................... Obstetrical blood-clot embolism, with delivery, with or without mention of antepartum condition. 

67322 ............................................... Obstetrical blood-clot embolism, with mention of postpartum complication. 

67323 ............................................... Obstetrical blood-clot embolism, antepartum. 

67324 ............................................... Obstetrical blood-clot embolism, postpartum. 

67331 ............................................... Obstetrical pyemic and septic embolism, with delivery, with or without mention of antepartum condition. 

67332 ............................................... Obstetrical pyemic and septic embolism, with delivery, with mention of postpartum complicaton. 

67333 ............................................... Obstetrical pyemic and septic embolism, antepartum. 

67334 ............................................... Obstetrical pyemic and septic embolism, postpartum. 

67381 ............................................... Other obstetrical pulmonary embolism, with delivery, with or without mention of antepartum condition. 

67382 ............................................... Other obstetrical pulmonary embolism, with delivery, with mention of postpartum complication. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24995 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

67383 ............................................... Other obstetrical pulmonary embolism, antepartum. 

67384 ............................................... Other obstetrical pulmonary embolism, postpartum. 

67401 ............................................... Cerebrovascular disorders, with delivery, with or without mention of antepartum condition. 

67450 ............................................... Peripartum cardiomyopathy, unspecified as to episode of care or not applicable. 

67451 ............................................... Peripartum cardiomyopathy, delivered, with or without mention of antepartum condition. 

67452 ............................................... Peripartum cardiomyopathy, delivered, with mention of postpartum condition.

67453 ............................................... Peripartum cardiomyopathy, antepartum condition or complication. 

67454 ............................................... Peripartum cardiomyopathy, postpartum condition or complication. 

70702 ............................................... Decubitus ulcer, upper back. 

70703 ............................................... Decubitus ulcer, lower back. 

70704 ............................................... Decubitus ulcer, hip. 

70705 ............................................... Decubitus ulcer, buttock. 

70706 ............................................... Decubitus ulcer, ankle. 

70707 ............................................... Decubitus ulcer, heel. 

72886 ............................................... Necrotizing fasciitis. 

7400 ................................................. Anencephalus. 

7401 ................................................. Craniorachischisis. 

7402 ................................................. Iniencephaly. 

7422 ................................................. Congenital reduction deformities of brain. 

7450 ................................................. Common truncus. 

74510 ............................................... Complete transposition of great vessels. 

74511 ............................................... Double outlet right ventricle. 

74519 ............................................... Other transposition of great vessels. 

7452 ................................................. Tetralogy of fallot. 

7453 ................................................. Common ventricle. 

7457 ................................................. Cor biloculare. 

74601 ............................................... Atresia of pulmonary valve, congenital. 

7461 ................................................. Tricuspid atresia and stenosis, congenital. 

7462 ................................................. Ebstein’s anomaly. 

7467 ................................................. Hypoplastic left heart syndrome. 

74681 ............................................... Subaortic stenosis, congenital. 

74682 ............................................... Cor triatriatum. 

74684 ............................................... Congenital obstructive anomalies of heart, not elsewhere classified. 

74686 ............................................... Congenital heart block. 

74711 ............................................... Interruption of aortic arch. 

7473 ................................................. Congenital anomalies of pulmonary artery. 

74781 ............................................... Congenital anomalies of cerebrovascular system. 

74783 ............................................... Persistent fetal circulation. 

7485 ................................................. Congenital agenesis, hypoplasia, and dysplasia of lung. 

7503 ................................................. Congenital tracheoesophageal fistula, esophageal atresia and stenosis. 

75161 ............................................... Biliary atresia, congenital. 

75555 ............................................... Acrocephalosyndactyly. 

7566 ................................................. Congenital anomalies of diaphragm. 

75670 ............................................... Anomaly of abdominal wall, unspecified. 

75671 ............................................... Prune belly syndrome. 

75679 ............................................... Other congenital anomalies of abdominal wall. 

75832 ............................................... Velo-cardio-facial syndrome. 

7594 ................................................. Conjoined twins. 

7670 ................................................. Subdural and cerebral hemorrhage due to birth trauma. 

7685 ................................................. Severe birth asphyxia. 

7687 ................................................. Hypoxic-ischemic encephalopathy (HIE). 

769 ................................................... Respiratory distress syndrome in newborn. 

7700 ................................................. Congenital pneumonia. 

77012 ............................................... Meconium aspiration with respiratory symptoms. 

77014 ............................................... Aspiration of clear amniotic fluid with respiratory symptoms. 

77016 ............................................... Aspiration of blood with respiratory symptoms. 

77018 ............................................... Other fetal and newborn aspiration with respiratory symptoms. 

7702 ................................................. Interstitial emphysema and related conditions of newborn. 

7703 ................................................. Pulmonary hemorrhage of fetus or newborn. 

7707 ................................................. Chronic respiratory disease arising in the perinatal period. 

77084 ............................................... Respiratory failure of newborn. 

77086 ............................................... Aspiration of postnatal stomach contents with respiratory symptoms. 

77087 ............................................... Respiratory arrest of newborn. 

7711 ................................................. Congenital cytomegalovirus infection. 

7712 ................................................. Other congenital infections specific to the perinatal period. 

7713 ................................................. Tetanus neonatorum. 

77181 ............................................... Septicemia [sepsis] of newborn. 

77213 ............................................... Intraventricular hemorrhage grade iii. 

77214 ............................................... Intraventricular hemorrhage grade iv. 

7722 ................................................. Subarachnoid hemorrhage of newborn. 

7724 ................................................. Gastrointestinal hemorrhage of fetus or newborn. 

7733 ................................................. Hydrops fetalis due to isoimmunization. 

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24996 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

7734 ................................................. Kernicterus of fetus or newborn due to isoimmunization. 

7744 ................................................. Perinatal jaundice due to hepatocellular damage. 

7747 ................................................. Kernicterus of fetus or newborn not due to isoimmunization. 

7757 ................................................. Late metabolic acidosis of newborn. 

7761 ................................................. Transient neonatal thrombocytopenia. 

7762 ................................................. Disseminated intravascular coagulation in newborn. 

7767 ................................................. Transient neonatal neutropenia. 

7775 ................................................. Necrotizing enterocolitis in fetus or newborn. 

7776 ................................................. Perinatal intestinal perforation. 

7780 ................................................. Hydrops fetalis not due to isoimmunization. 

7790 ................................................. Convulsions in newborn. 

7792 ................................................. Cerebral depression, coma, and other abnormal cerebral signs in fetus or newborn. 

7797 ................................................. Preventricular leukomalacia. 

77985 ............................................... Cardiac arrest of newborn. 

78551 ............................................... Cardiogenic shock. 

78552 ............................................... Septic shock. 

78559 ............................................... Other shock without mention of trauma. 

7991 ................................................. Respiratory arrest. 

80003 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. 

80004 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80005 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80010 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with state of consciousness unspecified. 

80011 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with no loss of consciousness. 

80012 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. 

80013 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. 

80014 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80015 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80016 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. 

80019 ............................................... Closed fracture of vault of skull with cerebral laceration and contusion, with concussion, unspecified. 

80020 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. 

80021 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. 

80022 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of 

consciousness. 

80023 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of 

consciousness. 

80024 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

80025 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80026 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. 

80029 ............................................... Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80030 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80031 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. 

80032 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. 

80033 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80034 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss 

of consciousness and return to pre-existing conscious level. 

80035 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss 

of consciousness, without return to pre-existing conscious level. 

80036 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified 

duration. 

80039 ............................................... Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. 

80043 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 

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TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80044 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

80045 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80050 ............................................... Open fracture of vault of skull without mention of intracranial injury, with state of consciousness unspecified. 

80051 ............................................... Open fracture of vault of skull without mention of intracranial injury, with no loss of consciousness. 

80052 ............................................... Open fracture of vault of skull without mention of intracranial injury, with brief (less than one hour) loss of consciousness. 

80053 ............................................... Open fracture of vault of skull without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. 

80054 ............................................... Open fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

80055 ............................................... Open fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80056 ............................................... Open fracture of vault of skull without mention of intracranial injury, with loss of consciousness of unspecified duration. 

80059 ............................................... Open fracture of vault of skull without mention of intracranial injury, with concussion, unspecified. 

80060 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with state of consciousness unspecified. 

80061 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with no loss of consciousness. 

80062 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. 

80063 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. 

80064 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80065 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80066 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. 

80069 ............................................... Open fracture of vault of skull with cerebral laceration and contusion, with concussion, unspecified. 

80070 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. 

80071 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. 

80072 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of 

consciousness. 

80073 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of 

consciousness. 

80074 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

80075 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80076 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. 

80079 ............................................... Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80080 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80081 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. 

80082 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. 

80083 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80084 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours)loss of 

consciousness and return to pre-existing conscious level. 

80085 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours)loss of 

consciousness, without return to pre-existing conscious level. 

80086 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified 

duration. 

80089 ............................................... Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. 

80090 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. 

80091 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. 

80092 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of 

consciousness. 

80093 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 

80094 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss 

of consciousness and return to pre-existing conscious level. 

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24998 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80095 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss 

of consciousness, without return to pre-existing conscious level. 

80096 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified 

duration. 

80099 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80103 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with moderate (1–24 hours) loss of consciousness. 

80104 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80105 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80110 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with state of consciousness unspecified. 

80111 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness. 

80112 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. 

80113 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. 

80114 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80115 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80116 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. 

80119 ............................................... Closed fracture of base of skull with cerebral laceration and contusion, with concussion, unspecified. 

80120 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. 

80121 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. 

80122 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of 

consciousness. 

80123 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of 

consciousness. 

80124 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

80125 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80126 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. 

80129 ............................................... Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80130 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80131 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. 

80132 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. 

80133 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80134 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss 

of consciousness and return to pre-existing conscious level. 

80135 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss 

of consciousness, without return to pre-existing conscious level. 

80136 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified 

duration. 

80139 ............................................... Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. 

80143 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 

80144 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

80145 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80150 ............................................... Open fracture of base of skull without mention of intracranial injury, with state of consciousness unspecified. 

80151 ............................................... Open fracture of base of skull without mention of intracranial injury, with no loss of consciousness. 

80152 ............................................... Open fracture of base of skull without mention of intracranial injury, with brief (less than one hour) loss of consciousness. 

80153 ............................................... Open fracture of base of skull without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. 

80154 ............................................... Open fracture of base of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24999 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80155 ............................................... Open fracture of base of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80156 ............................................... Open fracture of base of skull without mention of intracranial injury, with loss of consciousness of unspecified duration. 

80159 ............................................... Open fracture of base of skull without mention of intracranial injury, with concussion, unspecified. 

80160 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with state of consciousness unspecified. 

80161 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness. 

80162 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. 

80163 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. 

80164 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80165 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80166 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. 

80169 ............................................... Open fracture of base of skull with cerebral laceration and contusion, with concussion, unspecified. 

80170 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. 

80171 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. 

80172 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of 

consciousness. 

80173 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of 

consciousness. 

80174 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

80175 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80176 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. 

80179 ............................................... Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80180 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80181 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. 

80182 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. 

80183 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80184 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

80185 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

80186 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified 

duration. 

80189 ............................................... Open fracture of base of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. 

80190 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. 

80191 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. 

80192 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of 

consciousness. 

80193 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 

80194 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss 

of consciousness and return to pre-existing conscious level. 

80195 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss 

of consciousness, without return to pre-existing conscious level. 

80196 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified 

duration. 

80199 ............................................... Open fracture of base of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80303 ............................................... Other closed skull fracture without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. 

80304 ............................................... Other closed skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

80305 ............................................... Other closed skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, 

without return to pre-existing conscious level. 

mmaher on DSK3CLS3C1PROD with $$_JOB

25000 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80310 ............................................... Other closed skull fracture with cerebral laceration and contusion, with state of consciousness unspecified. 

80311 ............................................... Other closed skull fracture with cerebral laceration and contusion, with no loss of consciousness. 

80312 ............................................... Other closed skull fracture with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. 

80313 ............................................... Other closed skull fracture with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. 

80314 ............................................... Other closed skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

80315 ............................................... Other closed skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, 

without return to pre-existing conscious level. 

80316 ............................................... Other closed skull fracture with cerebral laceration and contusion, with loss of consciousness of unspecified duration. 

80319 ............................................... Other closed skull fracture with cerebral laceration and contusion, with concussion, unspecified. 

80320 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. 

80321 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. 

80322 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. 

80323 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80324 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss 

of consciousness and return to pre-existing conscious level. 

80325 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss 

of consciousness, without return to pre-existing conscious level. 

80326 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified 

duration. 

80329 ............................................... Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80330 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with state of unconsciousness unspecified. 

80331 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with no loss of consciousness. 

80332 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. 

80333 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80334 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

80335 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

80336 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. 

80339 ............................................... Other closed skull fracture with other and unspecified intracranial hemorrhage, with concussion, unspecified. 

80343 ............................................... Other closed skull fracture with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 

80344 ............................................... Other closed skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

80345 ............................................... Other site of closed skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

80350 ............................................... Other open skull fracture without mention of injury, with state of consciousness unspecified. 

80351 ............................................... Other open skull fracture without mention of intracranial injury, with no loss of consciousness. 

80352 ............................................... Other open skull fracture without mention of intracranial injury, with brief (less than one hour) loss of consciousness. 

80353 ............................................... Other open skull fracture without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. 

80354 ............................................... Other open skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and 

return to pre-existing conscious level. 

80355 ............................................... Other open skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, 

without return to pre-existing conscious level. 

80356 ............................................... Other open skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration. 

80359 ............................................... Other open skull fracture without mention of intracranial injury, with concussion, unspecified. 

80360 ............................................... Other open skull fracture with cerebral laceration and contusion, with state of consciousness unspecified. 

80361 ............................................... Other open skull fracture with cerebral laceration and contusion, with no loss of consciousness. 

80362 ............................................... Other open skull fracture with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. 

80363 ............................................... Other open skull fracture with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. 

80364 ............................................... Other open skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

80365 ............................................... Other open skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, 

without return to pre-existing conscious level. 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25001 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80366 ............................................... Other open skull fracture with cerebral laceration and contusion, with loss of consciousness of unspecified duration. 

80369 ............................................... Other open skull fracture with cerebral laceration and contusion, with concussion, unspecified. 

80370 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. 

80371 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. 

80372 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. 

80373 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80374 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

80375 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

80376 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified 

duration. 

80379 ............................................... Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80380 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80381 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with no loss of consciousness. 

80382 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. 

80383 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80384 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80385 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80386 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. 

80389 ............................................... Other open skull fracture with other and unspecified intracranial hemorrhage, with concussion, unspecified. 

80390 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with state of consciousness unspecified. 

80391 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with no loss of consciousness. 

80392 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. 

80393 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 

80394 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

80395 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

80396 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. 

80399 ............................................... Other open skull fracture with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80403 ............................................... Closed fractures involving skull or face with other bones, without mention of intracranial injury, with moderate (1–24 hours) loss 

of consciousness. 

80404 ............................................... Closed fractures involving skull or face with other bones, without mention or intracranial injury, with prolonged (more than 24 

hours) loss of consciousness and return to pre-existing conscious level. 

80405 ............................................... Closed fractures involving skull of face with other bones, without mention of intracranial injury, with prolonged (more than 24 

hours) loss of consciousness, without return to pre-existing conscious level. 

80410 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with state of consciousness 

unspecified. 

80411 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with no loss of consciousness. 

80412 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with brief (less than one hour) 

loss of consciousness. 

80413 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with moderate (1–24 hours) 

loss of consciousness. 

80414 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 

hours) loss of consciousness and return to pre-existing conscious level. 

80415 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 

hours) loss of consciousness, without return to pre-existing conscious level. 

80416 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with loss of consciousness of 

unspecified duration. 

80419 ............................................... Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with concussion, unspecified. 

80420 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with state of 

consciousness unspecified. 

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25002 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80421 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with no loss 

of consciousness. 

80422 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with brief 

(less than one hour) loss of consciousness. 

80423 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. 

80424 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80425 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80426 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of 

consciousness of unspecified duration. 

80429 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80430 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80431 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with no loss of 

consciousness. 

80432 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with brief (less 

than one hour) loss of consciousness. 

80433 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with moderate 

(1–24 hours) loss of consciousness. 

80434 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged 

(more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80435 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged 

(more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80436 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. 

80439 ............................................... Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with concussion, 

unspecified. 

80443 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with moderate 

(1–24 hours) loss of consciousness. 

80444 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged 

(more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80445 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged 

(more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80453 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with moderate (1–24 hours) loss 

of consciousness. 

80454 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with prolonged (more than 24 

hours) loss of consciousness and return to pre-existing conscious level. 

80455 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with prolonged (more than 24 

hours) loss of consciousness, without return to pre-existing conscious level. 

80460 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with state of consciousness unspecified. 

80461 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with no loss of consciousness. 

80462 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with brief (less than one hour) 

loss of consciousness. 

80463 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with moderate (1–24 hours) 

loss of consciousness. 

80464 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 

hours) loss of consciousness and return to pre-existing conscious level. 

80465 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 

hours) loss of consciousness, without return to pre-existing conscious level. 

80466 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with loss of consciousness of 

unspecified duration. 

80469 ............................................... Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with concussion, unspecified. 

80470 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with state of 

consciousness unspecified. 

80471 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with no loss 

of consciousness. 

80472 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with brief 

(less than one hour) loss of consciousness. 

80473 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate 

(1–24 hours) loss of consciousness. 

80474 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25003 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80475 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

80476 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of 

consciousness of unspecified duration. 

80479 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. 

80480 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. 

80481 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with no loss of 

consciousness. 

80482 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with brief (less 

than one hour) loss of consciousness. 

80483 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with moderate (1– 

24 hours) loss of consciousness. 

80484 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged 

(more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80485 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged 

(more than 24 hours) loss consciousness, without return to pre-existing conscious level. 

80486 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. 

80489 ............................................... Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with concussion, 

unspecified. 

80493 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with moderate 

(1–24 hours) loss of consciousness. 

80494 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged 

(more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

80495 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged 

(more than 24 hours) loss of consciousness without return to pre-existing conscious level. 

80510 ............................................... Open fracture of cervical vertebra, unspecified level. 

80511 ............................................... Open fracture of first cervical vertebra. 

80512 ............................................... Open fracture of second cervical vertebra. 

80513 ............................................... Open fracture of third cervical vertebra. 

80514 ............................................... Open fracture of fourth cervical vertebra. 

80515 ............................................... Open fracture of fifth cervical vertebra. 

80516 ............................................... Open fracture of sixth cervical vertebra. 

80517 ............................................... Open fracture of seventh cervical vertebra. 

80518 ............................................... Open fracture of multiple cervical vertebrae. 

8053 ................................................. Open fracture of dorsal (thoracic) vertebra without mention of spinal cord injury. 

8055 ................................................. Open fracture of lumbar vertebra without mention of spinal cord injury. 

8057 ................................................. Open fracture of sacrum and coccyx without mention of spinal cord injury. 

8059 ................................................. Open fracture of unspecified part of vertebral column without mention of spinal cord injury. 

80600 ............................................... Closed fracture of C1–C4 level with unspecified spinal cord injury. 

80601 ............................................... Closed fracture of C1–C4 level with complete lesion of cord. 

80602 ............................................... Closed fracture of C1–C4 level with anterior cord syndrome. 

80603 ............................................... Closed fracture of C1–C4 level with central cord syndrome. 

80604 ............................................... Closed fracture of C1–C4 level with other specified spinal cord injury. 

80605 ............................................... Closed fracture of C5–C7 level with unspecified spinal cord injury. 

80606 ............................................... Closed fracture of C5–C7 level with complete lesion of cord. 

80607 ............................................... Closed fracture of C5–C7 level with anterior cord syndrome. 

80608 ............................................... Closed fracture of C5–C7 level with central cord syndrome. 

80609 ............................................... Closed fracture of C5–C7 level with other specified spinal cord injury. 

80610 ............................................... Open fracture of C1–C4 level with unspecified spinal cord injury. 

80611 ............................................... Open fracture of C1–C4 level with complete lesion of cord. 

80612 ............................................... Open fracture of C1–C4 level with anterior cord syndrome. 

80613 ............................................... Open fracture of C1–C4 level with central cord syndrome. 

80614 ............................................... Open fracture of C1–C4 level with other specified spinal cord injury. 

80615 ............................................... Open fracture of C5–C7 level with unspecified spinal cord injury. 

80616 ............................................... Open fracture of C5–C7 level with complete lesion of cord. 

80617 ............................................... Open fracture of C5–C7 level with anterior cord syndrome. 

80618 ............................................... Open fracture of C5–C7 level with central cord syndrome. 

80619 ............................................... Open fracture of C5–C7 level with other specified spinal cord injury. 

80620 ............................................... Closed fracture of T1–T6 level with unspecified spinal cord injury. 

80621 ............................................... Closed fracture of T1–T6 level with complete lesion of cord. 

80622 ............................................... Closed fracture of T1–T6 level with anterior cord syndrome. 

80623 ............................................... Closed fracture of T1–T6 level with central cord syndrome. 

80624 ............................................... Closed fracture of T1–T6 level with other specified spinal cord injury. 

80625 ............................................... Closed fracture of T7–T12 level with unspecified spinal cord injury. 

80626 ............................................... Closed fracture of T7–T12 level with complete lesion of cord. 

80627 ............................................... Closed fracture of T7–T12 level with anterior cord syndrome. 

80628 ............................................... Closed fracture of T7–T12 level with central cord syndrome. 

80629 ............................................... Closed fracture of T7–T12 level with other specified spinal cord injury. 

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25004 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

80630 ............................................... Open fracture of T1–T6 level with unspecified spinal cord injury. 

80631 ............................................... Open fracture of T1–T6 level with complete lesion of cord. 

80632 ............................................... Open fracture of T1–T6 level with anterior cord syndrome. 

80633 ............................................... Open fracture of T1–T6 level with central cord syndrome. 

80634 ............................................... Open fracture of T1–T6 level with other specified spinal cord injury. 

80635 ............................................... Open fracture of T7–T12 level with unspecified spinal cord injury. 

80636 ............................................... Open fracture of T7–T12 level with complete lesion of cord. 

80637 ............................................... Open fracture of T7–T12 level with anterior cord syndrome. 

80638 ............................................... Open fracture of T7–T12 level with central cord syndrome. 

80639 ............................................... Open fracture of T7–T–12 level with other specified spinal cord injury. 

8064 ................................................. Closed fracture of lumbar spine with spinal cord injury. 

8065 ................................................. Open fracture of lumbar spine with spinal cord injury. 

80660 ............................................... Closed fracture of sacrum and coccyx with unspecified spinal cord injury. 

80661 ............................................... Closed fracture of sacrum and coccyx with complete cauda equina lesion. 

80662 ............................................... Closed fracture of sacrum and coccyx with other cauda equina injury. 

80669 ............................................... Closed fracture of sacrum and coccyx with other spinal cord injury. 

80670 ............................................... Open fracture of sacrum and coccyx with unspecified spinal cord injury. 

80671 ............................................... Open fracture of sacrum and coccyx with complete cauda equina lesion. 

80672 ............................................... Open fracture of sacrum and coccyx with other cauda equina injury. 

80679 ............................................... Open fracture of sacrum and coccyx with other spinal cord injury. 

8068 ................................................. Closed fracture of unspecified vertebra with spinal cord injury. 

8069 ................................................. Open fracture of unspecified vertebra with spinal cord injury. 

80710 ............................................... Open fracture of rib(s), unspecified. 

80711 ............................................... Open fracture of one rib. 

80712 ............................................... Open fracture of two ribs. 

80713 ............................................... Open fracture of three ribs. 

80714 ............................................... Open fracture of four ribs. 

80715 ............................................... Open fracture of five ribs. 

80716 ............................................... Open fracture of six ribs. 

80717 ............................................... Open fracture of seven ribs. 

80718 ............................................... Open fracture of eight or more ribs. 

80719 ............................................... Open fracture of multiple ribs, unspecified. 

8073 ................................................. Open fracture of sternum. 

8074 ................................................. Flail chest. 

8075 ................................................. Closed fracture of larynx and trachea. 

8076 ................................................. Open fracture of larynx and trachea. 

8080 ................................................. Closed fracture of acetabulum. 

8081 ................................................. Open fracture of acetabulum. 

8083 ................................................. Open fracture of pubis. 

80851 ............................................... Open fracture of ilium. 

80852 ............................................... Open fracture of ischium. 

80853 ............................................... Multiple open pelvic fractures with disruption of pelvic circle. 

80859 ............................................... Open fracture of other specified part of pelvis. 

8089 ................................................. Unspecified open fracture of pelvis. 

8091 ................................................. Fracture of bones of trunk, open. 

81210 ............................................... Fracture of unspecified part of upper end of humerus, open. 

81211 ............................................... Fracture of surgical neck of humerus, open. 

81212 ............................................... Fracture of anatomical neck of humerus, open. 

81213 ............................................... Fracture of greater tuberosity of humerus, open. 

81219 ............................................... Other open fracture of upper end of humerus. 

81230 ............................................... Fracture of unspecified part of humerus, open. 

81231 ............................................... Fracture of shaft of humerus, open. 

81250 ............................................... Fracture of unspecified part of lower end of humerus, open. 

81251 ............................................... Supracondylar fracture of humerus, open. 

81252 ............................................... Fracture of lateral condyle of humerus, open. 

81253 ............................................... Fracture of medial condyle of humerus, open. 

81254 ............................................... Fracture of unspecified condyle(s) of humerus, open. 

81259 ............................................... Other fracture of lower end of humerus, open. 

81310 ............................................... Open fracture of upper end of forearm, unspecified. 

81311 ............................................... Fracture of olecranon process of ulna, open. 

81312 ............................................... Fracture of coronoid process of ulna, open. 

81313 ............................................... Monteggia’s fracture, open. 

81314 ............................................... Other and unspecified open fractures of proximal end of ulna (alone). 

81315 ............................................... Fracture of head of radius, open. 

81316 ............................................... Fracture of neck of radius, open. 

81317 ............................................... Other and unspecified open fractures of proximal end of radius (alone). 

81318 ............................................... Fracture of radius with ulna, upper end (any part), open. 

81330 ............................................... Fracture of shaft of radius or ulna, unspecified, open. 

81331 ............................................... Fracture of shaft of radius (alone), open. 

81332 ............................................... Fracture of shaft of ulna (alone), open. 

81333 ............................................... Fracture of shaft of radius with ulna, open. 

81350 ............................................... Open fracture of lower end of forearm, unspecified. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25005 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

81351 ............................................... Colles’ fracture, open. 

81352 ............................................... Other open fractures of distal end of radius (alone). 

81353 ............................................... Fracture of distal end of ulna (alone), open. 

81354 ............................................... Fracture of lower end of radius with ulna, open. 

81390 ............................................... Fracture of unspecified part of forearm, open. 

81391 ............................................... Fracture of unspecified part of radius (alone), open. 

81392 ............................................... Fracture of unspecified part of ulna (alone), open. 

81393 ............................................... Fracture of unspecified part of radius with ulna, open. 

82000 ............................................... Fracture of unspecified intracapsular section of neck of femur, closed. 

82001 ............................................... Fracture of epiphysis (separation) (upper) of neck of femur, closed. 

82002 ............................................... Fracture of midcervical section of femur, closed. 

82003 ............................................... Fracture of base of neck of femur, closed. 

82009 ............................................... Other transcervical fracture of femur, closed. 

82010 ............................................... Fracture of unspecified intracapsular section of neck of femur, open. 

82011 ............................................... Fracture of epiphysis (separation) (upper) of neck of femur, open. 

82012 ............................................... Fracture of midcervical section of femur, open. 

82013 ............................................... Fracture of base of neck of femur, open. 

82019 ............................................... Other transcervical fracture of femur, open. 

82020 ............................................... Fracture of unspecified trochanteric section of femur, closed. 

82021 ............................................... Fracture of intertrochanteric section of femur, closed. 

82022 ............................................... Fracture of subtrochanteric section of femur, closed. 

82030 ............................................... Fracture of unspecified trochanteric section of femur, open. 

82031 ............................................... Fracture of intertrochanteric section of femur, open. 

82032 ............................................... Fracture of subtrochanteric section of femur, open. 

8208 ................................................. Fracture of unspecified part of neck of femur, closed. 

8209 ................................................. Fracture of unspecified part of neck of femur, open. 

82100 ............................................... Fracture of unspecified part of femur, closed. 

82101 ............................................... Fracture of shaft of femur, closed. 

82110 ............................................... Fracture of unspecified part of femur, open. 

82111 ............................................... Fracture of shaft of femur, open. 

82130 ............................................... Fracture of lower end of femur, unspecified part, open. 

82131 ............................................... Fracture of femoral condyle, open. 

82132 ............................................... Fracture of lower epiphysis of femur, open. 

82133 ............................................... Supracondylar fracture of femur, open. 

82139 ............................................... Other fracture of lower end of femur, open. 

82310 ............................................... Open fracture of upper end of tibia. 

82311 ............................................... Open fracture of upper end of fibula. 

82312 ............................................... Open fracture of upper end of fibula with tibia. 

82330 ............................................... Open fracture of shaft of tibia. 

82331 ............................................... Open fracture of shaft of fibula. 

82332 ............................................... Open fracture of shaft of fibula with tibia. 

82390 ............................................... Open fracture of unspecified part of tibia. 

82391 ............................................... Open fracture of unspecified part of fibula. 

82392 ............................................... Open fracture of unspecified part of fibula with tibia. 

8280 ................................................. Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum, closed. 

8281 ................................................. Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum, open. 

83510 ............................................... Open dislocation of hip, unspecified site. 

83511 ............................................... Open posterior dislocation of hip. 

83512 ............................................... Open obturator dislocation of hip. 

83513 ............................................... Other open anterior dislocation of hip. 

83910 ............................................... Open dislocation, cervical vertebra, unspecified. 

83911 ............................................... Open dislocation, first cervical vertebra. 

83912 ............................................... Open dislocation, second cervical vertebra. 

83913 ............................................... Open dislocation, third cervical vertebra. 

83914 ............................................... Open dislocation, fourth cervical vertebra. 

83915 ............................................... Open dislocation, fifth cervical vertebra. 

83916 ............................................... Open dislocation, sixth cervical vertebra. 

83917 ............................................... Open dislocation, seventh cervical vertebra. 

83918 ............................................... Open dislocation, multiple cervical vertebrae. 

83930 ............................................... Open dislocation, lumbar vertebra. 

83931 ............................................... Open dislocation, thoracic vertebra. 

83950 ............................................... Open dislocation, vertebra, unspecified site. 

83959 ............................................... Open dislocation, other vertebra. 

83971 ............................................... Open dislocation, sternum. 

8504 ................................................. Concussion with prolonged loss of consciousness, without return to pre-existing conscious level. 

85105 ............................................... Cortex (cerebral) contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85110 ............................................... Cortex (cerebral) contusion with open intracranial wound, without mention of specific state of consciousness. 

85111 ............................................... Cortex (cerebral) contusion with open intracranial wound, with no loss of consciousness. 

85112 ............................................... Cortex (cerebral) contusion with open intracranial wound, with brief (less than one hour) loss of consciousness. 

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25006 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

85113 ............................................... Cortex (cerebral) contusion with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85114 ............................................... Cortex (cerebral) contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85115 ............................................... Cortex (cerebral) contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without 

return to pre-existing conscious level. 

85116 ............................................... Cortex (cerebral) contusion with open intracranial wound, with loss of consciousness of unspecified duration. 

85119 ............................................... Cortex (cerebral) contusion with open intracranial wound, with concussion, unspecified. 

85120 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with state of consciousness unspecified. 

85121 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with no loss of consciousness. 

85122 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. 

85123 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85124 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85125 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85126 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85129 ............................................... Cortex (cerebral) laceration without mention of open intracranial wound, with concussion, unspecified. 

85130 ............................................... Cortex (cerebral) laceration with open intracranial wound, with state of consciousness unspecified. 

85131 ............................................... Cortex (cerebral) laceration with open intracranial wound, with no loss of consciousness. 

85132 ............................................... Cortex (cerebral) laceration with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85133 ............................................... Cortex (cerebral) laceration with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85134 ............................................... Cortex (cerebral) laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85135 ............................................... Cortex (cerebral) laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without 

return to pre-existing conscious level. 

85136 ............................................... Cortex (cerebral) laceration with open intracranial wound, with loss of consciousness of unspecified duration. 

85139 ............................................... Cortex (cerebral) laceration with open intracranial wound, with concussion, unspecified. 

85145 ............................................... Cerebellar or brain stem contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

85150 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with state of consciousness unspecified. 

85151 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with no loss of consciousness. 

85152 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85153 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85154 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

85155 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, 

without return to pre-existing conscious level. 

85156 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with loss of consciousness of unspecified duration. 

85159 ............................................... Cerebellar or brain stem contusion with open intracranial wound, with concussion, unspecified. 

85160 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with state of consciousness unspecified. 

85161 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with no loss of consciousness. 

85162 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with brief (less than 1 hour) loss of consciousness. 

85163 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85164 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

85165 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

85166 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85169 ............................................... Cerebellar or brain stem laceration without mention of open intracranial wound, with concussion, unspecified. 

85170 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with state of consciousness unspecified. 

85171 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with no loss of consciousness. 

85172 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85173 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85174 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness 

and return to pre-existing conscious level. 

85175 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, 

without return to pre-existing conscious level. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25007 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

85176 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with loss of consciousness of unspecified duration. 

85179 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with concussion, unspecified. 

85180 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with state of consciousness unspecified. 

85181 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness. 

85182 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief (less than one 

hour) loss of consciousness. 

85183 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with moderate (1–24 

hours) loss of consciousness. 

85184 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with prolonged (more 

than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85185 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with prolonged (more 

than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85186 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85189 ............................................... Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with concussion, unspecified. 

85190 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with state of consciousness unspecified. 

85191 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with no loss of consciousness. 

85192 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with brief (less than one hour) loss of 

consciousness. 

85193 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with moderate (1–24 hours) loss of 

consciousness. 

85194 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

85195 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

85196 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with loss of consciousness of unspecified duration. 

85199 ............................................... Other and unspecified cerebral laceration and contusion, with open intracranial wound, with concussion, unspecified. 

85200 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. 

85201 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. 

85202 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with brief (less than one hour) loss of 

consciousness. 

85203 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with moderate (1–24 hours) loss of 

consciousness. 

85204 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) 

loss of consciousness and return to pre-existing conscious level. 

85205 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) 

loss of consciousness, without return to pre-existing conscious level. 

85206 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85209 ............................................... Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. 

85210 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. 

85211 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with no loss of consciousness. 

85212 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85213 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85214 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85215 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85216 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. 

85219 ............................................... Subarachnoid hemorrhage following injury, with open intracranial wound, with concussion, unspecified. 

85220 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. 

85221 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. 

85222 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. 

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25008 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

85223 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85224 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

85225 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

85226 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified 

duration. 

85229 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. 

85230 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. 

85231 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with no loss of consciousness. 

85232 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85233 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85234 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85235 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85236 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. 

85239 ............................................... Subdural hemorrhage following injury, with open intracranial wound, with concussion, unspecified. 

85240 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. 

85241 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. 

85242 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with brief (less than 1 hour) loss of consciousness. 

85243 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85244 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss 

of consciousness and return to pre-existing conscious level. 

85245 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss 

of consciousness, without return to pre-existing conscious level. 

85246 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified 

duration. 

85249 ............................................... Extradural hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. 

85250 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. 

85251 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with no loss of consciousness. 

85252 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85253 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85254 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85255 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85256 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. 

85259 ............................................... Extradural hemorrhage following injury, with open intracranial wound, with concussion, unspecified. 

85300 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. 

85301 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. 

85302 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with brief (less than 

one hour) loss of consciousness. 

85303 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with moderate (1– 

24 hours) loss of consciousness. 

85304 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with prolonged 

(more than 24 hours) loss of consciousness and return to pre-existing conscious level. 

85305 ............................................... Other and unspecified intracranial hemorrhage following injury. without mention of open intracranial wound, with prolonged 

(more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 

85306 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85309 ............................................... Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with concussion, 

unspecified. 

85310 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. 

85311 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with no loss of consciousness. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25009 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

85312 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with brief (less than one hour) 

loss of consciousness. 

85313 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss 

of consciousness. 

85314 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with prolonged( more than 24 

hours) loss of consciousness and return to pre-existing conscious level. 

85315 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 

hours) loss of consciousness, without return to pre-existing conscious level. 

85316 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. 

85319 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with concussion, unspecified. 

85405 ............................................... Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with prolonged (more than 24 

hours) loss of consciousness, without return to pre-existing conscious level. 

85410 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with state of consciousness unspecified. 

85411 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with no loss of consciousness. 

85412 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with brief (less than one hour) loss of consciousness. 

85413 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. 

85414 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness and return to pre-existing conscious level. 

85415 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with prolonged (more than 24 hours) loss of 

consciousness, without return to pre-existing conscious level. 

85416 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with loss of consciousness of unspecified duration. 

85419 ............................................... Intracranial injury of other and unspecified nature, with open intracranial wound, with concussion, unspecified. 

8601 ................................................. Traumatic pneumothorax with open wound into thorax. 

8602 ................................................. Traumatic hemothorax without mention of open wound into thorax. 

8603 ................................................. Traumatic hemothorax with open wound into thorax. 

8604 ................................................. Traumatic pneumohemothorax without mention of open wound into thorax. 

8605 ................................................. Traumatic pneumohemothorax with open wound into thorax. 

86102 ............................................... Laceration of heart without penetration of heart chambers or open wound into thorax. 

86103 ............................................... Laceration of heart with penetration of heart chambers, without mention of open wound into thorax. 

86110 ............................................... Unspecified injury of heart with open wound into thorax. 

86111 ............................................... Contusion of heart with open wound into thorax. 

86112 ............................................... Laceration of heart without penetration of heart chambers, with open wound into thorax. 

86113 ............................................... Laceration of heart with penetration of heart chambers and open wound into thorax. 

86122 ............................................... Laceration of lung without open wound into thorax. 

86130 ............................................... Unspecified injury of lung with open wound into thorax. 

86131 ............................................... Contusion of lung with open wound into thorax. 

86132 ............................................... Laceration of lung with open wound into thorax. 

8621 ................................................. Injury to diaphragm with open wound into cavity. 

86221 ............................................... Injury to bronchus without open wound into cavity. 

86222 ............................................... Injury to esophagus without mention of open wound into cavity. 

86231 ............................................... Injury to bronchus with open wound into cavity. 

86232 ............................................... Injury to esophagus with open wound into cavity. 

86239 ............................................... Injury to other specified intrathoracic organs with open wound into cavity.

8629 ................................................. Injury to multiple and unspecified intrathoracic organs with open wound into cavity. 

8631 ................................................. Injury to stomach with open wound into cavity. 

86330 ............................................... Injury to small intestine, unspecified site, with open wound into cavity. 

86331 ............................................... Injury to duodenum with open wound into cavity. 

86339 ............................................... Other injury to small intestine with open wound into cavity. 

86350 ............................................... Injury to colon, unspecified site, with open wound into cavity. 

86351 ............................................... Injury to ascending (right) colon with open wound into cavity. 

86352 ............................................... Injury to transverse colon with open wound into cavity. 

86353 ............................................... Injury to descending (left) colon with open wound into cavity. 

86354 ............................................... Injury to sigmoid colon with open wound into cavity. 

86355 ............................................... Injury to rectum with open wound into cavity. 

86356 ............................................... Injury to multiple sites in colon and rectum with open wound into cavity. 

86359 ............................................... Other injury to colon and rectum with open wound into cavity. 

86390 ............................................... Injury to gastrointestinal tract, unspecified site, with open wound into cavity. 

86391 ............................................... Injury to pancreas head with open wound into cavity. 

86392 ............................................... Injury to pancreas body with open wound into cavity. 

86393 ............................................... Injury to pancreas tail with open wound into cavity. 

86394 ............................................... Injury to pancreas, multiple and unspecified sites, with open wound into cavity. 

86395 ............................................... Injury to appendix with open wound into cavity. 

86399 ............................................... Injury to other and unspecified gastrointestinal sites with open wound into cavity. 

86403 ............................................... Laceration of liver, moderate, without mention of open wound into cavity. 

86404 ............................................... Laceration of liver, major, without mention of open wound into cavity. 

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25010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

86410 ............................................... Unspecified injury to liver with open wound into cavity. 

86411 ............................................... Hematoma and contusion of liver with open wound into cavity. 

86412 ............................................... Laceration of liver, minor, with open wound into cavity. 

86413 ............................................... Laceration of liver, moderate, with open wound into cavity. 

86414 ............................................... Laceration of liver, major, with open wound into cavity. 

86415 ............................................... Laceration of liver, unspecified, with open wound into cavity. 

86419 ............................................... Other injury to liver with open wound into cavity. 

86503 ............................................... Laceration of spleen extending into parenchyma without mention of open wound into cavity. 

86504 ............................................... Massive parenchymal disruption of spleen without mention of open wound into cavity. 

86510 ............................................... Unspecified injury to spleen with open wound into cavity. 

86511 ............................................... Hematoma of spleen, without rupture of capsule, with open wound into cavity. 

86512 ............................................... Capsular tears to spleen, without major disruption of parenchyma, with open wound into cavity. 

86513 ............................................... Laceration of spleen extending into parenchyma, with open wound into cavity. 

86514 ............................................... Massive parenchyma disruption of spleen with open wound into cavity. 

86519 ............................................... Other injury to spleen with open wound into cavity. 

86603 ............................................... Complete disruption of kidney parenchyma, without mention of open wound into cavity. 

86610 ............................................... Unspecified injury to kidney with open wound into cavity. 

86611 ............................................... Hematoma of kidney, without rupture of capsule, with open wound into cavity. 

86612 ............................................... Laceration of kidney with open wound into cavity. 

86613 ............................................... Complete disruption of kidney parenchyma, with open wound into cavity. 

8671 ................................................. Injury to bladder and urethra with open wound into cavity. 

8673 ................................................. Injury to ureter with open wound into cavity. 

8675 ................................................. Injury to uterus with open wound into cavity. 

8677 ................................................. Injury to other specified pelvic organs with open wound into cavity. 

8679 ................................................. Injury to unspecified pelvic organ with open wound into cavity. 

86810 ............................................... Injury to unspecified intra-abdominal organ, with open wound into cavity. 

86811 ............................................... Injury to adrenal gland, with open wound into cavity. 

86812 ............................................... Injury to bile duct and gallbladder, with open wound into cavity. 

86813 ............................................... Injury to peritoneum with open wound into cavity. 

86814 ............................................... Injury to retroperitoneum with open wound into cavity. 

86819 ............................................... Injury to other and multiple intra-abdominal organs, with open wound into cavity. 

8691 ................................................. Internal injury to unspecified or ill-defined organs with open wound into cavity. 

87400 ............................................... Open wound of larynx with trachea, uncomplicated. 

87401 ............................................... Open wound of larynx, uncomplicated. 

87402 ............................................... Open wound of trachea, uncomplicated. 

87410 ............................................... Open wound of larynx with trachea, complicated. 

87411 ............................................... Open wound of larynx, complicated. 

87412 ............................................... Open wound of trachea, complicated. 

8876 ................................................. Traumatic amputation of arm and hand (complete) (partial), bilateral (any level), without mention of complication. 

8877 ................................................. Traumatic amputation of arm and hand (complete) (partial), bilateral (any level), complicated. 

8962 ................................................. Traumatic amputation of foot (complete) (partial), bilateral, without mention of complication. 

8963 ................................................. Traumatic amputation of foot (complete) (partial), bilateral, complicated.

8976 ................................................. Traumatic amputation of leg(s) (complete) (partial), bilateral (any level), without mention of complication. 

8977 ................................................. Traumatic amputation of leg(s) (complete) (partial), bilateral (any level), complicated. 

9010 ................................................. Injury to thoracic aorta. 

9011 ................................................. Injury to innominate and subclavian arteries. 

9012 ................................................. Injury to superior vena cava. 

9013 ................................................. Injury to innominate and subclavian veins. 

90140 ............................................... Injury to pulmonary vessel(s), unspecified. 

90141 ............................................... Injury to pulmonary artery. 

90142 ............................................... Injury to pulmonary vein. 

90183 ............................................... Injury to multiple blood vessels of thorax. 

9020 ................................................. Injury to abdominal aorta. 

90210 ............................................... Injury to inferior vena cava, unspecified. 

90211 ............................................... Injury to hepatic veins. 

90219 ............................................... Injury to other specified branches of inferior vena cava. 

90220 ............................................... Injury to celiac and mesenteric arteries, unspecified. 

90221 ............................................... Injury to gastric artery. 

90222 ............................................... Injury to hepatic artery. 

90223 ............................................... Injury to splenic artery. 

90224 ............................................... Injury to other specified branches of celiac axis. 

90225 ............................................... Injury to superior mesenteric artery (trunk). 

90226 ............................................... Injury to primary branches of superior mesenteric artery. 

90227 ............................................... Injury to inferior mesenteric artery. 

90229 ............................................... Injury to other celiac and mesenteric arteries. 

90231 ............................................... Injury to superior mesenteric vein and primary subdivisions. 

90232 ............................................... Injury to inferior mesenteric vein. 

90233 ............................................... Injury to portal vein. 

90234 ............................................... Injury to splenic vein. 

90239 ............................................... Injury to other portal and splenic veins. 

90240 ............................................... Injury to renal vessel(s), unspecified. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25011 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

90241 ............................................... Injury to renal artery. 

90242 ............................................... Injury to renal vein. 

90249 ............................................... Injury to other renal blood vessels. 

90250 ............................................... Injury to iliac vessel(s), unspecified. 

90251 ............................................... Injury to hypogastric artery. 

90252 ............................................... Injury to hypogastric vein. 

90253 ............................................... Injury to iliac artery. 

90254 ............................................... Injury to iliac vein. 

90259 ............................................... Injury to other iliac blood vessels. 

90287 ............................................... Injury to multiple blood vessels of abdomen and pelvis. 

90300 ............................................... Injury to axillary vessel(s), unspecified. 

90301 ............................................... Injury to axillary artery. 

90302 ............................................... Injury to axillary vein. 

9040 ................................................. Injury to common femoral artery. 

9041 ................................................. Injury to superficial femoral artery. 

9042 ................................................. Injury to femoral veins. 

90440 ............................................... Injury to popliteal vessel(s), unspecified. 

90441 ............................................... Injury to popliteal artery. 

90442 ............................................... Injury to popliteal vein. 

94821 ............................................... Burn (any degree) involving 20–29 percent of body surface with third degree burn of 10–19%. 

94822 ............................................... Burn (any degree) involving 20–29 percent of body surface with third degree burn of 20–29%. 

94831 ............................................... Burn (any degree) involving 30–39 percent of body surface with third degree burn of 10–19%. 

94832 ............................................... Burn (any degree) involving 30–39 percent of body surface with third degree burn of 20–29%. 

94833 ............................................... Burn (any degree) involving 30–39 percent of body surface with third degree burn of 30–39%. 

94841 ............................................... Burn (any degree) involving 40–49 percent of body surface with third degree burn of 10–19%. 

94842 ............................................... Burn (any degree) involving 40–49 percent of body surface with third degree burn of 20–29%. 

94843 ............................................... Burn (any degree) involving 40–49 percent of body surface with third degree burn of 30–39%. 

94844 ............................................... Burn (any degree) involving 40–49 percent of body surface with third degree burn of 40–49%. 

94851 ............................................... Burn (any degree) involving 50–59 percent of body surface with third degree burn of 10–19%. 

94852 ............................................... Burn (any degree) involving 50–59 percent of body surface with third degree burn of 20–29%. 

94853 ............................................... Burn (any degree) involving 50–59 percent of body surface with third degree burn of 30–39%. 

94854 ............................................... Burn (any degree) involving 50–59 percent of body surface with third degree burn of 40–49%. 

94855 ............................................... Burn (any degree) involving 50–59 percent of body surface with third degree burn of 50–59%. 

94861 ............................................... Burn (any degree) involving 60–69 percent of body surface with third degree burn of 10–19%. 

94862 ............................................... Burn (any degree) involving 60–69 percent of body surface with third degree burn of 20–29%. 

94863 ............................................... Burn (any degree) involving 60–69 percent of body surface with third degree burn of 30–39%. 

94864 ............................................... Burn (any degree) involving 60–69 percent of body surface with third degree burn of 40–49%. 

94865 ............................................... Burn (any degree) involving 60–69 percent of body surface with third degree burn of 50–59%. 

94866 ............................................... Burn (any degree) involving 60–69 percent of body surface with third degree burn of 60–69%. 

94871 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 10–19%. 

94872 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 20–29%. 

94873 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 30–39%. 

94874 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 40–49%. 

94875 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 50–59%. 

94876 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 60–69%. 

94877 ............................................... Burn (any degree) involving 70–79 percent of body surface with third degree burn of 70–79%. 

94881 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 10–19%. 

94882 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 20–29%. 

94883 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 30–39%. 

94884 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 40–49%. 

94885 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 50–59%. 

94886 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 60–69%. 

94887 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 70–79%. 

94888 ............................................... Burn (any degree) involving 80–89 percent of body surface with third degree burn of 80–89%. 

94891 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 10–19%. 

94892 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 20–29%. 

94893 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 30–39%. 

94894 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 40–49%. 

94895 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 50–59%. 

94896 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 60–69%. 

94897 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 70–79%. 

94898 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 80–89%. 

94899 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of 90% or more of body surface. 

95200 ............................................... C1–C4 level spinal cord injury, unspecified. 

95201 ............................................... C1–C4 level with complete lesion of spinal cord. 

95202 ............................................... C1–C4 level with anterior cord syndrome. 

95203 ............................................... C1–C4 level with central cord syndrome. 

95204 ............................................... C1–C4 level with other specified spinal cord injury. 

95205 ............................................... C5–C7 level spinal cord injury, unspecified. 

95206 ............................................... C5–C7 level with complete lesion of spinal cord. 

95207 ............................................... C5–C7 level with anterior cord syndrome. 

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25012 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued 

Diagnosis code Code title 

95208 ............................................... C5–C7 level with central cord syndrome. 

95209 ............................................... C5–C7 level with other specified spinal cord injury. 

95210 ............................................... T1–T6 level spinal cord injury, unspecified. 

95211 ............................................... T1–T6 level with complete lesion of spinal cord. 

95212 ............................................... T1–T6 level with anterior cord syndrome. 

95213 ............................................... T1–T6 level with central cord syndrome. 

95214 ............................................... T1–T6 level with other specified spinal cord injury. 

95215 ............................................... T7–T12 level spinal cord injury, unspecified. 

95216 ............................................... T7–T12 level with complete lesion of spinal cord. 

95217 ............................................... T7–T12 level with anterior cord syndrome. 

95218 ............................................... T7–T12 level with central cord syndrome. 

95219 ............................................... T7–T12 level with other specified spinal cord injury. 

9522 ................................................. Lumbar spinal cord injury without spinal bone injury. 

9523 ................................................. Sacral spinal cord injury without spinal bone injury. 

9524 ................................................. Cauda equina spinal cord injury without spinal bone injury. 

9528 ................................................. Multiple sites of spinal cord injury without spinal bone injury. 

9580 ................................................. Air embolism as an early complication of trauma. 

9581 ................................................. Fat embolism as an early complication of trauma. 

9584 ................................................. Traumatic shock. 

9585 ................................................. Traumatic anuria. 

99591 ............................................... Sepsis. 

99592 ............................................... Severe sepsis. 

99594 ............................................... Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction. 

9991 ................................................. Air embolism as a complication of medical care, not elsewhere classified. 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST

Diagnosis code Code title 

0010 ................................................. Cholera due to vibrio cholerae. 

0011 ................................................. Cholera due to vibrio cholerae el tor. 

0019 ................................................. Cholera, unspecified. 

0020 ................................................. Typhoid fever. 

0021 ................................................. Paratyphoid fever A. 

0022 ................................................. Paratyphoid fever B. 

0023 ................................................. Paratyphoid fever C. 

0029 ................................................. Paratyphoid fever, unspecified. 

0030 ................................................. Salmonella gastroenteritis. 

00323 ............................................... Salmonella arthritis. 

00324 ............................................... Salmonella osteomyelitis. 

00329 ............................................... Other localized salmonella infections. 

0038 ................................................. Other specified salmonella infections. 

0039 ................................................. Salmonella infection, unspecified. 

0040 ................................................. Shigella dysenteriae. 

0050 ................................................. Staphylococcal food poisoning. 

0051 ................................................. Botulism food poisoning. 

0052 ................................................. Food poisoning due to clostridium perfringens (c. welchii). 

0053 ................................................. Food poisoning due to other clostridia. 

0054 ................................................. Food poisoning due to vibrio parahaemolyticus. 

00581 ............................................... Food poisoning due to vibrio vulnificus. 

00589 ............................................... Other bacterial food poisoning. 

0060 ................................................. Acute amebic dysentery without mention of abscess. 

0061 ................................................. Chronic intestinal amebiasis without mention of abscess. 

0062 ................................................. Amebic nondysenteric colitis. 

0068 ................................................. Amebic infection of other sites. 

0071 ................................................. Giardiasis. 

0072 ................................................. Coccidiosis. 

0074 ................................................. Cryptosporidiosis. 

0075 ................................................. Cyclosporiasis. 

0078 ................................................. Other specified protozoal intestinal diseases. 

0079 ................................................. Unspecified protozoal intestinal disease. 

00800 ............................................... Intestinal infection due to e. coli, unspecified. 

00801 ............................................... Intestinal infection due to enteropathogenic e. coli. 

00802 ............................................... Intestinal infection due to enterotoxigenic e. coli. 

00803 ............................................... Intestinal infection due to enteroinvasive e. coli. 

00804 ............................................... Intestinal infection due to enterohemorrhagic e. coli. 

00809 ............................................... Intestinal infection due to other intestinal e. coli infections. 

0081 ................................................. Intestinal infection due to arizona group of paracolon bacilli. 

0082 ................................................. Intestinal infection due to aerobacter aerogenes. 

0083 ................................................. Intestinal infection due to proteus (mirabilis) (morganii). 

00841 ............................................... Intestinal infection due to staphylococcus. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25013 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

00842 ............................................... Intestinal infection due to pseudomonas. 

00843 ............................................... Intestinal infection due to campylobacter. 

00844 ............................................... Intestinal infection due to yersinia enterocolitica. 

00845 ............................................... Intestinal infection due to clostridium difficile. 

00846 ............................................... Intestinal infection due to other anaerobes. 

00847 ............................................... Intestinal infection due to other gram-negative bacteria. 

00849 ............................................... Intestinal infection due to other organisms. 

0085 ................................................. Bacterial enteritis, unspecified. 

00861 ............................................... Enteritis due to rotavirus. 

00862 ............................................... Enteritis due to adenovirus. 

00863 ............................................... Enteritis due to norwalk virus. 

00864 ............................................... Enteritis due to other small round viruses [srv’s]. 

00865 ............................................... Enteritis due to calcivirus. 

00866 ............................................... Enteritis due to astrovirus. 

00867 ............................................... Enteritis due to enterovirus nec. 

00869 ............................................... Enteritis due to other viral enteritis. 

0090 ................................................. Infectious colitis, enteritis, and gastroenteritis. 

0091 ................................................. Colitis, enteritis, and gastroenteritis of presumed infectious origin. 

0092 ................................................. Infectious diarrhea. 

0093 ................................................. Diarrhea of presumed infectious origin. 

01000 ............................................... Primary tuberculous complex, unspecified examination. 

01001 ............................................... Primary tuberculous complex, bacteriological or histological examination not done. 

01002 ............................................... Primary tuberculous complex, bacteriological or histological examination results unknown (at present). 

01003 ............................................... Primary tuberculous complex, tubercle bacilli found (in sputum) by microscopy. 

01004 ............................................... Primary tuberculous complex, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01005 ............................................... Primary tuberculous complex, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01006 ............................................... Primary tuberculous complex, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01010 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, confirmation unspecified. 

01011 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, bacteriological or histological examination not done. 

01012 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, bacteriological or histological examination results unknown (at 

present). 

01013 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01014 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by 

bacterial culture. 

01015 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01016 ............................................... Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01080 ............................................... Other primary progressive tuberculosis, confirmation unspecified. 

01081 ............................................... Other primary progressive tuberculosis, bacteriological or histological examination not done. 

01082 ............................................... Other primary progressive tuberculosis, bacteriological or histological examination results unknown (at present). 

01083 ............................................... Other primary progressive tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01084 ............................................... Other primary progressive tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01085 ............................................... Other primary progressive tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01086 ............................................... Other primary progressive tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01090 ............................................... Primary tuberculous infection, unspecified type, confirmation unspecified. 

01091 ............................................... Primary tuberculous infection, unspecified type, bacteriological or histological examination not done. 

01092 ............................................... Primary tuberculous infection, unspecified type, bacteriological or histological examination results unknown (at present). 

01093 ............................................... Primary tuberculous infection, unspecified type, tubercle bacilli found (in sputum) by microscopy. 

01094 ............................................... Primary tuberculous infection, unspecified type, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01095 ............................................... Primary tuberculous infection, unspecified type, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01096 ............................................... Primary tuberculous infection, unspecified type, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01100 ............................................... Tuberculosis of lung, infiltrative, confirmation unspecified. 

01101 ............................................... Tuberculosis of lung, infiltrative, bacteriological or histological examination not done. 

01102 ............................................... Tuberculosis of lung, infiltrative, bacteriological or histological examination results unknown (at present). 

01103 ............................................... Tuberculosis of lung, infiltrative, tubercle bacilli found (in sputum) by microscopy. 

01104 ............................................... Tuberculosis of lung, infiltrative, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01105 ............................................... Tuberculosis of lung, infiltrative, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

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25014 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

01106 ............................................... Tuberculosis of lung, infiltrative, tubercle bacilli not found bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01110 ............................................... Tuberculosis of lung, nodular, unspecified examination. 

01111 ............................................... Tuberculosis of lung, nodular, bacteriological or histological examination not done. 

01112 ............................................... Tuberculosis of lung, nodular, bacteriological or histological examination results unknown (at present). 

01113 ............................................... Tuberculosis of lung, nodular, tubercle bacilli found (in sputum) by microscopy. 

01114 ............................................... Tuberculosis of lung, nodular, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01115 ............................................... Tuberculosis of lung, nodular, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01116 ............................................... Tuberculosis of lung, nodular, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01120 ............................................... Tuberculosis of lung with cavitation, unspecified examination. 

01121 ............................................... Tuberculosis of lung with cavitation, bacteriological or histological examination not done. 

01122 ............................................... Tuberculosis of lung with cavitation, bacteriological or histological examination results unknown (at present). 

01123 ............................................... Tuberculosis of lung with cavitation, tubercle bacilli found (in sputum) by microscopy. 

01124 ............................................... Tuberculosis of lung with cavitation, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01125 ............................................... Tuberculosis of lung with cavitation, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01126 ............................................... Tuberculosis of lung with cavitation, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01130 ............................................... Tuberculosis of bronchus, unspecified examination. 

01131 ............................................... Tuberculosis of bronchus, bacteriological or histological examination not done. 

01132 ............................................... Tuberculosis of bronchus, bacteriological or histological examination results unknown (at present). 

01133 ............................................... Tuberculosis of bronchus, tubercle bacilli found (in sputum) by microscopy.

01134 ............................................... Tuberculosis of bronchus, tubercle bacilli not found (in sputum) by microscopy, but found in bacterial culture. 

01135 ............................................... Tuberculosis of bronchus, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01136 ............................................... Tuberculosis of bronchus, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01140 ............................................... Tuberculous fibrosis of lung, unspecified examination. 

01141 ............................................... Tuberculous fibrosis of lung, bacteriological or histological examination not done. 

01142 ............................................... Tuberculous fibrosis of lung, bacteriological or histological examination unknown (at present). 

01143 ............................................... Tuberculous fibrosis of lung, tubercle bacilli found (in sputum) by microscopy. 

01144 ............................................... Tuberculous fibrosis of lung, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01145 ............................................... Tuberculous fibrosis of lung, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01146 ............................................... Tuberculous fibrosis of lung, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01150 ............................................... Tuberculous bronchiectasis, unspecified examination. 

01151 ............................................... Tuberculous bronchiectasis, bacteriological or histological examination not done. 

01152 ............................................... Tuberculous bronchiectasis, bacteriological or histological examination results unknown (at present). 

01153 ............................................... Tuberculous bronchiectasis, tubercle bacilli found (in sputum) by microscopy. 

01154 ............................................... Tuberculous bronchiectasis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01155 ............................................... Tuberculous bronchiectasis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01156 ............................................... Tuberculous bronchiectasis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01170 ............................................... Tuberculous pneumothorax, unspecified examination. 

01171 ............................................... Tuberculous pneumothorax, bacteriological or histological examination not done. 

01172 ............................................... Tuberculous pneumothorax, bacteriological or histological examination results unknown (at present). 

01173 ............................................... Tuberculous pneumothorax, tubercle bacilli found (in sputum) by microscopy.

01174 ............................................... Tuberculous pneumothorax, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01175 ............................................... Tuberculous pneumothorax, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01176 ............................................... Tuberculous pneumothorax, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01180 ............................................... Other specified pulmonary tuberculosis, unspecified confirmation. 

01181 ............................................... Other specified pulmonary tuberculosis, bacteriological or histological examination not done. 

01182 ............................................... Other specified pulmonary tuberculosis, bacteriological or histological examination results unknown (at present). 

01183 ............................................... Other specified pulmonary tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01184 ............................................... Other specified pulmonary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01185 ............................................... Other specified pulmonary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01186 ............................................... Other specified pulmonary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25015 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

01190 ............................................... Unspecified pulmonary tuberculosis, confirmation unspecified. 

01191 ............................................... Unspecified pulmonary tuberculosis, bacteriological or histological examination not done. 

01192 ............................................... Unspecified pulmonary tuberculosis, bacteriological or histological examination results unknown (at present). 

01193 ............................................... Unspecified pulmonary tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01194 ............................................... Unspecified pulmonary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01195 ............................................... Unspecified pulmonary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01196 ............................................... Unspecified pulmonary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01200 ............................................... Tuberculous pleurisy, confirmation unspecified. 

01201 ............................................... Tuberculous pleurisy, bacteriological or histological examination not done.

01202 ............................................... Tuberculous pleurisy, bacteriological or histological examination results unknown (at present). 

01203 ............................................... Tuberculous pleurisy, tubercle bacilli found (in sputum) by microscopy. 

01204 ............................................... Tuberculous pleurisy, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01205 ............................................... Tuberculous pleurisy, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01206 ............................................... Tuberculous pleurisy, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01210 ............................................... Tuberculosis of intrathoracic lymph nodes, confirmation unspecified. 

01211 ............................................... Tuberculosis of intrathoracic lymph nodes, bacteriological or histological examination not done. 

01212 ............................................... Tuberculosis of intrathoracic lymph nodes, bacteriological or histological examination results unknown (at present). 

01213 ............................................... Tuberculosis of intrathoracic lymph nodes, tubercle bacilli found (in sputum) by microscopy. 

01214 ............................................... Tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01215 ............................................... Tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01216 ............................................... Tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01220 ............................................... Isolated tracheal or bronchial tuberculosis, unspecified examination. 

01221 ............................................... Isolated tracheal or bronchial tuberculosis, bacteriological or histological examination not done. 

01222 ............................................... Isolated tracheal or bronchial tuberculosis, bacteriological or histological examination results unknown (at present). 

01223 ............................................... Isolated tracheal or bronchial tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01224 ............................................... Isolated tracheal or bronchial tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01225 ............................................... Isolated tracheal or bronchial tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01226 ............................................... Isolated tracheal or bronchial tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01230 ............................................... Tuberculous laryngitis, unspecified examination. 

01231 ............................................... Tuberculous laryngitis, bacteriological or histological examination not done. 

01232 ............................................... Tuberculous laryngitis, bacteriological or histological examination results unknown (at present). 

01233 ............................................... Tuberculous laryngitis, tubercle bacilli found (in sputum) by microscopy. 

01234 ............................................... Tuberculous laryngitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01235 ............................................... Tuberculous laryngitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01236 ............................................... Tuberculous laryngitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01280 ............................................... Other specified respiratory tuberculosis, unspecified examination. 

01281 ............................................... Other specified respiratory tuberculosis, bacteriological or histological examination not done. 

01282 ............................................... Other specified respiratory tuberculosis, bacteriological or histological examination results unknown (at present). 

01283 ............................................... Other specified respiratory tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01284 ............................................... Other specified respiratory tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01285 ............................................... Other specified respiratory tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01286 ............................................... Other specified respiratory tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01480 ............................................... Other tuberculosis of intestines and mesenteric glands, unspecified examination. 

01481 ............................................... Other tuberculosis of intestines and mesenteric glands, bacteriological or histological examination not done. 

01482 ............................................... Other tuberculosis of intestines and mesenteric glands, bacteriological or histological examination results unknown (at present). 

01483 ............................................... Other tuberculosis of intestines and mesenteric glands, tubercle bacilli found (in sputum) by microscopy. 

01484 ............................................... Other tuberculosis of intestines and mesenteric glands, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01485 ............................................... Other tuberculosis of intestines and mesenteric glands, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01486 ............................................... Other tuberculosis of intestines and mesenteric glands, tubercle bacilli not found by bacteriological or histological examination, 

but tuberculosis confirmed by other methods (inoculation of animals). 

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25016 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

01500 ............................................... Tuberculosis of vertebral column, unspecified examination. 

01501 ............................................... Tuberculosis of vertebral column, bacteriological or histological examination not done. 

01502 ............................................... Tuberculosis of vertebral column, bacteriological or histological examination results unknown (at present). 

01503 ............................................... Tuberculosis of vertebral column, tubercle bacilli found (in sputum) by microscopy. 

01504 ............................................... Tuberculosis of vertebral column, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01505 ............................................... Tuberculosis of vertebral column, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01506 ............................................... Tuberculosis of vertebral column, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01510 ............................................... Tuberculosis of hip, unspecified examination. 

01511 ............................................... Tuberculosis of hip, bacteriological or histological examination not done. 

01512 ............................................... Tuberculosis of hip, bacteriological or histological examination results unknown (at present). 

01513 ............................................... Tuberculosis of hip, tubercle bacilli found (in sputum) by microscopy. 

01514 ............................................... Tuberculosis of hip, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01515 ............................................... Tuberculosis of hip, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01516 ............................................... Tuberculosis of hip, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other 

methods (inoculation of animals). 

01520 ............................................... Tuberculosis of knee, unspecified examination. 

01521 ............................................... Tuberculosis of knee, bacteriological or histological examination not done.

01522 ............................................... Tuberculosis of knee, bacteriological or histological examination results unknown (at present). 

01523 ............................................... Tuberculosis of knee, tubercle bacilli found (in sputum) by microscopy. 

01524 ............................................... Tuberculosis of knee, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01525 ............................................... Tuberculosis of knee, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01526 ............................................... Tuberculosis of knee, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01550 ............................................... Tuberculosis of limb bones, unspecified examination. 

01551 ............................................... Tuberculosis of limb bones, bacteriological or histological examination not done. 

01552 ............................................... Tuberculosis of limb bones, bacteriological or histological examination results unknown (at present). 

01553 ............................................... Tuberculosis of limb bones, tubercle bacilli found (in sputum) by microscopy. 

01554 ............................................... Tuberculosis of limb bones, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01555 ............................................... Tuberculosis of limb bones, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01556 ............................................... Tuberculosis of limb bones, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01560 ............................................... Tuberculosis of mastoid, unspecified examination. 

01561 ............................................... Tuberculosis of mastoid, bacteriological or histological examination not done. 

01562 ............................................... Tuberculosis of mastoid, bacteriological or histological examination results unknown (at present). 

01563 ............................................... Tuberculosis of mastoid, tubercle bacilli found (in sputum) by microscopy. 

01564 ............................................... Tuberculosis of mastoid, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01565 ............................................... Tuberculosis of mastoid, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01566 ............................................... Tuberculosis of mastoid, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01570 ............................................... Tuberculosis of other specified bone, unspecified examination. 

01571 ............................................... Tuberculosis of other specified bone, bacteriological or histological examination not done. 

01572 ............................................... Tuberculosis of other specified bone, bacteriological or histological examination results unknown (at present). 

01573 ............................................... Tuberculosis of other specified bone, tubercle bacilli found (in sputum) by microscopy. 

01574 ............................................... Tuberculosis of other specified bone, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01575 ............................................... Tuberculosis of other specified bone, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01576 ............................................... Tuberculosis of other specified bone, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01580 ............................................... Tuberculosis of other specified joint, unspecified examination. 

01581 ............................................... Tuberculosis of other specified joint, bacteriological or histological examination not done. 

01582 ............................................... Tuberculosis of other specified joint, bacteriological or histological examination results unknown (at present). 

01583 ............................................... Tuberculosis of other specified joint, tubercle bacilli found (in sputum) by microscopy. 

01584 ............................................... Tuberculosis of other specified joint, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01585 ............................................... Tuberculosis of other specified joint, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01586 ............................................... Tuberculosis of other specified joint, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01590 ............................................... Tuberculosis of unspecified bones and joints, unspecified examination. 

01591 ............................................... Tuberculosis of unspecified bones and joints, bacteriological or histological examination not done. 

01592 ............................................... Tuberculosis of unspecified bones and joints, bacteriological or histological examination results unknown (at present). 

01593 ............................................... Tuberculosis of unspecified bones and joints, tubercle bacilli found (in sputum) by microscopy. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25017 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

01594 ............................................... Tuberculosis of unspecified bones and joints, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01595 ............................................... Tuberculosis of unspecified bones and joints, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01596 ............................................... Tuberculosis of unspecified bones and joints, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01600 ............................................... Tuberculosis of kidney, unspecified examination. 

01601 ............................................... Tuberculosis of kidney, bacteriological or histological examination not done. 

01602 ............................................... Tuberculosis of kidney, bacteriological or histological examination results unknown (at present). 

01603 ............................................... Tuberculosis of kidney, tubercle bacilli found (in sputum) by microscopy. 

01604 ............................................... Tuberculosis of kidney, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01605 ............................................... Tuberculosis of kidney, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01606 ............................................... Tuberculosis of kidney, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01610 ............................................... Tuberculosis of bladder, unspecified examination. 

01611 ............................................... Tuberculosis of bladder, bacteriological or histological examination not done. 

01612 ............................................... Tuberculosis of bladder, bacteriological or histological examination results unknown (at present). 

01613 ............................................... Tuberculosis of bladder, tubercle bacilli found (in sputum) by microscopy. 

01614 ............................................... Tuberculosis of bladder, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01615 ............................................... Tuberculosis of bladder, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01616 ............................................... Tuberculosis of bladder, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01620 ............................................... Tuberculosis of ureter, unspecified examination. 

01621 ............................................... Tuberculosis of ureter, bacteriological or histological examination not done. 

01622 ............................................... Tuberculosis of ureter, bacteriological or histological examination results unknown (at present). 

01623 ............................................... Tuberculosis of ureter, tubercle bacilli found (in sputum) by microscopy. 

01624 ............................................... Tuberculosis of ureter, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01625 ............................................... Tuberculosis of ureter, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01626 ............................................... Tuberculosis of ureter, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01630 ............................................... Tuberculosis of other urinary organs, unspecified examination. 

01631 ............................................... Tuberculosis of other urinary organs, bacteriological or histological examination not done. 

01632 ............................................... Tuberculosis of other urinary organs, bacteriological or histological examination results unknown (at present). 

01633 ............................................... Tuberculosis of other urinary organs, tubercle bacilli found (in sputum) by microscopy. 

01634 ............................................... Tuberculosis of other urinary organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01635 ............................................... Tuberculosis of other urinary organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01636 ............................................... Tuberculosis of other urinary organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01640 ............................................... Tuberculosis of epididymis, unspecified examination. 

01641 ............................................... Tuberculosis of epididymis, bacteriological or histological examination not done. 

01642 ............................................... Tuberculosis of epididymis, bacteriological or histological examination results unknown (at present). 

01643 ............................................... Tuberculosis of epididymis, tubercle bacilli found (in sputum) by microscopy. 

01644 ............................................... Tuberculosis of epididymis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01645 ............................................... Tuberculosis of epididymis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01646 ............................................... Tuberculosis of epididymis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01650 ............................................... Tuberculosis of other male genital organs, unspecified examination. 

01651 ............................................... Tuberculosis of other male genital organs, bacteriological or histological examination not done. 

01652 ............................................... Tuberculosis of other male genital organs, bacteriological or histological examination results unknown (at present). 

01653 ............................................... Tuberculosis of other male genital organs, tubercle bacilli found (in sputum) by microscopy. 

01654 ............................................... Tuberculosis of other male genital organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01655 ............................................... Tuberculosis of other male genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01656 ............................................... Tuberculosis of other male genital organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01660 ............................................... Tuberculous oophoritis and salpingitis, unspecified examination. 

01661 ............................................... Tuberculous oophoritis and salpingitis, bacteriological or histological examination not done. 

01662 ............................................... Tuberculous oophoritis and salpingitis, bacteriological or histological examination results unknown (at present). 

01663 ............................................... Tuberculous oophoritis and salpingitis, tubercle bacilli found (in sputum) by microscopy. 

01664 ............................................... Tuberculous oophoritis and salpingitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01665 ............................................... Tuberculous oophoritis and salpingitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

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25018 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

01666 ............................................... Tuberculous oophoritis and salpingitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01670 ............................................... Tuberculosis of other female genital organs, unspecified examination. 

01671 ............................................... Tuberculosis of other female genital organs, bacteriological or histological examination not done. 

01672 ............................................... Tuberculosis of other female genital organs, bacteriological or histological examination results unknown (at present). 

01673 ............................................... Tuberculosis of other female genital organs, tubercle bacilli found (in sputum) by microscopy. 

01674 ............................................... Tuberculosis of other female genital organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01675 ............................................... Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01676 ............................................... Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01690 ............................................... Unspecified genitourinary tuberculosis, unspecified examination. 

01691 ............................................... Unspecified genitourinary tuberculosis, bacteriological or histological examination not done. 

01692 ............................................... Unspecified genitourinary tuberculosis, bacteriological or histological examination results unknown (at present). 

01693 ............................................... Unspecified genitourinary tuberculosis, tubercle bacilli found (in sputum) by microscopy. 

01694 ............................................... Unspecified genitourinary tuberculosis, tubercle ba cilli not found (in sputum) by microscopy, but found by bacterial culture. 

01695 ............................................... Unspecified genitourinary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01696 ............................................... Unspecified genitourinary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

01700 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, unspecified examination. 

01701 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, bacteriological or histological examination not done. 

01702 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, bacteriological or histological examination results unknown (at present). 

01703 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli found (in sputum) by microscopy. 

01704 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01705 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli not found by bacteriological examination, but tuberculosis 

confirmed histologically. 

01706 ............................................... Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli not found by bacteriological or histological examination, 

but tuberculosis confirmed by other methods (inoculation of animals). 

01720 ............................................... Tuberculosis of peripheral lymph nodes, unspecified examination. 

01721 ............................................... Tuberculosis of peripheral lymph nodes, bacteriological or histological examination not done. 

01722 ............................................... Tuberculosis of peripheral lymph nodes, bacteriological or histological examination results unknown (at present). 

01723 ............................................... Tuberculosis of peripheral lymph nodes, tubercle bacilli found (in sputum) by microscopy. 

01724 ............................................... Tuberculosis of peripheral lymph nodes, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01725 ............................................... Tuberculosis of peripheral lymph nodes, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01726 ............................................... Tuberculosis of peripheral lymph nodes, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01730 ............................................... Tuberculosis of eye, unspecified examination. 

01731 ............................................... Tuberculosis of eye, bacteriological or histological examination not done. 

01732 ............................................... Tuberculosis of eye, bacteriological or histological examination results unknown (at present). 

01733 ............................................... Tuberculosis of eye, tubercle bacilli found (in sputum) by microscopy. 

01734 ............................................... Tuberculosis of eye, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01735 ............................................... Tuberculosis of eye, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01736 ............................................... Tuberculosis of eye, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other 

methods (inoculation of animals). 

01740 ............................................... Tuberculosis of ear, unspecified examination. 

01741 ............................................... Tuberculosis of ear, bacteriological or histological examination not done. 

01742 ............................................... Tuberculosis of ear, bacteriological or histological examination results unknown (at present). 

01743 ............................................... Tuberculosis of ear, tubercle bacilli found (in sputum) by microscopy. 

01744 ............................................... Tuberculosis of ear, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01745 ............................................... Tuberculosis of ear, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01746 ............................................... Tuberculosis of ear, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other 

methods (inoculation of animals). 

01750 ............................................... Tuberculosis of thyroid gland, unspecified origin. 

01751 ............................................... Tuberculosis of thyroid gland, bacteriological or histological examination not done. 

01752 ............................................... Tuberculosis of thyroid gland, bacteriological or histological examination results unknown (at present). 

01753 ............................................... Tuberculosis of thyroid gland, tubercle bacilli found (in sputum) by microscopy. 

01754 ............................................... Tuberculosis of thyroid gland, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01755 ............................................... Tuberculosis of thyroid gland, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25019 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

01756 ............................................... Tuberculosis of thyroid gland, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01760 ............................................... Tuberculosis of adrenal glands, unspecified examination. 

01761 ............................................... Tuberculosis of adrenal glands, bacteriological or histological examination not done. 

01762 ............................................... Tuberculosis of adrenal glands, bacteriological or histological examination results unknown (at present). 

01763 ............................................... Tuberculosis of adrenal glands, tubercle bacilli found (in sputum) by microscopy. 

01764 ............................................... Tuberculosis of adrenal glands, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01765 ............................................... Tuberculosis of adrenal glands, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01766 ............................................... Tuberculosis of adrenal glands, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 

01770 ............................................... Tuberculosis of spleen, unspecified examination. 

01771 ............................................... Tuberculosis of spleen, bacteriological or histological examination not done. 

01772 ............................................... Tuberculosis of spleen, bacteriological or histological examination results unknown (at present). 

01773 ............................................... Tuberculosis of spleen, tubercle bacilli found (in sputum) by microscopy. 

01774 ............................................... Tuberculosis of spleen, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01775 ............................................... Tuberculosis of spleen, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01776 ............................................... Tuberculosis of spleen, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by 

other methods (inoculation of animals). 

01780 ............................................... Tuberculosis of esophagus, unspecified examination. 

01781 ............................................... Tuberculosis of esophagus, bacteriological or histological examination not done. 

01782 ............................................... Tuberculosis of esophagus, bacteriological or histological examination results unknown (at present). 

01783 ............................................... Tuberculosis of esophagus, tubercle bacilli found (in sputum) by microscopy. 

01784 ............................................... Tuberculosis of esophagus, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01785 ............................................... Tuberculosis of esophagus, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 

01786 ............................................... Tuberculosis of esophagus, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed 

by other methods (inoculation of animals). 

01790 ............................................... Tuberculosis of other specified organs, unspecified examination. 

01791 ............................................... Tuberculosis of other specified organs, bacteriological or histological examination not done. 

01792 ............................................... Tuberculosis of other specified organs, bacteriological or histological examination results unknown (at present). 

01793 ............................................... Tuberculosis of other specified organs, tubercle bacilli found (in sputum) by microscopy. 

01794 ............................................... Tuberculosis of other specified organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. 

01795 ............................................... Tuberculosis of other specified organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed 

histologically. 

01796 ............................................... Tuberculosis of other specified organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis 

confirmed by other methods (inoculation of animals). 

0210 ................................................. Ulceroglandular tularemia. 

0211 ................................................. Enteric tularemia. 

0212 ................................................. Pulmonary tularemia. 

0213 ................................................. Oculoglandular tularemia. 

0218 ................................................. Other specified tularemia. 

0219 ................................................. Unspecified tularemia. 

0220 ................................................. Cutaneous anthrax. 

0222 ................................................. Gastrointestinal anthrax. 

0228 ................................................. Other specified manifestations of anthrax. 

0229 ................................................. Anthrax, unspecified. 

0238 ................................................. Other brucellosis. 

0239 ................................................. Brucellosis, unspecified. 

024 ................................................... Glanders. 

025 ................................................... Melioidosis. 

0260 ................................................. Spirillary fever. 

0261 ................................................. Streptobacillary fever. 

0269 ................................................. Unspecified rat-bite fever. 

0270 ................................................. Listeriosis. 

0272 ................................................. Pasteurellosis. 

0278 ................................................. Other specified zoonotic bacterial diseases. 

0279 ................................................. Unspecified zoonotic bacterial disease. 

0300 ................................................. Lepromatous leprosy (type L). 

0301 ................................................. Tuberculoid leprosy (type T). 

0302 ................................................. Indeterminate leprosy (group I). 

0303 ................................................. Borderline leprosy (group B). 

0308 ................................................. Other specified leprosy. 

0309 ................................................. Leprosy, unspecified. 

0310 ................................................. Pulmonary diseases due to other mycobacteria. 

0311 ................................................. Cutaneous diseases due to other mycobacteria. 

0312 ................................................. Disseminated mycobacterium. 

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25020 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

0318 ................................................. Other specified mycobacterial diseases. 

0319 ................................................. Unspecified diseases due to mycobacteria. 

0320 ................................................. Faucial diphtheria. 

0321 ................................................. Nasopharyngeal diphtheria. 

0322 ................................................. Anterior nasal diphtheria. 

0323 ................................................. Laryngeal diphtheria. 

03281 ............................................... Conjunctival diphtheria. 

03282 ............................................... Diphtheritic myocarditis. 

03283 ............................................... Diphtheritic peritonitis. 

03284 ............................................... Diphtheritic cystitis. 

03285 ............................................... Cutaneous diphtheria. 

03289 ............................................... Other specified diphtheria. 

0329 ................................................. Diphtheria, unspecified. 

0330 ................................................. Whooping cough due to bordetella pertussis (b. pertussis). 

0331 ................................................. Whooping cough due to bordetella parapertussis (b. parapertussis). 

0338 ................................................. Whooping cough due to other specified organism. 

0339 ................................................. Whooping cough, unspecified organism. 

0341 ................................................. Scarlet fever. 

03681 ............................................... Meningococcal optic neuritis. 

03682 ............................................... Meningococcal arthropathy. 

03689 ............................................... Other specified meningococcal infections. 

0369 ................................................. Meningococcal infection, unspecified. 

0390 ................................................. Cutaneous actinomycotic infection. 

0391 ................................................. Pulmonary actinomycotic infection. 

0392 ................................................. Abdominal actinomycotic infection. 

0393 ................................................. Cervicofacial actinomycotic infection. 

0394 ................................................. Madura foot. 

0398 ................................................. Actinomycotic infection of other specified sites. 

0399 ................................................. Actinomycotic infection of unspecified site. 

0402 ................................................. Whipple’s disease. 

0403 ................................................. Necrobacillosis. 

04041 ............................................... Infant botulism. 

04042 ............................................... Wound botulism. 

04081 ............................................... Tropical pyomyositis. 

0460 ................................................. Kuru. 

0461 ................................................. Jakob-creutzfeldt disease. 

0462 ................................................. Subacute sclerosing panencephalitis. 

0463 ................................................. Progressive multifocal leukoencephalopathy. 

0468 ................................................. Other specified slow virus infection of central nervous system. 

0469 ................................................. Unspecified slow virus infection of central nervous system. 

0470 ................................................. Meningitis due to coxsackie virus. 

0471 ................................................. Meningitis due to echo virus. 

0478 ................................................. Other specified viral meningitis. 

0479 ................................................. Unspecified viral meningitis. 

048 ................................................... Other enterovirus diseases of central nervous system. 

0490 ................................................. Non-arthopod borne lymphocytic choriomeningitis. 

0491 ................................................. Non-arthopod borne meningitis due to adenovirus. 

0498 ................................................. Other specified non-arthropod-borne viral diseases of central nervous system. 

0499 ................................................. Unspecified non-arthropod-borne viral diseases of central nervous system. 

0500 ................................................. Variola major. 

0501 ................................................. Alastrim. 

0502 ................................................. Modified smallpox. 

0509 ................................................. Smallpox, unspecified. 

0527 ................................................. Chickenpox with other specified complications. 

0528 ................................................. Chickenpox with unspecified complication. 

0529 ................................................. Varicella without mention of complication. 

05310 ............................................... Herpes zoster with unspecified nervous system complication. 

05311 ............................................... Geniculate herpes zoster. 

05312 ............................................... Postherpetic trigeminal neuralgia. 

05313 ............................................... Postherpetic polyneuropathy. 

05319 ............................................... Herpes zoster with other nervous system complications. 

05320 ............................................... Herpes zoster dermatitis of eyelid. 

05321 ............................................... Herpes zoster keratoconjunctivitis. 

05322 ............................................... Herpes zoster iridocyclitis. 

05329 ............................................... Herpes zoster with other ophthalmic complications. 

05371 ............................................... Otitis externa due to herpes zoster. 

05379 ............................................... Herpes zoster with other specified complications. 

0538 ................................................. Herpes zoster with unspecified complication. 

0542 ................................................. Herpetic gingivostomatitis. 

05440 ............................................... Herpes simplex with unspecified ophthalmic complication. 

05441 ............................................... Herpes simplex dermatitis of eyelid. 

05442 ............................................... Dendritic keratitis. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25021 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

05443 ............................................... Herpes simplex disciform keratitis. 

05444 ............................................... Herpes simplex iridocyclitis. 

05449 ............................................... Herpes simplex with other ophthalmic complications. 

05471 ............................................... Visceral herpes simplex. 

05479 ............................................... Herpes simplex with other specified complications. 

05571 ............................................... Measles keratoconjunctivitis. 

05579 ............................................... Measles with other specified complications. 

05600 ............................................... Rubella with unspecified neurological complication. 

05609 ............................................... Rubella with other neurological complications. 

05671 ............................................... Arthritis due to rubella. 

05679 ............................................... Rubella with other specified complications. 

0570 ................................................. Erythema infectiosum (fifth disease). 

0600 ................................................. Sylvatic yellow fever. 

0601 ................................................. Urban yellow fever. 

0609 ................................................. Yellow fever, unspecified. 

061 ................................................... Dengue. 

0650 ................................................. Crimean hemorrhagic fever (chf congo virus). 

0651 ................................................. Omsk hemorrhagic fever. 

0652 ................................................. Kyasanur forest disease. 

0653 ................................................. Other tick-borne hemorrhagic fever. 

0654 ................................................. Mosquito-borne hemorrhagic fever. 

0658 ................................................. Other specified arthropod-borne hemorrhagic fever. 

0659 ................................................. Arthropod-borne hemorrhagic fever, unspecified. 

0660 ................................................. Phlebotomus fever. 

0661 ................................................. Tick-borne fever. 

0662 ................................................. Venezuelan equine fever. 

0663 ................................................. Other mosquito-borne fever. 

0668 ................................................. Other specified arthropod-borne viral diseases. 

0669 ................................................. Arthropod-borne viral disease, unspecified. 

0701 ................................................. Viral hepatitis a without mention of hepatic coma. 

07030 ............................................... Viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta. 

07031 ............................................... Viral hepatitis b without mention of hepatic coma, acute or unspecified, with hepatitis delta. 

07032 ............................................... Chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta. 

07033 ............................................... Chronic viral hepatitis b without mention of hepatic coma with hepatitis delta. 

07051 ............................................... Acute hepatitis C without mention of hepatic coma. 

07052 ............................................... Hepatitis delta without mention of active hepatitis B disease or hepatic coma. 

07053 ............................................... Hepatitis E without mention of hepatic coma. 

07059 ............................................... Other specified viral hepatitis without mention of hepatic coma. 

0709 ................................................. Unspecified viral hepatitis without mention of hepatic coma. 

071 ................................................... Rabies. 

0720 ................................................. Mumps orchitis. 

0723 ................................................. Mumps pancreatitis. 

07271 ............................................... Mumps hepatitis. 

07272 ............................................... Mumps polyneuropathy. 

07279 ............................................... Mumps with other specified complications. 

0728 ................................................. Mumps with unspecified complication. 

0737 ................................................. Ornithosis with other specified complications. 

0738 ................................................. Ornithosis with unspecified complication. 

0739 ................................................. Ornithosis, unspecified. 

07420 ............................................... Coxsackie carditis, unspecified. 

07421 ............................................... Coxsackie pericarditis. 

07422 ............................................... Coxsackie endocarditis. 

07423 ............................................... Coxsackie myocarditis. 

0783 ................................................. Cat-scratch disease. 

0785 ................................................. Cytomegaloviral disease. 

0786 ................................................. Hemorrhagic nephrosonephritis. 

0787 ................................................. Arenaviral hemorrhagic fever. 

07951 ............................................... Human t-cell lymphotrophic virus, type i [HTLV–I]. 

07952 ............................................... Human t-cell lymphotrophic virus, type ii [HTLV–II]. 

07953 ............................................... Human immunodeficiency virus, type 2 [HIV–2]. 

07981 ............................................... Hantaviris infection. 

07982 ............................................... Sars-assoc coronavirus. 

07983 ............................................... Parvovirus B19. 

080 ................................................... Louse-borne (epidemic) typhus. 

0810 ................................................. Murine (endemic) typhus. 

0811 ................................................. Brill’s disease. 

0812 ................................................. Scrub typhus. 

0819 ................................................. Typhus, unspecified. 

0820 ................................................. Spotted fevers. 

0821 ................................................. Boutonneuse fever. 

0822 ................................................. North asian tick fever. 

0823 ................................................. Queensland tick typhus. 

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25022 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

08240 ............................................... Unspecified ehrlichiosis. 

08241 ............................................... Ehrlichiosis chafeensis (e chafeensis). 

08249 ............................................... Other ehrlichiosis. 

0828 ................................................. Other specified tick-borne rickettsioses. 

0829 ................................................. Tick-borne rickettsiosis, unspecified. 

0830 ................................................. Q fever. 

0831 ................................................. Trench fever. 

0832 ................................................. Rickettsialpox. 

0838 ................................................. Other specified rickettsioses. 

0839 ................................................. Rickettsiosis, unspecified. 

0841 ................................................. Vivax malaria (benign tertian). 

0842 ................................................. Quartan malaria. 

0843 ................................................. Ovale malaria. 

0844 ................................................. Other malaria. 

0845 ................................................. Mixed malaria. 

0846 ................................................. Malaria, unspecified. 

0847 ................................................. Induced malaria. 

0848 ................................................. Blackwater fever. 

0849 ................................................. Other pernicious complications of malaria. 

0850 ................................................. Leishmaniasis visceral (kala-azar). 

0851 ................................................. Cutaneous leishmaniasis, urban. 

0852 ................................................. Cutaneous leishmaniasis, asian desert. 

0853 ................................................. Cutaneous leishmaniasis, ethiopian. 

0854 ................................................. Cutaneous leishmaniasis, american. 

0855 ................................................. Mucocutaneous leishmaniasis, (american). 

0859 ................................................. Leishmaniasis, unspecified. 

0860 ................................................. Chagas’ disease with heart involvement. 

0861 ................................................. Chagas’ disease with other organ involvement. 

0862 ................................................. Chagas’ disease without mention of organ involvement. 

0863 ................................................. Gambian trypanosomiasis. 

0864 ................................................. Rhodesian trypanosomiasis. 

0865 ................................................. African trypanosomiasis, unspecified. 

0869 ................................................. Trypanosomiasis, unspecified. 

0870 ................................................. Relapsing fever, louse-borne. 

0871 ................................................. Relapsing fever, tick-borne. 

0879 ................................................. Relapsing fever, unspecified. 

0880 ................................................. Bartonellosis. 

08881 ............................................... Lyme disease. 

08882 ............................................... Babesiosis. 

0900 ................................................. Early congenital syphilis, symptomatic. 

0902 ................................................. Early congenital syphilis, unspecified. 

0903 ................................................. Syphilitic interstitial keratitis. 

09040 ............................................... Juvenile neurosyphilis, unspecified. 

09049 ............................................... Other juvenile neurosyphilis. 

0905 ................................................. Other late congenital syphilis, symptomatic. 

0913 ................................................. Secondary syphilis of skin or mucous membranes. 

0914 ................................................. Adenopathy due to secondary syphilis. 

09150 ............................................... Syphilitic uveitis, unspecified. 

09151 ............................................... Syphilitic chorioretinitis (secondary). 

09152 ............................................... Syphilitic iridocyclitis (secondary). 

09161 ............................................... Secondary syphilitic periostitis. 

09162 ............................................... Secondary syphilitic hepatitis. 

09169 ............................................... Secondary syphilis of other viscera. 

0917 ................................................. Secondary syphilis, relapse. 

09182 ............................................... Syphilitic alopecia. 

09189 ............................................... Other forms of secondary syphilis. 

0919 ................................................. Unspecified secondary syphilis. 

0930 ................................................. Aneurysm of aorta, specified as syphilitic. 

0931 ................................................. Syphilitic aortitis. 

09320 ............................................... Syphilitic endocarditis of valve, unspecified. 

09321 ............................................... Syphilitic endocarditis of mitral valve. 

09322 ............................................... Syphilitic endocarditis of aortic valve. 

09323 ............................................... Syphilitic endocarditis of tricuspid valve. 

09324 ............................................... Syphilitic endocarditis of pulmonary valve. 

09381 ............................................... Syphilitic pericarditis. 

09382 ............................................... Syphilitic myocarditis. 

09389 ............................................... Other specified cardiovascular syphilis. 

0939 ................................................. Cardiovascular syphilis, unspecified. 

0940 ................................................. Tabes dorsalis. 

0941 ................................................. General paresis. 

0943 ................................................. Asymptomatic neurosyphilis. 

09482 ............................................... Syphilitic parkinsonism. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25023 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

09483 ............................................... Syphilitic disseminated retinochoroiditis. 

09484 ............................................... Syphilitic optic atrophy. 

09485 ............................................... Syphilitic retrobulbar neuritis. 

09486 ............................................... Syphilitic acoustic neuritis. 

09489 ............................................... Other specified neurosyphilis. 

0949 ................................................. Neurosyphilis, unspecified. 

0950 ................................................. Syphilitic episcleritis. 

0951 ................................................. Syphilis of lung. 

0952 ................................................. Syphilitic peritonitis. 

0953 ................................................. Syphilis of liver. 

0954 ................................................. Syphilis of kidney. 

0955 ................................................. Syphilis of bone. 

0956 ................................................. Syphilis of muscle. 

0957 ................................................. Syphilis of synovium, tendon, and bursa. 

0958 ................................................. Other specified forms of late symptomatic syphilis. 

0959 ................................................. Late symptomatic syphilis, unspecified. 

0980 ................................................. Gonococcal infection (acute) of lower genitourinary tract. 

09810 ............................................... Gonococcal infection (acute) of upper genitourinary tract, site unspecified. 

09811 ............................................... Gonococcal cystitis (acute). 

09812 ............................................... Gonococcal prostatitis (acute). 

09813 ............................................... Gonococcal epididymo-orchitis (acute). 

09814 ............................................... Gonococcal seminal vesiculitis (acute). 

09815 ............................................... Gonococcal cervicitis (acute). 

09816 ............................................... Gonococcal endometritis (acute). 

09817 ............................................... Gonococcal salpingitis, specified as acute. 

09819 ............................................... Other gonococcal infection (acute) of upper genitourinary tract. 

09840 ............................................... Gonococcal conjunctivitis (neonatorum). 

09841 ............................................... Gonococcal iridocyclitis. 

09842 ............................................... Gonococcal endophthalmia. 

09843 ............................................... Gonococcal keratitis. 

09849 ............................................... Other gonococcal infection of eye. 

09850 ............................................... Gonococcal arthritis. 

09851 ............................................... Gonococcal synovitis and tenosynovitis. 

09852 ............................................... Gonococcal bursitis. 

09853 ............................................... Gonococcal spondylitis. 

09859 ............................................... Other gonococcal infection of joint. 

09881 ............................................... Gonococcal keratosis (blennorrhagica). 

09885 ............................................... Other gonococcal heart disease. 

09886 ............................................... Gonococcal peritonitis. 

09889 ............................................... Gonococcal infection of other specified sites. 

09956 ............................................... Other venereal diseases due to chlamydia trachomatis, peritoneum. 

1000 ................................................. Leptospirosis icterohemorrhagica. 

10089 ............................................... Other specified leptospiral infections. 

1009 ................................................. Leptospirosis, unspecified. 

101 ................................................... Vincent’s angina. 

1120 ................................................. Candidiasis of mouth. 

1122 ................................................. Candidiasis of other urogenital sites. 

11282 ............................................... Candidal otitis externa. 

11284 ............................................... Candidal esophagitis. 

11285 ............................................... Candidal enteritis. 

11289 ............................................... Other candidiasis of other specified sites. 

1140 ................................................. Primary coccidioidomycosis (pulmonary). 

1141 ................................................. Primary extrapulmonary coccidioidomycosis. 

1143 ................................................. Other forms of progressive coccidioidomycosis. 

1144 ................................................. Chronic pulmonary coccidioidomycosis. 

1145 ................................................. Pulmonary coccidioidomycosis, unspecified. 

1149 ................................................. Coccidioidomycosis, unspecified. 

11502 ............................................... Histoplasma capsulatum retinitis. 

11509 ............................................... Infection by histoplasma capsulatum, with mention of other manifestation. 

11512 ............................................... Histoplasma duboisii retinitis. 

11519 ............................................... Infection by histoplasma duboisii with mention of other manifestation. 

11592 ............................................... Histoplasmosis retinitis, unspecified. 

1160 ................................................. Blastomycosis. 

1161 ................................................. Paracoccidioidomycosis. 

1173 ................................................. Aspergillosis. 

1174 ................................................. Mycotic mycetomas. 

1175 ................................................. Cryptococcosis. 

1176 ................................................. Allescheriosis (petriellidosis). 

1178 ................................................. Infection by dematiacious fungi, (phaehyphomycosis). 

1179 ................................................. Other and unspecified mycoses. 

118 ................................................... Opportunistic mycoses. 

1200 ................................................. Schistosomiasis due to schistosoma haematobium. 

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25024 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

1201 ................................................. Schistosomiasis due to schistosoma mansoni. 

1202 ................................................. Schistosomiasis due to schistosoma japonicum. 

1203 ................................................. Cutaneous schistosomiasis. 

1208 ................................................. Other specified schistosomiasis. 

1209 ................................................. Schistosomiasis, unspecified. 

1210 ................................................. Opisthorchiasis. 

1211 ................................................. Clonorchiasis. 

1212 ................................................. Paragonimiasis. 

1213 ................................................. Fascioliasis. 

1214 ................................................. Fasciolopsiasis. 

1215 ................................................. Metagonimiasis. 

1216 ................................................. Heterophyiasis. 

1218 ................................................. Other specified trematode infections. 

1220 ................................................. Echinococcus granulosus infection of liver. 

1221 ................................................. Echinococcus granulosus infection of lung. 

1222 ................................................. Echinococcus granulosus infection of thyroid. 

1223 ................................................. Echinococcus granulosus infection, other. 

1224 ................................................. Echinococcus granulosus infection, unspecified. 

1225 ................................................. Echinococcus multilocularis infection of liver. 

1226 ................................................. Echinococcus multilocularis infection, other. 

1227 ................................................. Echinococcus multilocularis infection, unspecified. 

1228 ................................................. Echinococcosis, unspecified, of liver. 

1229 ................................................. Echinococcosis, other and unspecified. 

1230 ................................................. Taenia solium infection, intestinal form. 

1231 ................................................. Cysticercosis. 

1232 ................................................. Taenia saginata infection. 

1233 ................................................. Taeniasis, unspecified. 

1234 ................................................. Diphyllobothriasis, intestinal. 

1235 ................................................. Sparganosis (larval diphyllobothriasis). 

1236 ................................................. Hymenolepiasis. 

1238 ................................................. Other specified cestode infection. 

124 ................................................... Trichinosis. 

1250 ................................................. Bancroftian filariasis. 

1251 ................................................. Malayan filariasis. 

1252 ................................................. Loiasis. 

1253 ................................................. Onchocerciasis. 

1254 ................................................. Dipetalonemiasis. 

1255 ................................................. Mansonella ozzardi infection. 

1256 ................................................. Other specified filariasis. 

1257 ................................................. Dracontiasis. 

1259 ................................................. Unspecified filariasis. 

1260 ................................................. Ancylostomiasis due to ancylostoma duodenale. 

1261 ................................................. Necatoriasis due to necator americanus. 

1262 ................................................. Ancylostomiasis due to ancylostoma braziliense. 

1263 ................................................. Ancylostomiasis due to ancylostoma ceylanicum. 

1268 ................................................. Other specified ancylostoma. 

1269 ................................................. Ancylostomiasis and necatoriasis, unspecified. 

1270 ................................................. Ascariasis. 

1271 ................................................. Anisakiasis. 

1272 ................................................. Strongyloidiasis. 

1273 ................................................. Trichuriasis. 

1274 ................................................. Enterobiasis. 

1275 ................................................. Capillariasis. 

1276 ................................................. Trichostrongyliasis. 

1277 ................................................. Other specified intestinal helminthiasis. 

1278 ................................................. Mixed intestinal helminthiasis. 

1279 ................................................. Intestinal helminthiasis, unspecified. 

1301 ................................................. Conjunctivitis due to toxoplasmosis. 

1302 ................................................. Chorioretinitis due to toxoplasmosis. 

1305 ................................................. Hepatitis due to toxoplasmosis. 

1307 ................................................. Toxoplasmosis of other specified sites. 

1309 ................................................. Toxoplasmosis, unspecified. 

1364 ................................................. Psorospermiasis. 

1365 ................................................. Sarcosporidiosis. 

1500 ................................................. Malignant neoplasm of cervical esophagus. 

1501 ................................................. Malignant neoplasm of thoracic esophagus. 

1502 ................................................. Malignant neoplasm of abdominal esophagus. 

1503 ................................................. Malignant neoplasm of upper third of esophagus. 

1504 ................................................. Malignant neoplasm of middle third of esophagus. 

1505 ................................................. Malignant neoplasm of lower third of esophagus. 

1508 ................................................. Malignant neoplasm of other specified part of esophagus. 

1509 ................................................. Malignant neoplasm of esophagus, unspecified site. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25025 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

1510 ................................................. Malignant neoplasm of cardia. 

1511 ................................................. Malignant neoplasm of pylorus. 

1512 ................................................. Malignant neoplasm of pyloric antrum. 

1513 ................................................. Malignant neoplasm of fundus of stomach. 

1514 ................................................. Malignant neoplasm of body of stomach. 

1515 ................................................. Malignant neoplasm of lesser curvature of stomach, unspecified. 

1516 ................................................. Malignant neoplasm of greater curvature of stomach, unspecified. 

1518 ................................................. Malignant neoplasm of other specified sites of stomach. 

1519 ................................................. Malignant neoplasm of stomach, unspecified site. 

1520 ................................................. Malignant neoplasm of duodenum. 

1521 ................................................. Malignant neoplasm of jejunum. 

1522 ................................................. Malignant neoplasm of ileum. 

1523 ................................................. Malignant neoplasm of meckel’s diverticulum. 

1528 ................................................. Malignant neoplasm of other specified sites of small intestine. 

1529 ................................................. Malignant neoplasm of small intestine, unspecified site. 

1530 ................................................. Malignant neoplasm of hepatic flexure. 

1531 ................................................. Malignant neoplasm of transverse colon. 

1532 ................................................. Malignant neoplasm of descending colon. 

1533 ................................................. Malignant neoplasm of sigmoid colon. 

1534 ................................................. Malignant neoplasm of cecum. 

1535 ................................................. Malignant neoplasm of appendix vermiformis. 

1536 ................................................. Malignant neoplasm of ascending colon. 

1537 ................................................. Malignant neoplasm of splenic flexure. 

1538 ................................................. Malignant neoplasm of other specified sites of large intestine. 

1539 ................................................. Malignant neoplasm of colon, unspecified site. 

1540 ................................................. Malignant neoplasm of rectosigmoid junction. 

1541 ................................................. Malignant neoplasm of rectum. 

1542 ................................................. Malignant neoplasm of anal canal. 

1543 ................................................. Malignant neoplasm of anus, unspecified site. 

1548 ................................................. Malignant neoplasm of other sites of rectum, rectosigmoid junction, and anus. 

1550 ................................................. Malignant neoplasm of liver, primary. 

1551 ................................................. Malignant neoplasm of intrahepatic bile ducts. 

1552 ................................................. Malignant neoplasm of liver, not specified as primary or secondary. 

1560 ................................................. Malignant neoplasm of gallbladder. 

1561 ................................................. Malignant neoplasm of extrahepatic bile ducts. 

1562 ................................................. Malignant neoplasm of ampulla of vater. 

1568 ................................................. Malignant neoplasm of other specified sites of gallbladder and extrahepatic bile ducts. 

1569 ................................................. Malignant neoplasm of biliary tract, part unspecified site. 

1570 ................................................. Malignant neoplasm of head of pancreas. 

1571 ................................................. Malignant neoplasm of body of pancreas. 

1572 ................................................. Malignant neoplasm of tail of pancreas. 

1573 ................................................. Malignant neoplasm of pancreatic duct. 

1574 ................................................. Malignant neoplasm of islets of langerhans. 

1578 ................................................. Malignant neoplasm of other specified sites of pancreas. 

1579 ................................................. Malignant neoplasm of pancreas, part unspecified. 

1580 ................................................. Malignant neoplasm of retroperitoneum. 

1588 ................................................. Malignant neoplasm of specified parts of peritoneum. 

1589 ................................................. Malignant neoplasm of peritoneum, unspecified. 

1620 ................................................. Malignant neoplasm of trachea. 

1622 ................................................. Malignant neoplasm of main bronchus. 

1623 ................................................. Malignant neoplasm of upper lobe, bronchus or lung. 

1624 ................................................. Malignant neoplasm of middle lobe, bronchus or lung. 

1625 ................................................. Malignant neoplasm of lower lobe, bronchus or lung. 

1628 ................................................. Malignant neoplasm of other parts of bronchus or lung. 

1629 ................................................. Malignant neoplasm of bronchus and lung, unspecified. 

1630 ................................................. Malignant neoplasm of parietal pleura. 

1631 ................................................. Malignant neoplasm of visceral pleura. 

1638 ................................................. Malignant neoplasm of other specified sites of pleura. 

1639 ................................................. Malignant neoplasm of pleura, unspecified. 

1640 ................................................. Malignant neoplasm of thymus. 

1641 ................................................. Malignant neoplasm of heart. 

1642 ................................................. Malignant neoplasm of anterior mediastinum. 

1643 ................................................. Malignant neoplasm of posterior mediastinum. 

1648 ................................................. Malignant neoplasm of other parts of mediastinum. 

1649 ................................................. Malignant neoplasm of mediastinum, part unspecified. 

1700 ................................................. Malignant neoplasm of bones of skull and face, except mandible. 

1701 ................................................. Malignant neoplasm of mandible. 

1702 ................................................. Malignant neoplasm of vertebral column, excluding sacrum and coccyx. 

1703 ................................................. Malignant neoplasm of ribs, sternum, and clavicle. 

1704 ................................................. Malignant neoplasm of scapula and long bones of upper limb. 

1705 ................................................. Malignant neoplasm of short bones of upper limb. 

1706 ................................................. Malignant neoplasm of pelvic bones, sacrum, and coccyx. 

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25026 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

1707 ................................................. Malignant neoplasm of long bones of lower limb. 

1708 ................................................. Malignant neoplasm of short bones of lower limb. 

1709 ................................................. Malignant neoplasm of bone and articular cartilage, site unspecified. 

1710 ................................................. Malignant neoplasm of connective and other soft tissue of head, face, and neck. 

1712 ................................................. Malignant neoplasm of connective and other soft tissue of upper limb, including shoulder. 

1713 ................................................. Malignant neoplasm of connective and other soft tissue of lower limb, including hip. 

1714 ................................................. Malignant neoplasm of connective and other soft tissue of thorax. 

1715 ................................................. Malignant neoplasm of connective and other soft tissue of abdomen. 

1716 ................................................. Malignant neoplasm of connective and other soft tissue of pelvis. 

1717 ................................................. Malignant neoplasm of connective and other soft tissue of trunk, unspecified. 

1718 ................................................. Malignant neoplasm of other specified sites of connective and other soft tissue. 

1719 ................................................. Malignant neoplasm of connective and other soft tissue, site unspecified. 

1760 ................................................. Kaposi’s sarcoma, skin. 

1761 ................................................. Kaposi’s sarcoma, soft tissue. 

1762 ................................................. Kaposi’s sarcoma, palate. 

1763 ................................................. Kaposi’s sarcoma, gastrointestinal sites. 

1764 ................................................. Kaposi’s sarcoma, lung. 

1765 ................................................. Kaposi’s sarcoma, lymph nodes. 

1768 ................................................. Kaposi’s sarcoma, other specified sites. 

1769 ................................................. Kaposi’s sarcoma, unspecified site. 

1830 ................................................. Malignant neoplasm of ovary. 

1890 ................................................. Malignant neoplasm of kidney, except pelvis. 

1891 ................................................. Malignant neoplasm of renal pelvis. 

1892 ................................................. Malignant neoplasm of ureter. 

1893 ................................................. Malignant neoplasm of urethra. 

1894 ................................................. Malignant neoplasm of paraurethral glands. 

1898 ................................................. Malignant neoplasm of other specified sites of urinary organs. 

1899 ................................................. Malignant neoplasm of urinary organ, site unspecified. 

1910 ................................................. Malignant neoplasm of cerebrum, except lobes and ventricles. 

1911 ................................................. Malignant neoplasm of frontal lobe. 

1912 ................................................. Malignant neoplasm of temporal lobe. 

1913 ................................................. Malignant neoplasm of parietal lobe. 

1914 ................................................. Malignant neoplasm of occipital lobe. 

1915 ................................................. Malignant neoplasm of ventricles. 

1916 ................................................. Malignant neoplasm of cerebellum nos. 

1917 ................................................. Malignant neoplasm of brain stem. 

1918 ................................................. Malignant neoplasm of other parts of brain. 

1919 ................................................. Malignant neoplasm of brain, unspecified site. 

1920 ................................................. Malignant neoplasm of cranial nerves. 

1921 ................................................. Malignant neoplasm of cerebral meninges. 

1922 ................................................. Malignant neoplasm of spinal cord. 

1923 ................................................. Malignant neoplasm of spinal meninges. 

1928 ................................................. Malignant neoplasm of other specified sites of nervous system. 

1929 ................................................. Malignant neoplasm of nervous system, part unspecified. 

1940 ................................................. Malignant neoplasm of adrenal gland. 

1941 ................................................. Malignant neoplasm of parathyroid gland. 

1943 ................................................. Malignant neoplasm of pituitary gland and craniopharyngeal duct. 

1944 ................................................. Malignant neoplasm of pineal gland. 

1945 ................................................. Malignant neoplasm of carotid body. 

1946 ................................................. Malignant neoplasm of aortic body and other paraganglia. 

1948 ................................................. Malignant neoplasm of other endocrine glands and related structures. 

1949 ................................................. Malignant neoplasm of endocrine gland, site unspecified. 

1960 ................................................. Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck. 

1961 ................................................. Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes.

1962 ................................................. Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes. 

1963 ................................................. Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb. 

1965 ................................................. Secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb. 

1966 ................................................. Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes. 

1968 ................................................. Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites. 

1969 ................................................. Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified. 

1970 ................................................. Secondary malignant neoplasm of lung. 

1971 ................................................. Secondary malignant neoplasm of mediastinum. 

1972 ................................................. Secondary malignant neoplasm of pleura. 

1973 ................................................. Secondary malignant neoplasm of other respiratory organs. 

1974 ................................................. Secondary malignant neoplasm of small intestine including duodenum. 

1975 ................................................. Secondary malignant neoplasm of large intestine and rectum. 

1976 ................................................. Secondary malignant neoplasm of retroperitoneum and peritoneum. 

1977 ................................................. Malignant neoplasm of liver, secondary. 

1978 ................................................. Secondary malignant neoplasm of other digestive organs and spleen. 

1980 ................................................. Secondary malignant neoplasm of kidney. 

1981 ................................................. Secondary malignant neoplasm of other urinary organs. 

1982 ................................................. Secondary malignant neoplasm of skin. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25027 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

1983 ................................................. Secondary malignant neoplasm of brain and spinal cord. 

1984 ................................................. Secondary malignant neoplasm of other parts of nervous system. 

1985 ................................................. Secondary malignant neoplasm of bone and bone marrow. 

1986 ................................................. Secondary malignant neoplasm of ovary. 

1987 ................................................. Secondary malignant neoplasm of adrenal gland. 

19881 ............................................... Secondary malignant neoplasm of breast. 

19882 ............................................... Secondary malignant neoplasm of genital organs. 

19889 ............................................... Secondary malignant neoplasm of other specified sites. 

1990 ................................................. Disseminated malignant neoplasm. 

20000 ............................................... Reticulosarcoma, unspecified site. 

20001 ............................................... Reticulosarcoma involving lymph nodes of head, face, and neck. 

20002 ............................................... Reticulosarcoma involving intrathoracic lymph nodes. 

20003 ............................................... Reticulosarcoma involving intra-abdominal lymph nodes. 

20004 ............................................... Reticulosarcoma involving lymph nodes of axilla and upper limb. 

20005 ............................................... Reticulosarcoma involving lymph nodes of inguinal region and lower limb. 

20006 ............................................... Reticulosarcoma involving intrapelvic lymph nodes. 

20007 ............................................... Reticulosarcoma involving spleen. 

20008 ............................................... Reticulosarcoma involving lymph nodes of multiple sites. 

20010 ............................................... Lymphosarcoma, unspecified site. 

20011 ............................................... Lymphosarcoma involving lymph nodes of head, face, and neck. 

20012 ............................................... Lymphosarcoma involving intrathoracic lymph nodes. 

20013 ............................................... Lymphosarcoma involving intra-abdominal lymph nodes. 

20014 ............................................... Lymphosarcoma involving lymph nodes of axilla and upper limb. 

20015 ............................................... Lymphosarcoma involving lymph nodes of inguinal region and lower limb. 

20016 ............................................... Lymphosarcoma involving intrapelvic lymph nodes. 

20017 ............................................... Lymphosarcoma involving spleen. 

20018 ............................................... Lymphosarcoma involving lymph nodes of multiple sites. 

20020 ............................................... Burkitt’s tumor or lymphoma, unspecified site. 

20021 ............................................... Burkitt’s tumor or lymphoma involving lymph nodes of head, face, and neck. 

20022 ............................................... Burkitt’s tumor or lymphoma involving intrathoracic lymph nodes. 

20023 ............................................... Burkitt’s tumor or lymphoma involving intra-abdominal lymph nodes. 

20024 ............................................... Burkitt’s tumor or lymphoma involving lymph nodes of axilla and upper limb.

20025 ............................................... Burkitt’s tumor or lymphoma involving lymph nodes of inguinal region and lower limb. 

20026 ............................................... Burkitt’s tumor or lymphoma involving intrapelvic lymph nodes. 

20027 ............................................... Burkitt’s tumor or lymphoma involving spleen. 

20028 ............................................... Burkitt’s tumor or lymphoma involving lymph nodes of multiple sites. 

20030 ............................................... Marginal zone lymphoma, unspecified site, extranodal and solid organ sites.

20031 ............................................... Marginal zone lymphoma, lymph nodes of head, face, and neck. 

20032 ............................................... Marginal zone lymphoma, intrathoracic lymph nodes. 

20033 ............................................... Marginal zone lymphoma, intraabdominal lymph nodes. 

20034 ............................................... Marginal zone lymphoma, lymph nodes of axilla and upper limb. 

20035 ............................................... Marginal zone lymphoma, lymph nodes of inguinal region and lower limb. 

20036 ............................................... Marginal zone lymphoma, intrapelvic lymph nodes. 

20037 ............................................... Marginal zone lymphoma, spleen. 

20038 ............................................... Marginal zone lymphoma, lymph nodes of multiple sites. 

20040 ............................................... Mantle cell lymphoma, unspecified site, extranodal and solid organ sites. 

20041 ............................................... Mantle cell lymphoma, lymph nodes of head, face, and neck. 

20042 ............................................... Mantle cell lymphoma, intrathoracic lymph nodes. 

20043 ............................................... Mantle cell lymphoma, intra-abdominal lymph nodes. 

20044 ............................................... Mantle cell lymphoma, lymph nodes of axilla and upper limb. 

20045 ............................................... Mantle cell lymphoma,lymph nodes of inguinal region and lower limb. 

20046 ............................................... Mantle cell lymphoma, intrapelvic lymph nodes. 

20047 ............................................... Mantle cell lymphoma, spleen. 

20048 ............................................... Mantle cell lymphoma, lymph nodes of multiple sites. 

20050 ............................................... Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sites. 

20051 ............................................... Primary central nervous system lymphoma, lymph nodes of head, face, and neck. 

20052 ............................................... Primary central nervous system lymphoma, intrathoracic lymph nodes. 

20053 ............................................... Primary central nervous system lymphoma, intra-abdominal lymph nodes. 

20054 ............................................... Primary central nervous system lymphoma, lymph nodes of axilla and upper limb. 

20055 ............................................... Primary central nervous system lymphoma, lymph nodes of inguinal region and lower limb. 

20056 ............................................... Primary central nervous system lymphoma, intrapelvic lymph nodes. 

20057 ............................................... Primary central nervous system lymphoma, spleen. 

20058 ............................................... Primary central nervous system lymphoma, lymph nodes of multiple sites. 

20060 ............................................... Anaplastic large cell lymphoma, unspecified site, extranodal and solid organ sites. 

20061 ............................................... Anaplastic large cell lymphoma, lymph nodes of head, face, and neck. 

20062 ............................................... Anaplastic large cell lymphoma, intrathoracic lymph nodes. 

20063 ............................................... Anaplastic large cell lymphoma, intra-abdominal lymph nodes. 

20064 ............................................... Anaplastic large cell lymphoma, lymph nodes of axilla and upper limb. 

20065 ............................................... Anaplastic large cell lymphoma, lymph nodes of inguinal region and lower limb. 

20066 ............................................... Anaplastic large cell lymphoma, intrapelvic lymph nodes. 

20067 ............................................... Anaplastic large cell lymphoma, spleen. 

20068 ............................................... Anaplastic large cell lymphoma, lymph nodes of multiple sites. 

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25028 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

20070 ............................................... Large cell lymphoma, unspecified site, extranodal and solid organ sites. 

20071 ............................................... Large cell lymphoma, lymph nodes of head, face, and neck. 

20072 ............................................... Large cell lymphoma, intrathoracic lymph nodes. 

20073 ............................................... Large cell lymphoma, intra-abdominal lymph nodes. 

20074 ............................................... Large cell lymphoma, lymph nodes of axilla and upper limb. 

20075 ............................................... Large cell lymphoma, lymph nodes of inguinal region and lower limb. 

20076 ............................................... Large cell lymphoma, intrapelvic lymph nodes. 

20077 ............................................... Large cell lymphoma, spleen. 

20078 ............................................... Large cell lymphoma, lymph nodes of multiple sites. 

20080 ............................................... Other named variants of lymphosarcoma and reticulosarcoma, unspecified site. 

20081 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of head, face, and neck. 

20082 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving intrathoracic lymph nodes. 

20083 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving intra-abdominal lymph nodes. 

20084 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of axilla and upper limb. 

20085 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of inguinal region and lower limb. 

20086 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving intrapelvic lymph nodes. 

20087 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving spleen.

20088 ............................................... Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of multiple sites. 

20100 ............................................... Hodgkin’s paragranuloma, unspecified site. 

20101 ............................................... Hodgkin’s paragranuloma involving lymph nodes of head, face, and neck. 

20102 ............................................... Hodgkin’s paragranuloma involving intrathoracic lymph nodes. 

20103 ............................................... Hodgkin’s paragranuloma involving intra-abdominal lymph nodes. 

20104 ............................................... Hodgkin’s paragranuloma involving lymph nodes of axilla and upper limb. 

20105 ............................................... Hodgkin’s paragranuloma involving lymph nodes of inguinal region and lower limb. 

20106 ............................................... Hodgkin’s paragranuloma involving intrapelvic lymph nodes. 

20107 ............................................... Hodgkin’s paragranuloma involving spleen. 

20108 ............................................... Hodgkin’s paragranuloma involving lymph nodes of multiple sites. 

20110 ............................................... Hodgkin’s granuloma, unspecified site. 

20111 ............................................... Hodgkin’s granuloma involving lymph nodes of head, face, and neck. 

20112 ............................................... Hodgkin’s granuloma involving intrathoracic lymph nodes. 

20113 ............................................... Hodgkin’s granuloma involving intra-abdominal lymph nodes. 

20114 ............................................... Hodgkin’s granuloma involving lymph nodes of axilla and upper limb. 

20115 ............................................... Hodgkin’s granuloma involving lymph nodes of inguinal region and lower limb. 

20116 ............................................... Hodgkin’s granuloma involving intrapelvic lymph nodes. 

20117 ............................................... Hodgkin’s granuloma involving spleen. 

20118 ............................................... Hodgkin’s granuloma involving lymph nodes of multiple sites. 

20120 ............................................... Hodgkin’s sarcoma, unspecified site. 

20121 ............................................... Hodgkin’s sarcoma involving lymph nodes of head, face, and neck. 

20122 ............................................... Hodgkin’s sarcoma involving intrathoracic lymph nodes. 

20123 ............................................... Hodgkin’s sarcoma involving intra-abdominal lymph nodes. 

20124 ............................................... Hodgkin’s sarcoma involving lymph nodes of axilla and upper limb. 

20125 ............................................... Hodgkin’s sarcoma involving lymph nodes of inguinal region and lower limb. 

20126 ............................................... Hodgkin’s sarcoma involving intrapelvic lymph nodes. 

20127 ............................................... Hodgkin’s sarcoma involving spleen. 

20128 ............................................... Hodgkin’s sarcoma involving lymph nodes of multiple sites. 

20140 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance, unspecified site. 

20141 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of head, face, and neck. 

20142 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving intrathoracic lymph nodes. 

20143 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving intra-abdominal lymph nodes. 

20144 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of axilla and upper limb. 

20145 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of inguinal region and lower limb. 

20146 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving intrapelvic lymph nodes. 

20147 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving spleen. 

20148 ............................................... Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of multiple sites. 

20150 ............................................... Hodgkin’s disease, nodular sclerosis, unspecified site. 

20151 ............................................... Hodgkin’s disease, nodular sclerosis, involving lymph nodes of head, face, and neck. 

20152 ............................................... Hodgkin’s disease, nodular sclerosis, involving intrathoracic lymph nodes. 

20153 ............................................... Hodgkin’s disease, nodular sclerosis, involving intra-abdominal lymph nodes. 

20154 ............................................... Hodgkin’s disease, nodular sclerosis, involving lymph nodes of axilla and upper limb. 

20155 ............................................... Hodgkin’s disease, nodular sclerosis, involving lymph nodes of inguinal region and lower limb. 

20156 ............................................... Hodgkin’s disease, nodular sclerosis, involving intrapelvic lymph nodes. 

20157 ............................................... Hodgkin’s disease, nodular sclerosis, involving spleen. 

20158 ............................................... Hodgkin’s disease, nodular sclerosis, involving lymph nodes of multiple sites. 

20160 ............................................... Hodgkin’s disease, mixed cellularity, unspecified site. 

20161 ............................................... Hodgkin’s disease, mixed cellularity, involving lymph nodes of head, face, and neck. 

20162 ............................................... Hodgkin’s disease, mixed cellularity, involving intrathoracic lymph nodes. 

20163 ............................................... Hodgkin’s disease, mixed cellularity, involving intra-abdominal lymph nodes. 

20164 ............................................... Hodgkin’s disease, mixed cellularity, involving lymph nodes of axilla and upper limb. 

20165 ............................................... Hodgkin’s disease, mixed cellularity, involving lymph nodes of inguinal region and lower limb. 

20166 ............................................... Hodgkin’s disease, mixed cellularity, involving intrapelvic lymph nodes. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25029 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

20167 ............................................... Hodgkin’s disease, mixed cellularity, involving spleen. 

20168 ............................................... Hodgkin’s disease, mixed cellularity, involving lymph nodes of multiple sites. 

20170 ............................................... Hodgkin’s disease, lymphocytic depletion, unspecified site. 

20171 ............................................... Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of head, face, and neck. 

20172 ............................................... Hodgkin’s disease, lymphocytic depletion, involving intrathoracic lymph nodes. 

20173 ............................................... Hodgkin’s disease, lymphocytic depletion, involving intra-abdominal lymph nodes. 

20174 ............................................... Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of axilla and upper limb. 

20175 ............................................... Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of inguinal region and lower limb. 

20176 ............................................... Hodgkin’s disease, lymphocytic depletion, involving intrapelvic lymph nodes. 

20177 ............................................... Hodgkin’s disease, lymphocytic depletion, involving spleen. 

20178 ............................................... Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of multiple sites. 

20190 ............................................... Hodgkin’s disease, unspecified type, unspecified site. 

20191 ............................................... Hodgkin’s disease, unspecified type, involving lymph nodes of head, face, and neck. 

20192 ............................................... Hodgkin’s disease, unspecified type, involving intrathoracic lymph nodes. 

20193 ............................................... Hodgkin’s disease, unspecified type, involving intra-abdominal lymph nodes.

20194 ............................................... Hodgkin’s disease, unspecified type, involving lymph nodes of axilla and upper limb. 

20195 ............................................... Hodgkin’s disease, unspecified type, involving lymph nodes of inguinal region and lower limb. 

20196 ............................................... Hodgkin’s disease, unspecified type, involving intrapelvic lymph nodes. 

20197 ............................................... Hodgkin’s disease, unspecified type, involving spleen. 

20198 ............................................... Hodgkin’s disease, unspecified type, involving lymph nodes of multiple sites. 

20200 ............................................... Nodular lymphoma, unspecified site. 

20201 ............................................... Nodular lymphoma involving lymph nodes of head, face, and neck. 

20202 ............................................... Nodular lymphoma involving intrathoracic lymph nodes. 

20203 ............................................... Nodular lymphoma involving intra-abdominal lymph nodes. 

20204 ............................................... Nodular lymphoma involving lymph nodes of axilla and upper limb. 

20205 ............................................... Nodular lymphoma involving lymph nodes of inguinal region and lower limb. 

20206 ............................................... Nodular lymphoma involving intrapelvic lymph nodes. 

20207 ............................................... Nodular lymphoma involving spleen. 

20208 ............................................... Nodular lymphoma involving lymph nodes of multiple sites. 

20210 ............................................... Mycosis fungoides, unspecified site. 

20211 ............................................... Mycosis fungoides involving lymph nodes of head, face, and neck. 

20212 ............................................... Mycosis fungoides involving intrathoracic lymph nodes. 

20213 ............................................... Mycosis fungoides involving intra-abdominal lymph nodes. 

20214 ............................................... Mycosis fungoides involving lymph nodes of axilla and upper limb. 

20215 ............................................... Mycosis fungoides involving lymph nodes of inguinal region and lower limb. 

20216 ............................................... Mycosis fungoides involving intrapelvic lymph nodes. 

20217 ............................................... Mycosis fungoides involving spleen. 

20218 ............................................... Mycosis fungoides involving lymph nodes of multiple sites. 

20220 ............................................... Sezary’s disease, unspecified site. 

20221 ............................................... Sezary’s disease involving lymph nodes of head, face, and neck. 

20222 ............................................... Sezary’s disease involving intrathoracic lymph nodes. 

20223 ............................................... Sezary’s disease involving intra-abdominal lymph nodes. 

20224 ............................................... Sezary’s disease involving lymph nodes of axilla and upper limb. 

20225 ............................................... Sezary’s disease involving lymph nodes of inguinal region and lower limb. 

20226 ............................................... Sezary’s disease involving intrapelvic lymph nodes. 

20227 ............................................... Sezary’s disease involving spleen. 

20228 ............................................... Sezary’s disease involving lymph nodes of multiple sites. 

20230 ............................................... Malignant histiocytosis, unspecified site. 

20231 ............................................... Malignant histiocytosis involving lymph nodes of head, face, and neck. 

20232 ............................................... Malignant histiocytosis involving intrathoracic lymph nodes. 

20233 ............................................... Malignant histiocytosis involving intra-abdominal lymph nodes. 

20234 ............................................... Malignant histiocytosis involving lymph nodes of axilla and upper limb. 

20235 ............................................... Malignant histiocytosis involving lymph nodes of inguinal region and lower limb. 

20236 ............................................... Malignant histiocytosis involving intrapelvic lymph nodes. 

20237 ............................................... Malignant histiocytosis involving spleen. 

20238 ............................................... Malignant histiocytosis involving lymph nodes of multiple sites. 

20240 ............................................... Leukemic reticuloendotheliosis, unspecified site. 

20241 ............................................... Leukemic reticuloendotheliosis involving lymph nodes of head, face, and neck. 

20242 ............................................... Leukemic reticuloendotheliosis involving intrathoracic lymph nodes. 

20243 ............................................... Leukemic reticuloendotheliosis involving intra-abdominal lymph nodes. 

20244 ............................................... Leukemic reticuloendotheliosis involving lymph nodes of axilla and upper arm. 

20245 ............................................... Leukemic reticuloendotheliosis involving lymph nodes of inguinal region and lower limb. 

20246 ............................................... Leukemic reticuloendotheliosis involving intrapelvic lymph nodes. 

20247 ............................................... Leukemic reticuloendotheliosis involving spleen. 

20248 ............................................... Leukemic reticuloendotheliosis involving lymph nodes of multipes sites. 

20250 ............................................... Letterer-siwe disease, unspecified site. 

20251 ............................................... Letterer-siwe disease involving lymph nodes of head, face, and neck. 

20252 ............................................... Letterer-siwe disease involving intrathoracic lymph nodes. 

20253 ............................................... Letterer-siwe disease involving intra-abdominal lymph nodes. 

20254 ............................................... Letterer-siwe disease involving lymph nodes of axilla and upper limb. 

20255 ............................................... Letterer-siwe disease involving lymph nodes of inguinal region and lower limb. 

20256 ............................................... Letterer-siwe disease involving intrapelvic lymph nodes. 

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25030 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

20257 ............................................... Letterer-siwe disease involving spleen. 

20258 ............................................... Letterer-siwe disease involving lymph nodes of multiple sites. 

20260 ............................................... Malignant mast cell tumors, unspecified site. 

20261 ............................................... Malignant mast cell tumors involving lymph nodes of head, face, and neck. 

20262 ............................................... Malignant mast cell tumors involving intrathoracic lymph nodes. 

20263 ............................................... Malignant mast cell tumors involving intra-abdominal lymph nodes. 

20264 ............................................... Malignant mast cell tumors involving lymph nodes of axilla and upper limb. 

20265 ............................................... Malignant mast cell tumors involving lymph nodes of inguinal region and lower limb. 

20266 ............................................... Malignant mast cell tumors involving intrapelvic lymph nodes. 

20267 ............................................... Malignant mast cell tumors involving spleen. 

20268 ............................................... Malignant mast cell tumors involving lymph nodes of multiple sites. 

20270 ............................................... Peripheral T cell lymphoma, unspecified site, extranodal and solid organ sites. 

20271 ............................................... Peripheral T cell lymphoma, lymph nodes of head, face, and neck. 

20272 ............................................... Peripheral T cell lymphoma, intrathoracic lymph nodes. 

20273 ............................................... Peripheral T cell lymphoma, intra-abdominal lymph nodes. 

20274 ............................................... Peripheral T cell lymphoma, lymph nodes of axilla and upper limb. 

20275 ............................................... Peripheral T cell lymphoma, lymph nodes of inguinal region and lower limb. 

20276 ............................................... Peripheral T cell lymphoma, intrapelvic lymph nodes. 

20277 ............................................... Peripheral T cell lymphoma, spleen. 

20278 ............................................... Peripheral T cell lymphoma, lymph nodes of multiple sites. 

20280 ............................................... Other malignant lymphomas, unspecified site. 

20281 ............................................... Other malignant lymphomas involving lymph nodes of head, face, and neck. 

20282 ............................................... Other malignant lymphomas involving intrathoracic lymph nodes. 

20283 ............................................... Other malignant lymphomas involving intra-abdominal lymph nodes. 

20284 ............................................... Other malignant lymphomas involving lymph nodes of axilla and upper limb. 

20285 ............................................... Other malignant lymphomas involving lymph nodes of inguinal region and lower limb. 

20286 ............................................... Other malignant lymphomas involving intrapelvic lymph nodes. 

20287 ............................................... Other malignant lymphomas involving spleen. 

20288 ............................................... Other malignant lymphomas involving lymph nodes of multiple sites. 

290 ................................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue, unspecified site. 

20291 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of head, face, and neck. 

20292 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving intrathoracic lymph nodes. 

20293 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving intra-abdominal lymph nodes. 

20294 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of axilla and upper limb. 

20295 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of inguinal region and 

lower limb. 

20296 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving intrapelvic lymph nodes. 

20297 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving spleen. 

20298 ............................................... Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of multiple sites. 

20300 ............................................... Multiple myeloma, without mention of remission. 

20301 ............................................... Multiple myeloma, in remission. 

20310 ............................................... Plasma cell leukemia, without mention of remission. 

20311 ............................................... Plasma cell leukemia, in remission. 

20380 ............................................... Other immunoproliferative neoplasms, without mention of remission. 

20381 ............................................... Other immunoproliferative neoplasms, in remission. 

20400 ............................................... Lymphoid leukemia, acute, without mention of remission. 

20401 ............................................... Lymphoid leukemia, acute, in remission. 

20410 ............................................... Lymphoid leukemia, chronic, without mention of remission. 

20411 ............................................... Lymphoid leukemia, chronic, in remission. 

20420 ............................................... Lymphoid leukemia, subacute, without mention of remission. 

20421 ............................................... Lymphoid leukemia, subacute, in remission. 

20480 ............................................... Other lymphoid leukemia, without mention of remission. 

20481 ............................................... Other lymphoid leukemia, in remission. 

20490 ............................................... Unspecified lymphoid leukemia, without mention of remission. 

20491 ............................................... Unspecified lymphoid leukemia, in remission. 

20500 ............................................... Myeloid leukemia, acute, without mention of remission. 

20501 ............................................... Myeloid leukemia, acute, in remission. 

20510 ............................................... Myeloid leukemia, chronic, without mention of remission. 

20511 ............................................... Myeloid leukemia, chronic, in remission. 

20520 ............................................... Myeloid leukemia, subacute, without mention of remission. 

20521 ............................................... Myeloid leukemia, subacute, in remission. 

20530 ............................................... Myeloid sarcoma, without mention of remission. 

20531 ............................................... Myeloid sarcoma, in remission. 

20580 ............................................... Other myeloid leukemia, without mention of remission. 

20581 ............................................... Other myeloid leukemia, in remission. 

20590 ............................................... Unspecified myeloid leukemia, without mention of remission. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25031 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

20591 ............................................... Unspecified myeloid leukemia, in remission. 

20600 ............................................... Monocytic leukemia, acute, without mention of remission. 

20601 ............................................... Monocytic leukemia, acute, in remission. 

20610 ............................................... Monocytic leukemia, chronic without mention of remission. 

20611 ............................................... Monocytic leukemia, chronic, in remission. 

20620 ............................................... Monocytic leukemia, subacute, without mention of remission. 

20621 ............................................... Monocytic leukemia, subacute, in remission. 

20680 ............................................... Other monocytic leukemia, without mention of remission. 

20681 ............................................... Other monocytic leukemia, in remission. 

20690 ............................................... Unspecified monocytic leukemia, without mention of remission. 

20691 ............................................... Unspecified monocytic leukemia, in remission. 

20700 ............................................... Acute erythremia and erythroleukemia, without mention of remission. 

20701 ............................................... Acute erythremia and erythroleukemia, in remission. 

20710 ............................................... Chronic erythremia, without mention of remission. 

20711 ............................................... Chronic erythremia, in remission. 

20720 ............................................... Megakaryocytic leukemia, without mention of remission. 

20721 ............................................... Megakaryocytic leukemia, in remission. 

20780 ............................................... Other specified leukemia, without mention of remission. 

20781 ............................................... Other specified leukemia, in remission. 

20800 ............................................... Leukemia of unspecified cell type, acute, without mention of remission. 

20801 ............................................... Leukemia of unspecified cell type, acute, in remission. 

20810 ............................................... Leukemia of unspecified cell type, chronic, without mention of remission. 

20811 ............................................... Leukemia of unspecified cell type, chronic, in remission. 

20820 ............................................... Leukemia of unspecified cell type, subacute, without mention of remission. 

20821 ............................................... Leukemia of unspecified cell type, subacute, in remission. 

20880 ............................................... Other leukemia of unspecified cell type, without mention of remission. 

20881 ............................................... Other leukemia of unspecified cell type, in remission. 

20890 ............................................... Unspecified leukemia, without mention of remission. 

20891 ............................................... Unspecified leukemia, in remission. 

2385 ................................................. Neoplasm of uncertain behavior of histiocytic and mast cells. 

2386 ................................................. Neoplasm of uncertain behavior of plasma cells. 

23873 ............................................... High grade myelodysplastic syndrome lesions. 

23874 ............................................... Myelodysplastic syndrome with 5q deletion. 

23876 ............................................... Myelofibrosis with myeloid metaplasia. 

23879 ............................................... Other lymphatic and hematopoietic tissues. 

2450 ................................................. Acute thyroiditis. 

2463 ................................................. Hemorrhage and infarction of thyroid. 

2510 ................................................. Hypoglycemic coma. 

2513 ................................................. Postsurgical hypoinsulinemia. 

2531 ................................................. Other and unspecified anterior pituitary hyperfunction. 

2532 ................................................. Panhypopituitarism. 

2535 ................................................. Diabetes insipidus. 

2536 ................................................. Other disorders of neurohypophysis. 

2541 ................................................. Abscess of thymus. 

2550 ................................................. Cushing’s syndrome. 

2553 ................................................. Other corticoadrenal overactivity. 

25541 ............................................... Glucocorticoid deficiency. 

25542 ............................................... Mineralocorticoid deficiency. 

2555 ................................................. Other adrenal hypofunction. 

2556 ................................................. Medulloadrenal hyperfunction. 

2592 ................................................. Carcinoid syndrome. 

2632 ................................................. Arrested development following protein-calorie malnutrition. 

2638 ................................................. Other protein-calorie malnutrition. 

2639 ................................................. Unspecified protein-calorie malnutrition. 

2650 ................................................. Beriberi. 

2651 ................................................. Other and unspecified manifestations of thiamine deficiency. 

2660 ................................................. Ariboflavinosis. 

2680 ................................................. Rickets, active. 

2700 ................................................. Disturbances of amino-acid transport. 

2701 ................................................. Phenylketonuria (PKU). 

2702 ................................................. Other disturbances of aromatic amino-acid metabolism. 

2703 ................................................. Disturbances of branched-chain amino-acid metabolism. 

2704 ................................................. Disturbances of sulphur-bearing amino-acid metabolism. 

2705 ................................................. Disturbances of histidine metabolism. 

2706 ................................................. Disorders of urea cycle metabolism. 

2707 ................................................. Other disturbances of straight-chain amino-acid metabolism. 

2708 ................................................. Other specified disorders of amino-acid metabolism. 

2709 ................................................. Unspecified disorder of amino-acid metabolism. 

2710 ................................................. Glycogenosis. 

2711 ................................................. Galactosemia. 

2718 ................................................. Other specified disorders of carbohydrate transport and metabolism. 

27411 ............................................... Uric acid nephrolithiasis. 

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25032 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

2760 ................................................. Hyperosmolality and/or hypernatremia. 

2761 ................................................. Hyposmolality and/or hyponatremia. 

2762 ................................................. Acidosis. 

2763 ................................................. Alkalosis. 

2764 ................................................. Mixed acid-base balance disorder. 

27700 ............................................... Cystic fibrosis without mention of meconium ileus. 

27703 ............................................... Cystic fibrosis with gastrointestinal manifestations. 

27709 ............................................... Cystic fibrosis with other manifestations. 

2771 ................................................. Disorders of porphyrin metabolism. 

2772 ................................................. Other disorders of purine and pyrimidine metabolism. 

27730 ............................................... Amyloidosis, unspecified. 

27731 ............................................... Familial Mediterranean fever. 

27739 ............................................... Other amyloidosis. 

2775 ................................................. Mucopolysaccharidosis. 

27785 ............................................... Disorders of fatty acid oxidation. 

27786 ............................................... Peroxisomal disorders. 

27787 ............................................... Disorders of mitochondrial metabolism. 

27789 ............................................... Other specified disorders of metabolism. 

27900 ............................................... Hypogammaglobulinemia, unspecified. 

27901 ............................................... Selective iga immunodeficiency. 

27902 ............................................... Selective igm immunodeficiency. 

27903 ............................................... Other selective immunoglobulin deficiencies. 

27904 ............................................... Congenital hypogammaglobulinemia. 

27905 ............................................... Immunodeficiency with increased igm. 

27906 ............................................... Common variable immunodeficiency. 

27909 ............................................... Other deficiency of humoral immunity. 

27910 ............................................... Immunodeficiency with predominant T-cell defect, unspecified. 

27911 ............................................... Digeorge’s syndrome. 

27912 ............................................... Wiskott-aldrich syndrome. 

27913 ............................................... Nezelof’s syndrome. 

27919 ............................................... Other deficiency of cell-mediated immunity. 

2792 ................................................. Combined immunity deficiency. 

2793 ................................................. Unspecified immunity deficiency. 

2828 ................................................. Other specified hereditary hemolytic anemias. 

2829 ................................................. Hereditary hemolytic anemia, unspecified. 

2830 ................................................. Autoimmune hemolytic anemias. 

28310 ............................................... Non-autoimmune hemolytic anemia, unspecified. 

28319 ............................................... Other non-autoimmune hemolytic anemias. 

2839 ................................................. Acquired hemolytic anemia, unspecified. 

28401 ............................................... Constitutional red blood cell aplasia. 

28409 ............................................... Other constitutional aplastic anemia. 

2841 ................................................. Pancytopenia. 

2842 ................................................. Myelophthisis. 

2849 ................................................. Aplastic anemia, unspecified. 

2862 ................................................. Congenital factor xi deficiency. 

2863 ................................................. Congenital deficiency of other clotting factors. 

2864 ................................................. Von willebrand’s disease. 

2865 ................................................. Hemorrhagic disorder due to intrinsic circulating anticoagulants. 

2867 ................................................. Acquired coagulation factor deficiency. 

2869 ................................................. Other and unspecified coagulation defects. 

2870 ................................................. Allergic purpura. 

28731 ............................................... Immune thrombocytopenic purpura. 

28732 ............................................... Evans’ syndrome. 

28733 ............................................... Congenital and hereditary thrombocytopenic purpura. 

2884 ................................................. Hemophagocytic syndromes. 

2897 ................................................. Methemoglobinemia. 

28981 ............................................... Primary hypercoagulable state. 

28982 ............................................... Secondary hypercoagulable state. 

28983 ............................................... Myelofibrosis. 

29011 ............................................... Presenile dementia with delirium. 

29012 ............................................... Presenile dementia with delusional features. 

29013 ............................................... Presenile dementia with depressive features. 

29020 ............................................... Senile dementia with delusional features. 

29021 ............................................... Senile dementia with depressive features. 

2903 ................................................. Senile dementia with delirium. 

29041 ............................................... Vascular dementia, with delirium. 

29042 ............................................... Vascular dementia, with delusions. 

29043 ............................................... Vascular dementia, with depressed mood. 

2908 ................................................. Other specified senile psychotic conditions. 

2909 ................................................. Unspecified senile psychotic condition. 

2910 ................................................. Alcohol withdrawal delirium. 

2912 ................................................. Alcohol-induced persisting dementia. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25033 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

2913 ................................................. Alcohol-induced psychotic disorder with hallucinations. 

29181 ............................................... Alcohol withdrawal. 

29189 ............................................... Other alcohol-induced mental disorders. 

2919 ................................................. Unspecified alcohol-induced mental disorders. 

2920 ................................................. Drug withdrawal. 

29211 ............................................... Drug-induced psychotic disorder with delusions. 

29212 ............................................... Drug-induced psychotic disorder with hallucinations. 

29281 ............................................... Drug-induced delirium. 

29282 ............................................... Drug-induced persisting dementia. 

2930 ................................................. Delirium due to conditions classified elsewhere. 

2931 ................................................. Subacute delirium. 

29381 ............................................... Psychotic disorder with delusions in conditions classified elsewhere. 

29382 ............................................... Psychotic disorder with hallucinations in conditions classified elsewhere. 

2939 ................................................. Unspecified transient mental disorder in conditions classified elsewhere. 

29411 ............................................... Dementia in conditions classified elsewhere with behavioral disturbance. 

29500 ............................................... Simple type schizophrenia, unspecified state. 

29501 ............................................... Simple type schizophrenia, subchronic state. 

29502 ............................................... Simple type schizophrenia, chronic state. 

29503 ............................................... Simple type schizophrenia, subchronic state with acute exacerbation. 

29504 ............................................... Simple type schizophrenia, chronic state with acute exacerbation. 

29510 ............................................... Disorganized type schizophrenia, unspecified state. 

29511 ............................................... Disorganized type schizophrenia, subchronic state. 

29512 ............................................... Disorganized type schizophrenia, chronic state. 

29513 ............................................... Disorganized type schizophrenia, subchronic state with acute exacerbation. 

29514 ............................................... Disorganized type schizophrenia, chronic state with acute exacerbation. 

29520 ............................................... Catatonic type schizophrenia, unspecified state. 

29521 ............................................... Catatonic type schizophrenia, subchronic state. 

29522 ............................................... Catatonic type schizophrenia, chronic state. 

29523 ............................................... Catatonic type schizophrenia, subchronic state with acute exacerbation. 

29524 ............................................... Catatonic type schizophrenia, chronic state with acute exacerbation. 

29530 ............................................... Paranoid type schizophrenia, unspecified state. 

29531 ............................................... Paranoid type schizophrenia, subchronic state. 

29532 ............................................... Paranoid type schizophrenia, chronic state. 

29533 ............................................... Paranoid type schizophrenia, subchronic state with acute exacerbation. 

29534 ............................................... Paranoid type schizophrenia, chronic state with acute exacerbation. 

29540 ............................................... Schizophreniform disorder, unspecified. 

29541 ............................................... Schizophreniform disorder, subchronic. 

29542 ............................................... Schizophreniform disorder, chronic. 

29543 ............................................... Schizophreniform disorder, subchronic with acute exacerbation. 

29544 ............................................... Schizophreniform disorder, chronic with acute exacerbation. 

29553 ............................................... Latent schizophrenia, subchronic state with acute exacerbation. 

29554 ............................................... Latent schizophrenia, chronic state with acute exacerbation. 

29560 ............................................... Schizophrenic disorders, residual type, unspecified. 

29561 ............................................... Schizophrenic disorders, residual type, subchronic. 

29562 ............................................... Schizophrenic disorders, residual type, chronic. 

29563 ............................................... Schizophrenic disorders, residual type, subchronic with acute exacerbation.

29564 ............................................... Schizophrenic disorders, residual type, chronic with acute exacerbation. 

29571 ............................................... Schizoaffective disorder, subchronic. 

29572 ............................................... Schizoaffective disorder, chronic. 

29573 ............................................... Schizoaffective disorder, subchronic with acute exacerbation. 

29574 ............................................... Schizoaffective disorder, chronic with acute exacerbation. 

29580 ............................................... Other specified types of schizophrenia, unspecified state. 

29581 ............................................... Other specified types of schizophrenia, subchronic state. 

29582 ............................................... Other specified types of schizophrenia, chronic state. 

29583 ............................................... Other specified types of schizophrenia, subchronic state with acute exacerbation. 

29584 ............................................... Other specified types of schizophrenia, chronic state with acute exacerbation. 

29591 ............................................... Unspecified type schizophrenia, subchronic state. 

29592 ............................................... Unspecified type schizophrenia, chronic state. 

29593 ............................................... Unspecified type schizophrenia, subchronic state with acute exacerbation. 

29594 ............................................... Unspecified type schizophrenia, chronic state with acute exacerbation. 

29600 ............................................... Bipolar I disorder, single manic episode, unspecified. 

29601 ............................................... Bipolar I disorder, single manic episode, mild. 

29602 ............................................... Bipolar I disorder, single manic episode, moderate. 

29603 ............................................... Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior. 

29604 ............................................... Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior. 

29610 ............................................... Manic affective disorder, recurrent episode, unspecified degree. 

29611 ............................................... Manic affective disorder, recurrent episode, mild degree. 

29612 ............................................... Manic affective disorder, recurrent episode, moderate degree. 

29613 ............................................... Manic affective disorder, recurrent episode, severe degree, without mention of psychotic behavior. 

29614 ............................................... Manic affective disorder, recurrent episode, severe degree, specified as with psychotic behavior. 

29620 ............................................... Major depressive affective disorder, single episode, unspecified degree. 

29621 ............................................... Major depressive affective disorder, single episode, mild degree. 

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25034 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

29622 ............................................... Major depressive affective disorder, single episode, moderate degree. 

29623 ............................................... Major depressive affective disorder, single episode, severe degree, without mention of psychotic behavior. 

29624 ............................................... Major depressive affective disorder, single episode, severe degree, specified as with psychotic behavior. 

29630 ............................................... Major depressive affective disorder, recurrent episode, unspecified degree.

29631 ............................................... Major depressive affective disorder, recurrent episode, mild degree. 

29632 ............................................... Major depressive affective disorder, recurrent episode, moderate degree. 

29633 ............................................... Major depressive affective disorder, recurrent episode, severe degree, without mention of psychotic behavior. 

29634 ............................................... Major depressive affective disorder, recurrent episode, severe degree, specified as with psychotic behavior. 

29640 ............................................... Bipolar I disorder, most recent episode (or current) manic, unspecified. 

29641 ............................................... Bipolar I disorder, most recent episode (or current) manic, mild. 

29642 ............................................... Bipolar I disorder, most recent episode (or current) manic, moderate. 

29643 ............................................... Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior. 

29644 ............................................... Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior. 

29650 ............................................... Bipolar I disorder, most recent episode (or current) depressed, unspecified. 

29651 ............................................... Bipolar I disorder, most recent episode (or current) depressed, mild. 

29652 ............................................... Bipolar I disorder, most recent episode (or current) depressed, moderate. 

29653 ............................................... Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior. 

29654 ............................................... Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior. 

29660 ............................................... Bipolar I disorder, most recent episode (or current) mixed, unspecified. 

29661 ............................................... Bipolar I disorder, most recent episode (or current) mixed, mild. 

29662 ............................................... Bipolar I disorder, most recent episode (or current) mixed, moderate. 

29663 ............................................... Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior. 

29664 ............................................... Bipolar I disorder, most recent episode (or current) mixed, severe, specified as with psychotic behavior. 

29689 ............................................... Other and unspecified bipolar disorders, other. 

29699 ............................................... Other specified episodic mood disorder. 

2980 ................................................. Depressive type psychosis. 

2981 ................................................. Excitative type psychosis. 

2983 ................................................. Acute paranoid reaction. 

2984 ................................................. Psychogenic paranoid psychosis. 

29900 ............................................... Autistic disorder, current or active state. 

29901 ............................................... Autistic disorder, residual state. 

29910 ............................................... Childhood disintegrative disorder, current or active state. 

29911 ............................................... Childhood disintegrative disorder, residual state. 

29980 ............................................... Other specified pervasive developmental disorders, current or active state.

29981 ............................................... Other specified pervasive developmental disorders, residual state. 

29990 ............................................... Unspecified pervasive developmental disorder, current or active state. 

29991 ............................................... Unspecified pervasive developmental disorder, residual state. 

30151 ............................................... Chronic factitious illness with physical symptoms. 

30401 ............................................... Opioid type dependence, continuous use. 

30411 ............................................... Sedative, hypnotic or anxiolytic dependence, continuous. 

30421 ............................................... Cocaine dependence, continuous use. 

30441 ............................................... Amphetamine and other psychostimulant dependence, continuous use. 

30451 ............................................... Hallucinogen dependence, continuous use. 

30461 ............................................... Other specified drug dependence, continuous use. 

30471 ............................................... Combinations of opioid type drug with any other drug dependence, continuous use. 

30481 ............................................... Combinations of drug dependence excluding opioid type drug, continuous use.

30491 ............................................... Unspecified drug dependence, continuous use. 

3071 ................................................. Anorexia nervosa. 

30751 ............................................... Bulimia nervosa. 

3181 ................................................. Severe mental retardation. 

3182 ................................................. Profound mental retardation. 

3222 ................................................. Chronic meningitis. 

3300 ................................................. Leukodystrophy. 

3301 ................................................. Cerebral lipidoses. 

3302 ................................................. Cerebral degeneration in generalized lipidoses. 

3303 ................................................. Cerebral degeneration of childhood in other diseases classified elsewhere.

3308 ................................................. Other specified cerebral degenerations in childhood. 

3309 ................................................. Unspecified cerebral degeneration in childhood. 

3313 ................................................. Communicating hydrocephalus. 

3314 ................................................. Obstructive hydrocephalus. 

3315 ................................................. Idiopathic normal pressure hydrocephalus (INPH). 

3321 ................................................. Secondary parkinsonism. 

3330 ................................................. Other degenerative diseases of the basal ganglia. 

3334 ................................................. Huntington’s chorea. 

33371 ............................................... Athetoid cerebral palsy. 

33372 ............................................... Acute dystonia due to drugs. 

33379 ............................................... Other acquired torsion dystonia. 

33390 ............................................... Unspecified extrapyramidal disease and abnormal movement disorder. 

33391 ............................................... Stiff-man syndrome. 

3340 ................................................. Friedreich’s ataxia. 

3341 ................................................. Hereditary spastic paraplegia. 

3342 ................................................. Primary cerebellar degeneration. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25035 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

3343 ................................................. Other cerebellar ataxia. 

3344 ................................................. Cerebellar ataxia in diseases classified elsewhere. 

3348 ................................................. Other spinocerebellar diseases. 

3349 ................................................. Spinocerebellar disease, unspecified. 

3350 ................................................. Werdnig-hoffmann disease. 

33510 ............................................... Spinal muscular atrophy, unspecified. 

33511 ............................................... Kugelberg-welander disease. 

33519 ............................................... Other spinal muscular atrophy. 

33520 ............................................... Amyotrophic lateral sclerosis. 

33521 ............................................... Progressive muscular atrophy. 

33522 ............................................... Progressive bulbar palsy. 

33523 ............................................... Pseudobulbar palsy. 

33524 ............................................... Primary lateral sclerosis. 

33529 ............................................... Other motor neuron diseases. 

3358 ................................................. Other anterior horn cell diseases. 

3359 ................................................. Anterior horn cell disease, unspecified. 

3360 ................................................. Syringomyelia and syringobulbia. 

3362 ................................................. Subacute combined degeneration of spinal cord in diseases classified elsewhere. 

3363 ................................................. Myelopathy in other diseases classified elsewhere. 

3368 ................................................. Other myelopathy. 

3369 ................................................. Unspecified disease of spinal cord. 

3370 ................................................. Idiopathic peripheral autonomic neuropathy. 

3371 ................................................. Peripheral autonomic neuropathy in disorders classified elsewhere. 

33720 ............................................... Reflex sympathetic dystrophy, unspecified. 

33721 ............................................... Reflex sympathetic dystrophy of the upper limb. 

33722 ............................................... Reflex sympathetic dystrophy of the lower limb. 

33729 ............................................... Reflex sympathetic dystrophy of other specified site. 

3410 ................................................. Neuromyelitis optica. 

3411 ................................................. Schilder’s disease. 

34120 ............................................... Acute (transverse) myelitis NOS. 

34121 ............................................... Acute (transverse) myelitis in conditions classified elsewhere. 

34122 ............................................... Idiopathic transverse myelitis. 

3418 ................................................. Other demyelinating diseases of central nervous system. 

3419 ................................................. Demyelinating disease of central nervous system, unspecified. 

34200 ............................................... Flaccid hemiplegia and hemiparesis affecting unspecified side. 

34201 ............................................... Flaccid hemiplegia and hemiparesis affecting dominant side. 

34202 ............................................... Flaccid hemiplegia and hemiparesis affecting nondominant side. 

34210 ............................................... Spastic hemiplegia and hemiparesis affecting unspecified side. 

34211 ............................................... Spastic hemiplegia and hemiparesis affecting dominant side. 

34212 ............................................... Spastic hemiplegia and hemiparesis affecting nondominant side. 

34280 ............................................... Other specified hemiplegia and hemiparesis affecting unspecified side. 

34281 ............................................... Other specified hemiplegia and hemiparesis affecting dominant side. 

34282 ............................................... Other specified hemiplegia and hemiparesis affecting nondominant side. 

34290 ............................................... Unspecified hemiplegia and hemiparesis affecting unspecified side. 

34291 ............................................... Unspecified hemiplegia and hemiparesis affecting dominant side. 

34292 ............................................... Unspecified hemiplegia and hemiparesis affecting nondominant side. 

3430 ................................................. Congenital diplegia. 

3431 ................................................. Congenital hemiplegia. 

3434 ................................................. Infantile hemiplegia. 

3441 ................................................. Paraplegia. 

3442 ................................................. Diplegia of upper limbs. 

34460 ............................................... Cauda equina syndrome without mention of neurogenic bladder. 

34461 ............................................... Cauda equina syndrome with neurogenic bladder. 

34501 ............................................... Generalized nonconvulsive epilepsy, with intractable epilepsy. 

34511 ............................................... Generalized convulsive epilepsy, with intractable epilepsy. 

3452 ................................................. Petit mal status, epileptic. 

34540 ............................................... Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy. 

34541 ............................................... Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy. 

34550 ............................................... Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable 

epilepsy. 

34551 ............................................... Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy. 

34560 ............................................... Infantile spasms, without mention of intractable epilepsy. 

34561 ............................................... Infantile spasms, with intractable epilepsy. 

34570 ............................................... Epilepsia partialis continua, without mention of intractable epilepsy. 

34571 ............................................... Epilepsia partialis continua, with intractable epilepsy. 

34580 ............................................... Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy. 

34581 ............................................... Other forms of epilepsy and recurrent seizures, with intractable epilepsy. 

34591 ............................................... Epilepsy, unspecified, with intractable epilepsy. 

3481 ................................................. Anoxic brain damage. 

mmaher on DSK3CLS3C1PROD with $$_JOB

25036 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

3491 ................................................. Nervous system complications from surgically implanted device. 

34981 ............................................... Cerebrospinal fluid rhinorrhea. 

3563 ................................................. Refsum’s disease. 

3570 ................................................. Acute infective polyneuritis. 

35781 ............................................... Chronic inflammatory demyelinating polyneuritis. 

35782 ............................................... Critical illness polyneuropathy. 

3581 ................................................. Myasthenic syndromes in diseases classified elsewhere. 

3590 ................................................. Congenital hereditary muscular dystrophy. 

3591 ................................................. Hereditary progressive muscular dystrophy. 

3594 ................................................. Toxic myopathy. 

3596 ................................................. Symptomatic inflammatory myopathy in diseases classified elsewhere. 

35981 ............................................... Critical illness myopathy. 

36000 ............................................... Purulent endophthalmitis, unspecified. 

36001 ............................................... Acute endophthalmitis. 

36002 ............................................... Panophthalmitis. 

36004 ............................................... Vitreous abscess. 

36011 ............................................... Sympathetic uveitis. 

36012 ............................................... Panuveitis. 

36013 ............................................... Parasitic endophthalmitis nos. 

36019 ............................................... Other endophthalmitis. 

3612 ................................................. Serous retinal detachment. 

36181 ............................................... Traction detachment of retina. 

36189 ............................................... Other forms of retinal detachment. 

3619 ................................................. Unspecified retinal detachment. 

36230 ............................................... Retinal vascular occlusion, unspecified. 

36231 ............................................... Central retinal artery occlusion. 

36232 ............................................... Retinal arterial branch occlusion. 

36233 ............................................... Partial retinal arterial occlusion. 

36234 ............................................... Transient retinal arterial occlusion. 

36235 ............................................... Central retinal vein occlusion. 

36240 ............................................... Retinal layer separation, unspecified. 

36242 ............................................... Serous detachment of retinal pigment epithelium. 

36243 ............................................... Hemorrhagic detachment of retinal pigment epithelium. 

36284 ............................................... Retinal ischemia. 

36310 ............................................... Disseminated chorioretinitis, unspecified. 

36311 ............................................... Disseminated choroiditis and chorioretinitis, posterior pole. 

36312 ............................................... Disseminated choroiditis and chorioretinitis, peripheral. 

36313 ............................................... Disseminated choroiditis and chorioretinitis, generalized. 

36314 ............................................... Disseminated retinitis and retinochoroiditis, metastatic. 

36315 ............................................... Disseminated retinitis and retinochoroiditis, pigment epitheliopathy. 

36320 ............................................... Chorioretinitis, unspecified. 

36363 ............................................... Choroidal rupture. 

36370 ............................................... Choroidal detachment, unspecified. 

36371 ............................................... Serous choroidal detachment. 

36372 ............................................... Hemorrhagic choroidal detachment. 

36400 ............................................... Acute and subacute iridocyclitis, unspecified. 

36401 ............................................... Primary iridocyclitis. 

36402 ............................................... Recurrent iridocyclitis. 

36403 ............................................... Secondary iridocyclitis, infectious. 

36422 ............................................... Glaucomatocyclitic crises. 

3643 ................................................. Unspecified iridocyclitis. 

36522 ............................................... Acute angle-closure glaucoma. 

36811 ............................................... Sudden visual loss. 

36812 ............................................... Transient visual loss. 

37601 ............................................... Orbital cellulitis. 

37602 ............................................... Orbital periostitis. 

37603 ............................................... Orbital osteomyelitis. 

37700 ............................................... Papilledema, unspecified. 

37701 ............................................... Papilledema associated with increased intracranial pressure. 

37730 ............................................... Optic neuritis, unspecified. 

37731 ............................................... Optic papillitis. 

37732 ............................................... Retrobulbar neuritis (acute). 

37739 ............................................... Other optic neuritis. 

37751 ............................................... Disorders of optic chiasm associated with pituitary neoplasms and disorders. 

37752 ............................................... Disorders of optic chiasm associated with other neoplasms. 

37753 ............................................... Disorders of optic chiasm associated with vascular disorders. 

37754 ............................................... Disorders of optic chiasm associated with inflammatory disorders. 

37761 ............................................... Disorders of other visual pathways associated with neoplasms. 

37762 ............................................... Disorders of other visual pathways associated with vascular disorders. 

37763 ............................................... Disorders of other visual pathways associated with inflammatory disorders. 

37771 ............................................... Disorders of visual cortex associated with neoplasms. 

37772 ............................................... Disorders of visual cortex associated with vascular disorders. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25037 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

37773 ............................................... Disorders of visual cortex associated with inflammatory disorders. 

38014 ............................................... Malignant otitis externa. 

38300 ............................................... Acute mastoiditis without complications. 

38301 ............................................... Subperiosteal abscess of mastoid. 

38302 ............................................... Acute mastoiditis with other complications. 

38861 ............................................... Cerebrospinal fluid otorrhea. 

3910 ................................................. Acute rheumatic pericarditis. 

3911 ................................................. Acute rheumatic endocarditis. 

3912 ................................................. Acute rheumatic myocarditis. 

3918 ................................................. Other acute rheumatic heart disease. 

3919 ................................................. Acute rheumatic heart disease, unspecified. 

3920 ................................................. Rheumatic chorea with heart involvement. 

3929 ................................................. Rheumatic chorea without mention of heart involvement. 

393 ................................................... Chronic rheumatic pericarditis. 

3980 ................................................. Rheumatic myocarditis. 

39891 ............................................... Rheumatic heart failure (congestive). 

4010 ................................................. Malignant essential hypertension. 

40200 ............................................... Malignant hypertensive heart disease without congestive heart failure. 

40201 ............................................... Malignant hypertensive heart disease with congestive heart failure. 

40211 ............................................... Benign hypertensive heart disease with congestive heart failure. 

40291 ............................................... Unspecified hypertensive heart disease with congestive heart failure. 

40300 ............................................... Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified. 

40301 ............................................... Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease. 

40311 ............................................... Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease. 

40400 ............................................... Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage I 

through stage IV, or unspecified. 

40401 ............................................... Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through 

stage IV, or unspecified. 

40402 ............................................... Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end 

stage renal disease. 

40403 ............................................... Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end 

stage renal disease. 

40411 ............................................... Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through 

stage IV, or unspecified. 

40412 ............................................... Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end 

stage renal disease. 

40413 ............................................... Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage 

renal disease. 

40491 ............................................... Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through 

stage IV, or unspecified. 

40492 ............................................... Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or 

end stage renal disease. 

40493 ............................................... Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage 

renal disease. 

40501 ............................................... Malignant renovascular hypertension. 

40509 ............................................... Other malignant secondary hypertension. 

4110 ................................................. Postmyocardial infarction syndrome. 

4111 ................................................. Intermediate coronary syndrome. 

41181 ............................................... Other acute and subacute forms of ischemic heart disease, acute ischemic heart disease without myocardial infarction. 

41189 ............................................... Other acute and subacute forms of ischemic heart disease, other. 

4130 ................................................. Angina decubitus. 

4131 ................................................. Prinzmetal angina. 

41402 ............................................... Coronary atherosclerosis of autologous vein bypass graft. 

41403 ............................................... Coronary atherosclerosis of nonautologous biological bypass graft. 

41404 ............................................... Coronary atherosclerosis of artery bypass graft. 

41406 ............................................... Coronary atherosclerosis of native coronary artery of transplanted heart. 

41407 ............................................... Coronary atherosclerosis, of bypass graft (artery) (vein) of transplanted heart. 

41410 ............................................... Aneurysm of heart (wall). 

41419 ............................................... Other aneurysm of heart. 

4160 ................................................. Primary pulmonary hypertension. 

4161 ................................................. Kyphoscoliotic heart disease. 

4170 ................................................. Arteriovenous fistula of pulmonary vessels. 

4171 ................................................. Aneurysm of pulmonary artery. 

4200 ................................................. Acute pericarditis in diseases classified elsewhere. 

42090 ............................................... Acute pericarditis, unspecified. 

42091 ............................................... Acute idiopathic pericarditis. 

42099 ............................................... Other acute pericarditis. 

4230 ................................................. Hemopericardium. 

4231 ................................................. Adhesive pericarditis. 

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25038 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

4232 ................................................. Constrictive pericarditis. 

4233 ................................................. Cardiac tamponade. 

4238 ................................................. Other specified diseases of pericardium. 

4239 ................................................. Unspecified disease of pericardium. 

42490 ............................................... Endocarditis, valve unspecified, unspecified cause. 

42491 ............................................... Endocarditis in diseases classified elsewhere. 

42499 ............................................... Other endocarditis, valve unspecified. 

4250 ................................................. Endomyocardial fibrosis. 

4251 ................................................. Hypertrophic obstructive cardiomyopathy. 

4252 ................................................. Obscure cardiomyopathy of africa. 

4253 ................................................. Endocardial fibroelastosis. 

4254 ................................................. Other primary cardiomyopathies. 

4255 ................................................. Alcoholic cardiomyopathy. 

4257 ................................................. Nutritional and metabolic cardiomyopathy. 

4258 ................................................. Cardiomyopathy in other diseases classified elsewhere. 

4259 ................................................. Secondary cardiomyopathy, unspecified. 

4260 ................................................. Atrioventricular block, complete. 

42612 ............................................... Mobitz (type) ii atrioventricular block. 

42689 ............................................... Other specified conduction disorders. 

4270 ................................................. Paroxysmal supraventricular tachycardia. 

4271 ................................................. Paroxysmal ventricular tachycardia. 

42732 ............................................... Atrial flutter. 

4281 ................................................. Left heart failure. 

42820 ............................................... Unspecified systolic heart failure. 

42822 ............................................... Chronic systolic heart failure. 

42830 ............................................... Unspecified diastolic heart failure. 

42832 ............................................... Chronic diastolic heart failure. 

42840 ............................................... Unspecified combined systolic and diastolic heart failure. 

42842 ............................................... Chronic combined systolic and diastolic heart failure. 

42971 ............................................... Certain sequelae of myocardial infarction, not elsewhere classified, acquired cardiac septal defect. 

42979 ............................................... Certain sequelae of myocardial infarction, not elsewhere classified, other.

42981 ............................................... Other disorders of papillary muscle. 

42982 ............................................... Hyperkinetic heart disease. 

42983 ............................................... Takotsubo syndrome. 

4329 ................................................. Unspecified intracranial hemorrhage. 

4350 ................................................. Basilar artery syndrome. 

4351 ................................................. Vertebral artery syndrome. 

4352 ................................................. Subclavian steal syndrome. 

4353 ................................................. Vertebrobasilar artery syndrome. 

4358 ................................................. Other specified transient cerebral ischemias. 

4359 ................................................. Unspecified transient cerebral ischemia. 

436 ................................................... Acute, but ill-defined, cerebrovascular disease. 

4371 ................................................. Other generalized ischemic cerebrovascular disease. 

4372 ................................................. Hypertensive encephalopathy. 

4374 ................................................. Cerebral arteritis. 

4375 ................................................. Moyamoya disease. 

4376 ................................................. Nonpyogenic thrombosis of intracranial venous sinus. 

43820 ............................................... Hemiplegia affecting unspecified side. 

43821 ............................................... Hemiplegia affecting dominant side. 

43822 ............................................... Hemiplegia affecting nondominant side. 

44024 ............................................... Atherosclerosis of native arteries of the extremities with gangrene. 

4440 ................................................. Embolism and thrombosis of abdominal aorta. 

4441 ................................................. Embolism and thrombosis of thoracic aorta. 

44421 ............................................... Arterial embolism and thrombosis of upper extremity. 

44422 ............................................... Arterial embolism and thrombosis of lower extremity. 

44481 ............................................... Embolism and thrombosis of iliac artery. 

44489 ............................................... Embolism and thrombosis of other artery. 

4449 ................................................. Embolism and thrombosis of unspecified artery. 

44501 ............................................... Atheroembolism, upper extremity. 

44502 ............................................... Atheroembolism, lower extremity. 

44581 ............................................... Atheroembolism, kidney. 

44589 ............................................... Atheroembolism, other site. 

4460 ................................................. Polyarteritis nodosa. 

4461 ................................................. Acute febrile mucocutaneous lymph node syndrome (mcls). 

44620 ............................................... Hypersensitivity angiitis, unspecified. 

44621 ............................................... Goodpasture’s syndrome. 

44629 ............................................... Other specified hypersensitivity angiitis. 

4463 ................................................. Lethal midline granuloma. 

4464 ................................................. Wegener’s granulomatosis. 

4467 ................................................. Takayasu’s disease. 

4472 ................................................. Rupture of artery. 

4474 ................................................. Celiac artery compression syndrome. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25039 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

4475 ................................................. Necrosis of artery. 

449 ................................................... Septic arterial embolism. 

45119 ............................................... Phlebitis and thrombophlebitis of other. 

45181 ............................................... Phlebitis and thrombophlebitis of iliac vein. 

45183 ............................................... Phlebitis and thrombophlebitis of deep veins of upper extremities. 

45189 ............................................... Phlebitis and thrombophlebitis of other sites. 

4531 ................................................. Thrombophlebitis migrans. 

4533 ................................................. Embolism and thrombosis of renal vein. 

45340 ............................................... Venous embolism and thrombosis of unspecified deep vessels of lower extremity. 

45341 ............................................... Venous embolism and thrombosis of deep vessels of proximal lower extremity.

45342 ............................................... Venous embolism and thrombosis of deep vessels of distal lower extremity. 

4538 ................................................. Embolism and thrombosis of other specified veins. 

4539 ................................................. Embolism and thrombosis of unspecified site. 

4542 ................................................. Varicose veins of lower extremities with ulcer and inflammation. 

4561 ................................................. Esophageal varices without mention of bleeding. 

45621 ............................................... Esophageal varices in diseases classified elsewhere, without mention of bleeding. 

45911 ............................................... Postphlebetic syndrome with ulcer. 

45913 ............................................... Postphlebetic syndrome with ulcer and inflammation. 

4592 ................................................. Compression of vein. 

45931 ............................................... Chronic venous hypertension with ulcer. 

45933 ............................................... Chronic venous hypertension with ulcer and inflammation. 

46430 ............................................... Acute epiglottitis without mention of obstruction. 

46611 ............................................... Acute bronchiolitis due to respiratory syncytial virus (RSV). 

46619 ............................................... Acute bronciolitis due to other infectious organisms. 

475 ................................................... Peritonsillar abscess. 

47821 ............................................... Cellulitis of pharynx or nasopharynx. 

47822 ............................................... Parapharyngeal abscess. 

47824 ............................................... Retropharyngeal abscess. 

47834 ............................................... Complete bilateral paralysis of vocal cords. 

47871 ............................................... Cellulitis and perichondritis of larynx. 

49121 ............................................... Obstructive chronic bronchitis, with (acute) exacerbation. 

49122 ............................................... Obstructive chronic bronchitis with acute bronchitis. 

49301 ............................................... Extrinsic asthma with status asthmaticus. 

49302 ............................................... Extrinsic asthma, with (acute) exacerbation. 

49311 ............................................... Intrinsic asthma with status asthmaticus. 

49312 ............................................... Intrinsic asthma, with (acute) exacerbation. 

49321 ............................................... Chronic obstructive asthma with status asthmaticus. 

49322 ............................................... Chronic obstructive asthma, with (acute) exacerbation. 

49391 ............................................... Asthma, unspecified type, with status asthmaticus. 

49392 ............................................... Asthma, unspecified type, with (acute) exacerbation. 

4941 ................................................. Bronchiectasis with acute exacerbation. 

4957 ................................................. ’Ventilation’ pneumonitis. 

4958 ................................................. Other specified allergic alveolitis and pneumonitis. 

4959 ................................................. Unspecified allergic alveolitis and pneumonitis. 

5060 ................................................. Bronchitis and pneumonitis due to fumes and vapors. 

5080 ................................................. Acute pulmonary manifestations due to radiation. 

5081 ................................................. Chronic and other pulmonary manifestations due to radiation. 

5119 ................................................. Unspecified pleural effusion. 

5121 ................................................. Iatrogenic pneumothorax. 

5128 ................................................. Other spontaneous pneumothorax. 

514 ................................................... Pulmonary congestion and hypostasis. 

5160 ................................................. Pulmonary alveolar proteinosis. 

5161 ................................................. Idiopathic pulmonary hemosiderosis. 

5162 ................................................. Pulmonary alveolar microlithiasis. 

5163 ................................................. Idiopathic fibrosing alveolitis. 

5168 ................................................. Other specified alveolar and parietoalveolar pneumonopathies. 

5169 ................................................. Unspecified alveolar and parietoalveolar pneumonopathy. 

5171 ................................................. Rheumatic pneumonia. 

5172 ................................................. Lung involvement in systemic sclerosis. 

5173 ................................................. Acute chest syndrome. 

5180 ................................................. Pulmonary collapse. 

5183 ................................................. Pulmonary eosinophilia. 

5186 ................................................. Allergic bronchopulmonary aspergilliosis. 

5187 ................................................. Transfusion related acute lung injury (TRALI). 

51882 ............................................... Other pulmonary insufficiency, not elsewhere classified. 

51883 ............................................... Chronic respiratory failure. 

51900 ............................................... Tracheostomy complication, unspecified. 

51901 ............................................... Infection of tracheostomy. 

51902 ............................................... Mechanical complication of tracheostomy. 

51909 ............................................... Other tracheostomy complications. 

5220 ................................................. Pulpitis. 

5224 ................................................. Acute apical periodontitis of pulpal origin. 

mmaher on DSK3CLS3C1PROD with $$_JOB

25040 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

5273 ................................................. Abscess of salivary gland. 

5274 ................................................. Fistula of salivary gland. 

5283 ................................................. Cellulitis and abscess of oral soft tissues. 

53012 ............................................... Acute esophagitis. 

53020 ............................................... Ulcer of esophagus without bleeding. 

53086 ............................................... Infection of esophagostomy. 

53087 ............................................... Mechanical complication of esophagostomy. 

53130 ............................................... Acute gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction. 

53230 ............................................... Acute duodenal ulcer without mention of hemorrhage or perforation, without mention of obstruction. 

53330 ............................................... Acute peptic ulcer of unspecified site without mention of hemorrhage and perforation, without mention of obstruction. 

53430 ............................................... Acute gastrojejunal ulcer without mention of hemorrhage or perforation, without mention of obstruction. 

5361 ................................................. Acute dilatation of stomach. 

53641 ............................................... Infection of gastrostomy. 

53642 ............................................... Mechanical complication of gastrostomy. 

5370 ................................................. Acquired hypertrophic pyloric stenosis. 

5373 ................................................. Other obstruction of duodenum. 

5374 ................................................. Fistula of stomach or duodenum. 

538 ................................................... Gastrointestinal mucositis (ulcerative). 

5409 ................................................. Acute appendicitis without mention of peritonitis. 

55010 ............................................... Unilateral or unspecified inguinal hernia, with obstruction, without mention of gangrene. 

55011 ............................................... Recurrent unilateral or unspecified inguinal hernia with obstruction, without mention of gangrene. 

55012 ............................................... Bilateral inguinal hernia, with obstruction, without mention of gangrene. 

55013 ............................................... Recurrent bilateral inguinal hernia, with obstruction, without mention of gangrene. 

55200 ............................................... Unilateral or unspecified femoral hernia with obstruction. 

55201 ............................................... Recurrent unilateral or unspecified femoral hernia with obstruction. 

55202 ............................................... Bilateral femoral hernia with obstruction. 

55203 ............................................... Recurrent bilateral femoral hernia with obstruction. 

5521 ................................................. Umbilical hernia with obstruction. 

55220 ............................................... Unspecified ventral hernia with obstruction. 

55221 ............................................... Incisional hernia with obstruction. 

55229 ............................................... Other ventral hernia with obstruction. 

5523 ................................................. Diaphragmatic hernia with obstruction. 

5528 ................................................. Hernia of other specified sites, with obstruction. 

5529 ................................................. Hernia of unspecified site, with obstruction. 

5550 ................................................. Regional enteritis of small intestine. 

5551 ................................................. Regional enteritis of large intestine. 

5552 ................................................. Regional enteritis of small intestine with large intestine. 

5559 ................................................. Regional enteritis of unspecified site. 

5560 ................................................. Ulcerative (chronic) enterocolitis. 

5561 ................................................. Ulcerative (chronic) ileocolitis. 

5562 ................................................. Ulcerative (chronic) proctitis. 

5563 ................................................. Ulcerative (chronic) proctosigmoiditis. 

5564 ................................................. Pseudopolyposis of colon. 

5565 ................................................. Left-sided ulcerative (chronic) colitis. 

5566 ................................................. Universal ulcerative (chronic) colitis. 

5568 ................................................. Other ulcerative colitis. 

5569 ................................................. Ulcerative colitis, unspecified. 

5571 ................................................. Chronic vascular insufficiency of intestine. 

5579 ................................................. Unspecified vascular insufficiency of intestine. 

5581 ................................................. Gastroenteritis and colitis due to radiation. 

5582 ................................................. Toxic gastroenteritis and colitis. 

5600 ................................................. Intussusception. 

5601 ................................................. Paralytic ileus. 

56030 ............................................... Impaction of intestine, unspecified. 

56031 ............................................... Gallstone ileus. 

56039 ............................................... Other impaction of intestine. 

56081 ............................................... Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection). 

56089 ............................................... Other specified intestinal obstruction. 

5609 ................................................. Unspecified intestinal obstruction. 

56201 ............................................... Diverticulitis of small intestine (without mention of hemorrhage). 

56211 ............................................... Diverticulitis of colon (without mention of hemorrhage). 

5647 ................................................. Megacolon, other than hirschsprung’s. 

56481 ............................................... Neurogenic bowel. 

566 ................................................... Abscess of anal and rectal regions. 

56782 ............................................... Sclerosing mesenteritis. 

56882 ............................................... Peritoneal effusion (chronic). 

5693 ................................................. Hemorrhage of rectum and anus. 

56941 ............................................... Ulcer of anus and rectum. 

5695 ................................................. Abscess of intestine. 

56961 ............................................... Infection of colostomy or enterostomy. 

56962 ............................................... Mechanical complication of colostomy and enterostomy. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25041 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

56969 ............................................... Other colostomy and enterostomy complication. 

56981 ............................................... Fistula of intestine, excluding rectum and anus. 

56982 ............................................... Ulceration of intestine. 

5723 ................................................. Portal hypertension. 

5731 ................................................. Hepatitis in viral diseases classified elsewhere. 

5732 ................................................. Hepatitis in other infectious diseases classified elsewhere. 

57400 ............................................... Calculus of gallbladder with acute cholecystitis, without mention of obstruction. 

57401 ............................................... Calculus of gallbladder with acute cholecystitis, with obstruction. 

57410 ............................................... Calculus of gallbladder with other cholecystitis, without mention of obstruction. 

57411 ............................................... Calculus of gallbladder with other cholecystitis, with obstruction. 

57421 ............................................... Calculus of gallbladder without mention of cholecystitis, with obstruction.

57430 ............................................... Calculus of bile duct with acute cholecystitis without mention of obstruction. 

57431 ............................................... Calculus of bile duct with acute cholecystitis, with obstruction. 

57440 ............................................... Calculus of bile duct with other cholecystitis, without mention of obstruction. 

57441 ............................................... Calculus of bile duct with other cholecystitis, with obstruction. 

57451 ............................................... Calculus of bile duct without mention of cholecystitis, with obstruction. 

57460 ............................................... Calculus of gallbladder and bile duct with acute cholecystitis, without mention of obstruction. 

57461 ............................................... Calculus of gallbladder and bile duct with acute cholecystitis, with obstruction. 

57470 ............................................... Calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction. 

57471 ............................................... Calculus of gallbladder and bile duct with other cholecystitis, with obstruction. 

57480 ............................................... Calculus of gallbladder and bile duct with acute and chronic cholecystitis, without mention of obstruction. 

57491 ............................................... Calculus of gallbladder and bile duct without cholecystitis, with obstruction. 

5750 ................................................. Acute cholecystitis. 

57512 ............................................... Acute and chronic cholecystitis. 

5752 ................................................. Obstruction of gallbladder. 

5753 ................................................. Hydrops of gallbladder. 

5755 ................................................. Fistula of gallbladder. 

5761 ................................................. Cholangitis. 

5764 ................................................. Fistula of bile duct. 

5771 ................................................. Chronic pancreatitis. 

5772 ................................................. Cyst and pseudocyst of pancreas. 

5780 ................................................. Hematemesis. 

5781 ................................................. Blood in stool. 

5789 ................................................. Hemorrhage of gastrointestinal tract, unspecified. 

5791 ................................................. Tropical sprue. 

5792 ................................................. Blind loop syndrome. 

5793 ................................................. Other and unspecified postsurgical nonabsorption. 

5794 ................................................. Pancreatic steatorrhea. 

5798 ................................................. Other specified intestinal malabsorption. 

5799 ................................................. Unspecified intestinal malabsorption. 

5810 ................................................. Nephrotic syndrome with lesion of proliferative glomerulonephritis. 

5811 ................................................. Nephrotic syndrome with lesion of membranous glomerulonephritis. 

5812 ................................................. Nephrotic syndrome with lesion of membranoproliferative glomerulonephritis. 

5813 ................................................. Nephrotic syndrome with lesion of minimal change glomerulonephritis. 

58181 ............................................... Nephrotic syndrome in diseases classified elsewhere. 

58189 ............................................... Other nephrotic syndrome with specified pathological lesion in kidney. 

5819 ................................................. Nephrotic syndrome with unspecified pathological lesion in kidney. 

5820 ................................................. Chronic glomerulonephritis with lesion of proliferative glomerulonephritis. 

5821 ................................................. Chronic glomerulonephritis with lesion of membranous glomerulonephritis. 

5822 ................................................. Chronic glomerulonephritis with lesion of membranoproliferative glomerulonephritis. 

5824 ................................................. Chronic glomerulonephritis with lesion of rapidly progressive glomerulonephritis. 

58281 ............................................... Chronic glomerulonephritis in diseases classified elsewhere. 

58289 ............................................... Other chronic glomerulonephritis with specified pathological lesion in kidney. 

5829 ................................................. Chronic glomerulonephritis with unspecified pathological lesion in kidney.

5830 ................................................. Nephritis and nephropathy, not specified as acute or chronic, with lesion of proliferative glomerulonephritis. 

5831 ................................................. Nephritis and nephropathy, not specified as acute or chronic, with lesion of membranous glomerulonephritis. 

5832 ................................................. Nephritis and nephropathy, not specified as acute or chronic, with lesion of membranoproliferative glomerulonephritis. 

5837 ................................................. Nephritis and nephropathy, not specified as acute or chronic, with lesion of renal medullary necrosis. 

5854 ................................................. Chronic kidney disease, Stage IV (severe). 

5855 ................................................. Chronic kidney disease, Stage V. 

5881 ................................................. Nephrogenic diabetes insipidus. 

58881 ............................................... Secondary hyperparathyroidism (of renal origin). 

59001 ............................................... Chronic pyelonephritis with lesion of renal medullary necrosis. 

59010 ............................................... Acute pyelonephritis without lesion of renal medullary necrosis. 

5903 ................................................. Pyeloureteritis cystica. 

59080 ............................................... Pyelonephritis, unspecified. 

59081 ............................................... Pyelitis or pyelonephritis in diseases classified elsewhere. 

591 ................................................... Hydronephrosis. 

5921 ................................................. Calculus of ureter. 

5934 ................................................. Other ureteric obstruction. 

5935 ................................................. Hydroureter. 

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25042 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

59381 ............................................... Vascular disorders of kidney. 

59382 ............................................... Ureteral fistula. 

5950 ................................................. Acute cystitis. 

59582 ............................................... Irradiation cystitis. 

5961 ................................................. Intestinovesical fistula. 

5962 ................................................. Vesical fistula, not elsewhere classified. 

5967 ................................................. Hemorrhage into bladder wall. 

5970 ................................................. Urethral abscess. 

5990 ................................................. Urinary tract infection, site not specified. 

5991 ................................................. Urethral fistula. 

6010 ................................................. Acute prostatitis. 

6012 ................................................. Abscess of prostate. 

6031 ................................................. Infected hydrocele. 

6040 ................................................. Orchitis, epididymitis, and epididymo-orchitis, with abscess. 

6073 ................................................. Priapism. 

60782 ............................................... Vascular disorders of penis. 

60820 ............................................... Torsion of testis, unspecified. 

60821 ............................................... Extravaginal torsion of spermatic cord. 

60822 ............................................... Intravaginal torsion of spermatic cord. 

60823 ............................................... Torsion of appendix testis. 

60824 ............................................... Torsion of appendix epididymis. 

6140 ................................................. Acute salpingitis and oophoritis. 

6143 ................................................. Acute parametritis and pelvic cellulitis. 

6147 ................................................. Other chronic pelvic peritonitis, female. 

6150 ................................................. Acute inflammatory diseases of uterus, except cervix. 

6163 ................................................. Abscess of bartholin’s gland. 

6164 ................................................. Other abscess of vulva. 

61681 ............................................... Mucositis (ulcerative) of cervix, vagina, and vulva. 

6190 ................................................. Urinary-genital tract fistula, female. 

6191 ................................................. Digestive-genital tract fistula, female. 

6192 ................................................. Genital tract-skin fistula, female. 

6198 ................................................. Other specified fistulas involving female genital tract. 

6199 ................................................. Unspecified fistula involving female genital tract. 

6205 ................................................. Torsion of ovary, ovarian pedicle, or fallopian tube. 

63300 ............................................... Abdominal pregnancy without intrauterine pregnancy. 

63301 ............................................... Abdominal pregnancy with intrauterine pregnancy. 

63310 ............................................... Tubal pregnancy without intrauterine pregnancy. 

63311 ............................................... Tubal pregnancy with intrauterine pregnancy. 

63320 ............................................... Ovarian pregnancy without intrauterine pregnancy. 

63321 ............................................... Ovarian pregnancy with intrauterine pregnancy. 

63380 ............................................... Other ectopic pregnancy without intrauterine pregnancy. 

63381 ............................................... Other ectopic pregnancy with intrauterine pregnancy. 

63390 ............................................... Unspecified ectopic pregnancy without intrauterine pregnancy. 

63391 ............................................... Unspecified ectopic pregnancy with intrauterine pregnancy. 

63400 ............................................... Spontaneous abortion, unspecified, complicated by genital tract and pelvic infection. 

63401 ............................................... Spontaneous abortion, incomplete, complicated by genital tract and pelvic infection. 

63402 ............................................... Spontaneous abortion, complete, complicated by genital tract and pelvic infection. 

63420 ............................................... Spontaneous abortion, unspecified, complicated by damage to pelvic organs or tissues. 

63421 ............................................... Spontaneous abortion, incomplete, complicated by damage to pelvic organs or tissues. 

63422 ............................................... Spontaneous abortion, complete, complicated by damage to pelvic organs or tissues. 

63440 ............................................... Spontaneous abortion, unspecified, complicated by metabolic disorder. 

63441 ............................................... Spontaneous abortion, incomplete, complicated by metabolic disorder. 

63442 ............................................... Spontaneous abortion, complete, complicated by metabolic disorder. 

63460 ............................................... Spontaneous abortion, unspecified, complicated by embolism. 

63470 ............................................... Spontaneous abortion, unspecified, with other specified complications. 

63471 ............................................... Spontaneous abortion, incomplete, with other specified complications. 

63472 ............................................... Spontaneous abortion, complete, with other specified complications. 

63480 ............................................... Spontaneous abortion, unspecified, with unspecified complication. 

63481 ............................................... Spontaneous abortion, incomplete, with unspecified complication. 

63482 ............................................... Spontaneous abortion, complete, with unspecified complication. 

63500 ............................................... Legally induced abortion, unspecified, complicated by genital tract and pelvic infection. 

63501 ............................................... Legally induced abortion, incomplete, complicated by genital tract and pelvic infection. 

63502 ............................................... Legally induced abortion, complete, complicated by genital tract and pelvic infection. 

63520 ............................................... Legally induced abortion, unspecified, complicated by damage to pelvic organs or tissues. 

63521 ............................................... Legally induced abortion, incomplete, complicated by damage to pelvic organs or tissues. 

63522 ............................................... Legally induced abortion, complete, complicated by damage to pelvic organs or tissues. 

63540 ............................................... Legally induced abortion, unspecified, complicated by metabolic disorder. 

63541 ............................................... Legally induced abortion, incomplete, complicated by metabolic disorder. 

63542 ............................................... Legally induced abortion, complete, complicated by metabolic disorder. 

63570 ............................................... Legally induced abortion, unspecified, with other specified complications. 

63571 ............................................... Legally induced abortion, incomplete, with other specified complications. 

63572 ............................................... Legally induced abortion, complete, with other specified complications. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25043 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

63580 ............................................... Legally induced abortion, unspecified, with unspecified complication. 

63581 ............................................... Legally induced abortion, incomplete, with unspecified complication. 

63582 ............................................... Legally induced abortion, complete, with unspecified complication. 

63600 ............................................... Illegal abortion, unspecified, complicated by genital tract and pelvic infection. 

63601 ............................................... Illegal abortion, incomplete, complicated by genital tract and pelvic infection. 

63602 ............................................... Illegal abortion, complete, complicated by genital tract and pelvic infection. 

63620 ............................................... Illegal abortion, unspecified, complicated by damage to pelvic organs or tissues. 

63621 ............................................... Illegal abortion, incomplete, complicated by damage to pelvic organs or tissues. 

63622 ............................................... Illegal abortion, complete, complicated by damage to pelvic organs or tissues. 

63640 ............................................... Illegal abortion, unspecified, complicated by metabolic disorder. 

63641 ............................................... Illegal abortion, incomplete, complicated by metabolic disorder. 

63642 ............................................... Illegal abortion, complete, complicated by metabolic disorder. 

63670 ............................................... Illegal abortion, unspecified, with other specified complications. 

63671 ............................................... Illegal abortion, incomplete, with other specified complications. 

63672 ............................................... Illegal abortion, complete, with other specified complications. 

63680 ............................................... Illegal abortion, unspecified, with unspecified complication. 

63681 ............................................... Illegal abortion, incomplete, with unspecified complication. 

63682 ............................................... Illegal abortion, complete, with unspecified complication. 

63700 ............................................... Unspecified type of abortion, unspecified, complicated by genital tract and pelvic infection. 

63701 ............................................... Unspecified abortion, incomplete, complicated by genital tract and pelvic infection. 

63702 ............................................... Unspecified abortion, complete, complicated by genital tract and pelvic infection. 

63720 ............................................... Legally unspecified type of abortion, unspecified, complicated by damage to pelvic organs or tissues. 

63721 ............................................... Legally unspecified abortion, incomplete, complicated by damage to pelvic organs or tissues. 

63722 ............................................... Legally unspecified abortion, complete, complicated by damage to pelvic organs or tissues. 

63740 ............................................... Legally unspecified type of abortion, unspecified, complicated by metabolic disorder. 

63741 ............................................... Legally unspecified abortion, incomplete, complicated by metabolic disorder. 

63742 ............................................... Legally unspecified abortion, complete, complicated by metabolic disorder. 

63770 ............................................... Legally unspecified type of abortion, unspecified, with other specified complications. 

63771 ............................................... Legally unspecified abortion, incomplete, with other specified complications. 

63772 ............................................... Legally unspecified abortion, complete, with other specified complications.

63780 ............................................... Legally unspecified type of abortion, unspecified, with unspecified complication. 

63781 ............................................... Legally unspecified abortion, incomplete, with unspecified complication. 

63782 ............................................... Legally unspecified abortion, complete, with unspecified complication. 

6380 ................................................. Failed attempted abortion complicated by genital tract and pelvic infection. 

6381 ................................................. Failed attempted abortion complicated by delayed or excessive hemorrhage. 

6382 ................................................. Failed attempted abortion complicated by damage to pelvic organs or tissues. 

6384 ................................................. Failed attempted abortion complicated by metabolic disorder. 

6387 ................................................. Failed attempted abortion with other specified complications. 

6388 ................................................. Failed attempted abortion with unspecified complication. 

6390 ................................................. Genital tract and pelvic infection following abortion or ectopic and molar pregnancies. 

6391 ................................................. Delayed or excessive hemorrhage following abortion or ectopic and molar pregnancies. 

6392 ................................................. Damage to pelvic organs and tissues following abortion or ectopic and molar pregnancies. 

6394 ................................................. Metabolic disorders following abortion or ectopic and molar pregnancies. 

6398 ................................................. Other specified complications following abortion or ectopic and molar pregnancies. 

6399 ................................................. Unspecified complication following abortion or ectopic and molar pregnancies. 

64001 ............................................... Threatened abortion, delivered. 

64003 ............................................... Threatened abortion, antepartum. 

64093 ............................................... Unspecified hemorrhage in early pregnancy, antepartum. 

64101 ............................................... Placenta previa without hemorrhage, with delivery. 

64103 ............................................... Placenta previa without hemorrhage, antepartum. 

64123 ............................................... Premature separation of placenta, antepartum. 

64201 ............................................... Benign essential hypertension with delivery. 

64202 ............................................... Benign essential hypertension, with delivery, with mention of postpartum complication. 

64203 ............................................... Antepartum benign essential hypertension. 

64213 ............................................... Hypertension secondary to renal disease, antepartum. 

64214 ............................................... Hypertension secondary to renal disease, postpartum. 

64231 ............................................... Transient hypertension of pregnancy, with delivery. 

64232 ............................................... Transient hypertension of pregnancy, with delivery, with mention of postpartum complication. 

64241 ............................................... Mild or unspecified pre-eclampsia, with delivery. 

64243 ............................................... Mild or unspecified pre-eclampsia, antepartum. 

64244 ............................................... Mild or unspecified pre-eclampsia, postpartum. 

64291 ............................................... Unspecified hypertension, with delivery. 

64292 ............................................... Unspecified hypertension, with delivery, with mention of postpartum complication. 

64293 ............................................... Unspecified antepartum hypertension. 

64294 ............................................... Unspecified postpartum hypertension. 

64413 ............................................... Other threatened labor, antepartum. 

64420 ............................................... Early onset of delivery, unspecified as to episode of care. 

64621 ............................................... Unspecified renal disease in pregnancy, with delivery. 

64622 ............................................... Unspecified renal disease in pregnancy, with delivery, with mention of postpartum complication. 

64623 ............................................... Unspecified antepartum renal disease. 

64624 ............................................... Unspecified postpartum renal disease. 

64631 ............................................... Habitual aborter, delivered, with or without mention of antepartum condition. 

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25044 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

64661 ............................................... Infections of genitourinary tract in pregnancy, with delivery. 

64662 ............................................... Infections of genitourinary tract in pregnancy, with delivery, with mention of postpartum complication. 

64663 ............................................... Antepartum infections of genitourinary tract. 

64664 ............................................... Postpartum infections of genitourinary tract. 

64671 ............................................... Liver disorders in pregnancy, with delivery. 

64673 ............................................... Antepartum liver disorders. 

64701 ............................................... Syphilis of mother, complicating pregnancy, with delivery. 

64702 ............................................... Syphilis of mother, complicating pregnancy, with delivery, with mention of postpartum complication. 

64703 ............................................... Antepartum syphilis. 

64704 ............................................... Postpartum syphilis. 

64711 ............................................... Gonorrhea of mother, with delivery. 

64712 ............................................... Gonorrhea of mother, with delivery, with mention of postpartum complication. 

64713 ............................................... Antepartum gonorrhea. 

64714 ............................................... Postpartum gonorrhea. 

64721 ............................................... Other venereal diseases of mother, with delivery. 

64722 ............................................... Other venereal diseases of mother, with delivery, with mention of postpartum complication. 

64723 ............................................... Other antepartum venereal diseases. 

64724 ............................................... Other postpartum venereal diseases. 

64731 ............................................... Tuberculosis of mother, with delivery. 

64732 ............................................... Tuberculosis of mother, with delivery, with mention of postpartum complication. 

64733 ............................................... Antepartum tuberculosis. 

64734 ............................................... Postpartum tuberculosis. 

64741 ............................................... Malaria of mother, with delivery. 

64742 ............................................... Malaria of mother, with delivery, with mention of postpartum complication. 

64743 ............................................... Antepartum malaria. 

64744 ............................................... Postpartum malaria. 

64751 ............................................... Rubella of mother, with delivery. 

64752 ............................................... Rubella of mother, with delivery, with mention of postpartum complication. 

64753 ............................................... Antepartum rubella. 

64754 ............................................... Postpartum rubella. 

64761 ............................................... Other viral diseases of mother, with delivery. 

64762 ............................................... Other viral diseases of mother, with delivery, with mention of postpartum complication. 

64763 ............................................... Other antepartum viral diseases. 

64764 ............................................... Other postpartum viral diseases. 

64781 ............................................... Other specified infectious and parasitic diseases of mother, with delivery.

64782 ............................................... Other specified infectious and parasitic diseases of mother, with delivery, with mention of postpartum complication. 

64783 ............................................... Other specified infectious and parasitic diseases of mother, antepartum. 

64784 ............................................... Other specified infectious and parasitic diseases of mother, postpartum. 

64791 ............................................... Unspecified infection or infestation of mother, with delivery. 

64792 ............................................... Unspecified infection or infestation of mother, with delivery, with mention of postpartum complication. 

64793 ............................................... Unspecified infection or infestation of mother, antepartum. 

64794 ............................................... Unspecified infection or infestation of mother, postpartum. 

64800 ............................................... Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care. 

64803 ............................................... Antepartum diabetes mellitus. 

64804 ............................................... Postpartum diabetes mellitus. 

64831 ............................................... Drug dependence of mother, with delivery. 

64832 ............................................... Drug dependence of mother, with delivery, with mention of postpartum complication. 

64833 ............................................... Antepartum drug dependence. 

64834 ............................................... Postpartum drug dependence. 

64851 ............................................... Congenital cardiovascular disorders of mother, with delivery. 

64852 ............................................... Congenital cardiovascular disorders of mother, with delivery, with mention of postpartum complication. 

64853 ............................................... Congenital cardiovascular disorders of mother, antepartum. 

64854 ............................................... Congenital cardiovascular disorders of mother, postpartum. 

64861 ............................................... Other cardiovascular diseases of mother, with delivery. 

64862 ............................................... Other cardiovascular diseases of mother, with delivery, with mention of postpartum complication. 

64863 ............................................... Other cardiovascular diseases of mother, antepartum. 

64864 ............................................... Other cardiovascular diseases of mother, postpartum. 

64871 ............................................... Bone and joint disorders of back, pelvis, and lower limbs of mother, with delivery. 

64872 ............................................... Bone and joint disorders of back, pelvis, and lower limbs of mother, with delivery, with mention of postpartum complication. 

64873 ............................................... Bone and joint disorders of back, pelvis, and lower limbs of mother, antepartum. 

64874 ............................................... Bone and joint disorders of back, pelvis, and lower limbs of mother, postpartum. 

64930 ............................................... Coagulation defects complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. 

64931 ............................................... Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum 

condition. 

64932 ............................................... Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. 

64933 ............................................... Coagulation defects complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25045 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

64934 ............................................... Coagulation defects complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. 

64941 ............................................... Epilepsy complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. 

64942 ............................................... Epilepsy complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. 

64943 ............................................... Epilepsy complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. 

64944 ............................................... Epilepsy complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. 

65101 ............................................... Twin pregnancy, delivered. 

65111 ............................................... Triplet pregnancy, delivered. 

65113 ............................................... Triplet pregnancy, antepartum condition or complication. 

65121 ............................................... Quadruplet pregnancy, delivered. 

65123 ............................................... Quadruplet pregnancy, antepartum condition or complication. 

65141 ............................................... Triplet pregnancy with fetal loss and retention of one or more fetus(es), delivered, with or without mention of antepartum condition. 

65143 ............................................... Triplet pregnancy with fetal loss and retention of one or more fetus(es), antepartum condition or complication. 

65151 ............................................... Quadruplet pregnancy with fetal loss and retention of one or more fetus(es), delivered, with or without mention of antepartum 

condition. 

65153 ............................................... Quadruplet pregnancy with fetal loss and retention of one or more fetus(es), antepartum condition or complication. 

65181 ............................................... Other specified multiple gestation, delivered. 

65183 ............................................... Other specified multiple gestation, antepartum condition or complication. 

65613 ............................................... Rhesus isoimmunization, affecting management of mother, antepartum condition. 

65631 ............................................... Fetal distress, affecting management of mother, delivered. 

65641 ............................................... Intrauterine death, affecting management of mother, delivered. 

65643 ............................................... Intrauterine death, affecting management of mother, antepartum. 

65651 ............................................... Poor fetal growth, affecting management of mother, delivered. 

65701 ............................................... Polyhydramnios, with delivery. 

65801 ............................................... Oligohydramnios, delivered. 

65803 ............................................... Oligohydramnios, antepartum. 

65881 ............................................... Other problems associated with amniotic cavity and membranes, delivered. 

65921 ............................................... Unspecified type maternal pyrexia during labor, delivered. 

66003 ............................................... Obstruction caused by malposition of fetus at onset of labor, antepartum. 

66211 ............................................... Unspecified type prolonged labor, delivered. 

66421 ............................................... Third-degree perineal laceration, with delivery. 

66431 ............................................... Fourth-degree perineal laceration, with delivery. 

66461 ............................................... Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration,delivered, with or without mention 

of antepartum condition. 

66464 ............................................... Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration,postpartum condition or complication. 

66522 ............................................... Inversion of uterus, delivered with postpartum complication. 

66531 ............................................... Laceration of cervix, with delivery. 

66541 ............................................... High vaginal laceration, with delivery. 

66551 ............................................... Other injury to pelvic organs, with delivery. 

66561 ............................................... Damage to pelvic joints and ligaments, with delivery. 

66571 ............................................... Pelvic hematoma, with delivery. 

66572 ............................................... Pelvic hematoma, delivered with postpartum complication. 

66602 ............................................... Third-stage postpartum hemorrhage, with delivery. 

66604 ............................................... Third-stage postpartum hemorrhage. 

66612 ............................................... Other immediate postpartum hemorrhage, with delivery. 

66614 ............................................... Other immediate postpartum hemorrhage. 

66622 ............................................... Delayed and secondary postpartum hemorrhage, with delivery. 

66624 ............................................... Delayed and secondary postpartum hemorrhage. 

66632 ............................................... Postpartum coagulation defects, with delivery. 

66924 ............................................... Maternal hypotension syndrome, postpartum. 

67120 ............................................... Superficial thrombophlebitis complicating pregnancy and the puerperium, unspecified as to episode of care. 

67121 ............................................... Superficial thrombophlebitis with delivery, with or without mention of antepartum condition. 

67122 ............................................... Superficial thrombophlebitis with delivery, with mention of postpartum complication. 

67123 ............................................... Antepartum superficial thrombophlebitis. 

67124 ............................................... Postpartum superficial thrombophlebitis. 

67130 ............................................... Deep phlebothrombosis, antepartum, unspecified as to episode of care. 

67140 ............................................... Deep phlebothrombosis, postpartum, unspecified as to episode of care. 

67150 ............................................... Other phlebitis and thrombosis complicating pregnancy and the puerperium, unspecified as to episode of care. 

67151 ............................................... Other phlebitis and thrombosis with delivery, with or without mention of antepartum condition. 

67152 ............................................... Other phlebitis and thrombosis with delivery, with mention of postpartum complication. 

67153 ............................................... Other antepartum phlebitis and thrombosis. 

67154 ............................................... Other postpartum phlebitis and thrombosis. 

67180 ............................................... Other venous complications of pregnancy and the puerperium, unspecified as to episode of care. 

67181 ............................................... Other venous complications, with delivery, with or without mention of antepartum condition. 

67182 ............................................... Other venous complications, with delivery, with mention of postpartum complication. 

67183 ............................................... Other antepartum venous complications. 

67184 ............................................... Other postpartum venous complications. 

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25046 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

67190 ............................................... Unspecified venous complication of pregnancy and the puerperium, unspecified as to episode of care. 

67191 ............................................... Unspecified venous complication, with delivery, with or without mention of antepartum condition. 

67192 ............................................... Unspecified venous complication, with delivery, with mention of postpartum complication. 

67202 ............................................... Puerperal pyrexia of unknown origin, delivered, with mention of postpartum complication. 

67204 ............................................... Puerperal pyrexia of unknown origin, postpartum. 

67330 ............................................... Obstetrical pyemic and septic embolism, unspecified as to episode of care. 

67402 ............................................... Cerebrovascular disorders, with delivery, with mention of postpartum complication. 

67403 ............................................... Antepartum cerebrovascular disorders. 

67404 ............................................... Postpartum cerebrovascular disorders. 

67511 ............................................... Abscess of breast associated with childbirth, delivered, with or without mention of antepartum condition. 

67512 ............................................... Abscess of breast associated with childbirth, delivered, with mention of postpartum complication. 

6820 ................................................. Cellulitis and abscess of face. 

6821 ................................................. Cellulitis and abscess of neck. 

6822 ................................................. Cellulitis and abscess of trunk. 

6823 ................................................. Cellulitis and abscess of upper arm and forearm. 

6824 ................................................. Cellulitis and abscess of hand, except fingers and thumb. 

6825 ................................................. Cellulitis and abscess of buttock. 

6826 ................................................. Cellulitis and abscess of leg, except foot. 

6827 ................................................. Cellulitis and abscess of foot, except toes. 

6828 ................................................. Cellulitis and abscess of other specified sites. 

6829 ................................................. Cellulitis and abscess of unspecified sites. 

6850 ................................................. Pilonidal cyst with abscess. 

68601 ............................................... Pyoderma gangrenosum. 

6944 ................................................. Pemphigus. 

6945 ................................................. Pemphigoid. 

6950 ................................................. Toxic erythema. 

6951 ................................................. Erythema multiforme. 

70700 ............................................... Decubitus ulcer, unspecified site. 

70701 ............................................... Decubitus ulcer, elbow. 

70709 ............................................... Decubitus ulcer, other site. 

70710 ............................................... Unspecified ulcer of lower limb. 

70711 ............................................... Ulcer of thigh. 

70712 ............................................... Ulcer of calf. 

70713 ............................................... Ulcer of ankle. 

70714 ............................................... Ulcer of heel and midfoot. 

70719 ............................................... Ulcer of other part of lower limb. 

7103 ................................................. Dermatomyositis. 

7104 ................................................. Polymyositis. 

7105 ................................................. Eosinophilia myalgia syndrome. 

7108 ................................................. Other specified diffuse diseases of connective tissue. 

71100 ............................................... Pyogenic arthritis, site unspecified. 

71101 ............................................... Pyogenic arthritis involving shoulder region. 

71102 ............................................... Pyogenic arthritis involving upper arm. 

71103 ............................................... Pyogenic arthritis involving forearm. 

71104 ............................................... Pyogenic arthritis involving hand. 

71105 ............................................... Pyogenic arthritis involving pelvic region and thigh. 

71106 ............................................... Pyogenic arthritis involving lower leg. 

71107 ............................................... Pyogenic arthritis involving ankle and foot. 

71108 ............................................... Pyogenic arthritis involving other specified sites. 

71109 ............................................... Pyogenic arthritis involving multiple sites. 

71110 ............................................... Arthropathy, site unspecified, associated with reiter’s disease and nonspecific urethritis. 

71111 ............................................... Arthropathy involving shoulder region associated with reiter’s disease and nonspecific urethritis. 

71112 ............................................... Arthropathy involving upper arm associated with reiter’s disease and nonspecific urethritis. 

71113 ............................................... Arthropathy involving forearm associated with reiter’s disease and nonspecific urethritis. 

71114 ............................................... Arthropathy involving hand associated with reiter’s disease and nonspecific urethritis. 

71115 ............................................... Arthropathy involving pelvic region and thigh associated with reiter’s disease and nonspecific urethritis. 

71116 ............................................... Arthropathy involving lower leg associated with reiter’s disease and nonspecific urethritis. 

71117 ............................................... Arthropathy involving ankle and foot associated with reiter’s disease and nonspecific urethritis. 

71118 ............................................... Arthropathy involving other specified sites associated with reiter’s disease and nonspecific urethritis. 

71119 ............................................... Arthropathy involving multiple sites associated with reiter’s disease and nonspecific urethritis. 

71120 ............................................... Arthropathy in behcet’s syndrome, site unspecified. 

71121 ............................................... Arthropathy in behcet’s syndrome involving shoulder region. 

71122 ............................................... Arthropathy in behcet’s syndrome involving upper arm. 

71123 ............................................... Arthropathy in behcet’s syndrome involving forearm. 

71124 ............................................... Arthropathy in behcet’s syndrome involving hand. 

71125 ............................................... Arthropathy in behcet’s syndrome involving pelvic region and thigh. 

71126 ............................................... Arthropathy in behcet’s syndrome involving lower leg. 

71127 ............................................... Arthropathy in behcet’s syndrome involving ankle and foot. 

71128 ............................................... Arthropathy in behcet’s syndrome involving other specified sites. 

71129 ............................................... Arthropathy in behcet’s syndrome involving multiple sites. 

71130 ............................................... Postdysenteric arthropathy, site unspecified. 

71131 ............................................... Postdysenteric arthropathy involving shoulder region. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25047 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

71132 ............................................... Postdysenteric arthropathy involving upper arm. 

71133 ............................................... Postdysenteric arthropathy involving forearm. 

71134 ............................................... Postdysenteric arthropathy involving hand. 

71135 ............................................... Postdysenteric arthropathy involving pelvic region and thigh. 

71136 ............................................... Postdysenteric arthropathy involving lower leg. 

71137 ............................................... Postdysenteric arthropathy involving ankle and foot. 

71138 ............................................... Postdysenteric arthropathy involving other specified sites. 

71139 ............................................... Postdysenteric arthropathy involving multiple sites. 

71140 ............................................... Arthropathy, site unspecified, associated with other bacterial diseases. 

71141 ............................................... Arthropathy involving shoulder region associated with other bacterial diseases. 

71142 ............................................... Arthropathy involving upper arm associated with other bacterial diseases. 

71143 ............................................... Arthropathy involving forearm associated with other bacterial diseases. 

71144 ............................................... Arthropathy involving hand associated with other bacterial diseases. 

71145 ............................................... Arthropathy involving pelvic region and thigh associated with other bacterial diseases. 

71146 ............................................... Arthropathy involving lower leg associated with other bacterial diseases. 

71147 ............................................... Arthropathy involving ankle and foot associated with other bacterial disease. 

71148 ............................................... Arthropathy involving other specified sites associated with other bacterial diseases. 

71149 ............................................... Arthropathy involving multiple sites associated with other bacterial diseases. 

71150 ............................................... Arthropathy, site unspecified, associated with other viral diseases. 

71151 ............................................... Arthropathy involving shoulder region associated with other viral diseases.

71152 ............................................... Arthropathy involving upper arm associated with other viral diseases. 

71153 ............................................... Arthropathy involving forearm associated with other viral diseases. 

71154 ............................................... Arthropathy involving hand associated with other viral diseases. 

71155 ............................................... Arthropathy involving pelvic region and thigh associated with other viral diseases. 

71156 ............................................... Arthropathy involving lower leg associated with other viral diseases. 

71157 ............................................... Arthropathy involving ankle and foot associated with other viral diseases. 

71158 ............................................... Arthropathy involving other specified sites associated with other viral diseases. 

71159 ............................................... Arthropathy involving multiple sites associated with other viral diseases. 

71160 ............................................... Arthropathy, site unspecified, associated with mycoses. 

71161 ............................................... Arthropathy involving shoulder region associated with mycoses. 

71162 ............................................... Arthropathy involving upper arm associated with mycoses. 

71163 ............................................... Arthropathy involving forearm associated with mycoses. 

71164 ............................................... Arthropathy involving hand associated with mycoses. 

71165 ............................................... Arthropathy involving pelvic region and thigh associated with mycoses. 

71166 ............................................... Arthropathy involving lower leg associated with mycoses. 

71167 ............................................... Arthropathy involving ankle and foot associated with mycoses. 

71168 ............................................... Arthropathy involving other specified sites associated with mycoses. 

71169 ............................................... Arthropathy involving multiple sites associated with mycoses. 

71170 ............................................... Arthropathy, site unspecified, associated with helminthiasis. 

71171 ............................................... Arthropathy involving shoulder region associated with helminthiasis. 

71172 ............................................... Arthropathy involving upper arm associated with helminthiasis. 

71173 ............................................... Arthropathy involving forearm associated with helminthiasis. 

71174 ............................................... Arthropathy involving hand associated with helminthiasis. 

71175 ............................................... Arthropathy involving pelvic region and thigh associated with helminthiasis. 

71176 ............................................... Arthropathy involving lower leg associated with helminthiasis. 

71177 ............................................... Arthropathy involving ankle and foot associated with helminthiasis. 

71178 ............................................... Arthropathy involving other specified sites associated with helminthiasis. 

71179 ............................................... Arthropathy involving multiple sites associated with helminthiasis. 

71180 ............................................... Arthropathy, site unspecified, associated with other infectious and parasitic diseases. 

71181 ............................................... Arthropathy involving shoulder region associated with other infectious and parasitic diseases. 

71182 ............................................... Arthropathy involving upper arm associated with other infectious and parasitic diseases. 

71183 ............................................... Arthropathy involving forearm associated with other infectious and parasitic diseases. 

71184 ............................................... Arthropathy involving hand associated with other infectious and parasitic diseases. 

71185 ............................................... Arthropathy involving pelvic region and thigh associated with other infectious and parasitic diseases. 

71186 ............................................... Arthropathy involving lower leg associated with other infectious and parasitic diseases. 

71187 ............................................... Arthropathy involving ankle and foot associated with other infectious and parasitic diseases. 

71188 ............................................... Arthropathy involving other specified sites associated with other infectious and parasitic diseases. 

71189 ............................................... Arthropathy involving multiple sites associated with other infectious and parasitic diseases. 

71190 ............................................... Unspecified infective arthritis, site unspecified. 

71191 ............................................... Unspecified infective arthritis involving shoulder region. 

71192 ............................................... Unspecified infective arthritis involving upper arm. 

71193 ............................................... Unspecified infective arthritis involving forearm. 

71194 ............................................... Unspecified infective arthritis involving hand. 

71195 ............................................... Unspecified infective arthritis involving pelvic region and thigh. 

71196 ............................................... Unspecified infective arthritis involving lower leg. 

71197 ............................................... Unspecified infective arthritis involving ankle and foot. 

71198 ............................................... Unspecified infective arthritis involving other specified sites. 

71199 ............................................... Unspecified infective arthritis involving multiple sites. 

71431 ............................................... Acute polyarticular juvenile rheumatoid arthritis. 

71910 ............................................... Hemarthrosis, site unspecified. 

71911 ............................................... Herarthrosis involving shoulder region. 

71912 ............................................... Hemarthorsis involving upper arm. 

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25048 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

71913 ............................................... Hemarthrosis involving forearm. 

71914 ............................................... Hemarthrosis involving hand. 

71915 ............................................... Hemarthrosis involving pelvic region and thigh. 

71916 ............................................... Hemarthrosis involving lower leg. 

71917 ............................................... Hemarthrosis involving ankle and foot. 

71918 ............................................... Hemarthrosis involving other specified sites. 

71919 ............................................... Hemarthrosis involving multiple sites. 

7211 ................................................. Cervical spondylosis with myelopathy. 

72141 ............................................... Spondylosis with myelopathy, thoracic region. 

72142 ............................................... Spondylosis with myelopathy, lumbar region. 

7217 ................................................. Traumatic spondylopathy. 

72191 ............................................... Spondylosis of unspecified site with myelopathy. 

72271 ............................................... Intervertebral disc disorder with myelopathy, cervical region. 

72272 ............................................... Intervertebral disc disorder with myelopathy, thoracic region. 

72273 ............................................... Intervertebral disc disorder with myelopathy, lumbar region. 

7280 ................................................. Infective myositis. 

72888 ............................................... Rhabdomyolysis. 

72971 ............................................... Nontraumatic compartment syndrome of upper extremity. 

72972 ............................................... Nontraumatic compartment syndrome of lower extremity. 

72973 ............................................... Nontraumatic compartment syndrome of abdomen. 

72979 ............................................... Nontraumatic compartment syndrome of other sites. 

73000 ............................................... Acute osteomyelitis, site unspecified. 

73001 ............................................... Acute osteomyelitis involving shoulder region. 

73002 ............................................... Acute osteomyelitis involving upper arm. 

73003 ............................................... Acute osteomyelitis involving forearm. 

73004 ............................................... Acute osteomyelitis involving hand. 

73005 ............................................... Acute osteomyelitis involving pelvic region and thigh. 

73006 ............................................... Acute osteomyelitis involving lower leg. 

73007 ............................................... Acute osteomyelitis involving ankle and foot. 

73008 ............................................... Acute osteomyelitis involving other specified sites. 

73009 ............................................... Acute osteomyelitis involving multiple sites. 

73010 ............................................... Chronic osteomyelitis, site unspecified. 

73011 ............................................... Chronic osteomyelitis involving shoulder region. 

73012 ............................................... Chronic osteomyelitis involving upper arm. 

73013 ............................................... Chronic osteomyelitis involving forearm. 

73014 ............................................... Chronic osteomyelitis involving hand. 

73015 ............................................... Chronic osteomyelitis involving pelvic region and thigh. 

73016 ............................................... Chronic osteomyelitis involving lower leg. 

73017 ............................................... Chronic osteomyelitis involving ankle and foot. 

73018 ............................................... Chronic osteomyelitis involving other specified sites. 

73019 ............................................... Chronic osteomyelitis involving multiple sites. 

73020 ............................................... Unspecified osteomyelitis, site unspecified. 

73021 ............................................... Unspecified osteomyelitis involving shoulder region. 

73022 ............................................... Unspecified osteomyelitis involving upper arm. 

73023 ............................................... Unspecified osteomyelitis involving forearm. 

73024 ............................................... Unspecified osteomyelitis involving hand. 

73025 ............................................... Unspecified osteomyelitis involving pelvic region and thigh. 

73026 ............................................... Unspecified osteomyelitis involving lower leg. 

73027 ............................................... Unspecified osteomyelitis involving ankle and foot. 

73028 ............................................... Unspecified osteomyelitis involving other specified sites. 

73029 ............................................... Unspecified osteomyelitis involving multiple sites. 

73080 ............................................... Other infections involving bone in diseases classified elsewhere, site unspecified. 

73081 ............................................... Other infections involving bone of shoulder region in diseases classified elsewhere. 

73082 ............................................... Other infections involving upper arm bone in diseases classified elsewhere.

73083 ............................................... Other infections involving forearm bone in diseases classified elsewhere. 

73084 ............................................... Other infections involving hand bone in diseases classified elsewhere. 

73085 ............................................... Other infections involving bone of pelvic region and thigh in diseases classified elsewhere. 

73086 ............................................... Other infections involving lower leg bone in diseases classified elsewhere.

73087 ............................................... Other infections involving ankle and foot bone in diseases classified elsewhere. 

73088 ............................................... Other infections involving bone, of other specified sites, in diseases classified elsewhere. 

73089 ............................................... Other infections involving bone, of multiple sites, in diseases classified elsewhere. 

73090 ............................................... Unspecified infection of bone, site unspecified. 

73091 ............................................... Unspecified infection of bone of shoulder region. 

73092 ............................................... Unspecified infection of upper arm bone. 

73093 ............................................... Unspecified infection of forearm bone. 

73094 ............................................... Unspecified infection of hand bone. 

73095 ............................................... Unspecified infection of bone of pelvic region and thigh. 

73096 ............................................... Unspecified infection of lower leg bone. 

73097 ............................................... Unspecified infection of ankle and foot bone. 

73098 ............................................... Unspecified infection of bone of other specified sites. 

73099 ............................................... Unspecified infection of bone in multiple sites. 

73310 ............................................... Pathologic fracture, unspecified site. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25049 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

73311 ............................................... Pathologic fracture of humerus. 

73312 ............................................... Pathologic fracture of distal radius and ulna. 

73313 ............................................... Pathologic fracture of vertebrae. 

73314 ............................................... Pathologic fracture of neck of femur. 

73315 ............................................... Pathologic fracture of other specified part of femur. 

73316 ............................................... Pathologic fracture of tibia or fibula. 

73319 ............................................... Pathologic fracture of other specified site. 

73340 ............................................... Aseptic necrosis of bone, site unspecified. 

73341 ............................................... Aseptic necrosis of head of humerus. 

73342 ............................................... Aseptic necrosis of head and neck of femur. 

73343 ............................................... Aseptic necrosis of medial femoral condyle. 

73344 ............................................... Aseptic necrosis of talus. 

73345 ............................................... Aseptic necrosis of bone, jaw. 

73349 ............................................... Aseptic necrosis of other bone sites. 

73381 ............................................... Malunion of fracture. 

73382 ............................................... Nonunion of fracture. 

74100 ............................................... Spina bifida, unspecified region, with hydrocephalus. 

74101 ............................................... Spina bifida, cervical region, with hydrocephalus. 

74102 ............................................... Spina bifida, dorsal (thoracic) region, with hydrocephalus. 

74103 ............................................... Spina bifida, lumbar region, with hydrocephalus. 

7420 ................................................. Encephalocele. 

7424 ................................................. Other specified congenital anomalies of brain. 

74512 ............................................... Corrected transposition of great vessels. 

7454 ................................................. Ventricular septal defect. 

7455 ................................................. Ostium secundum type atrial septal defect. 

74560 ............................................... Endocardial cushion defect, unspecified type. 

74561 ............................................... Ostium primum defect. 

74569 ............................................... Other endocardial cushion defects. 

74600 ............................................... Congenital pulmonary valve anomaly, unspecified. 

74602 ............................................... Stenosis of pulmonary valve, congenital. 

74609 ............................................... Other congenital anomalies of pulmonary valve. 

7463 ................................................. Congenital stenosis of aortic valve. 

7464 ................................................. Congenital insufficiency of aortic valve. 

7465 ................................................. Congenital mitral stenosis. 

7466 ................................................. Congenital mitral insufficiency. 

74683 ............................................... Infundibular pulmonic stenosis, congenital. 

74685 ............................................... Coronary artery anomaly, congenital. 

74687 ............................................... Malposition of heart and cardiac apex. 

7470 ................................................. Patent ductus arteriosus. 

74710 ............................................... Coarctation of aorta (preductal) (postductal). 

74720 ............................................... Congenital anomaly of aorta, unspecified. 

74721 ............................................... Congenital anomalies of aortic arch. 

74722 ............................................... Congenital atresia and stenosis of aorta. 

74729 ............................................... Other congenital anomalies of aorta. 

74740 ............................................... Congenital anomaly of great veins, unspecified. 

74741 ............................................... Total anomalous pulmonary venous connection. 

74742 ............................................... Partial anomalous pulmonary venous connection. 

74749 ............................................... Other anomalies of great veins. 

74782 ............................................... Spinal vessel anolmaly. 

74789 ............................................... Other specified congenital anomalies of circulatory system. 

7479 ................................................. Unspecified congenital anomaly of circulatory system. 

7483 ................................................. Other congenital anomalies of larynx, trachea, and bronchus. 

7484 ................................................. Congenital cystic lung. 

74861 ............................................... Congenital bronchiectasis. 

7504 ................................................. Other specified congenital anomalies of esophagus. 

7511 ................................................. Congenital atresia and stenosis of small intestine. 

7512 ................................................. Congenital atresia and stenosis of large intestine, rectum, and anal canal. 

7513 ................................................. Hirschsprung’s disease and other congenital functional disorders of colon.

7514 ................................................. Congenital anomalies of intestinal fixation. 

7515 ................................................. Other congenital anomalies of intestine. 

75160 ............................................... Unspecified congenital anomaly of gallbladder, bile ducts, and liver. 

75162 ............................................... Congenital cystic disease of liver. 

75169 ............................................... Other congenital anomalies of gallbladder, bile ducts, and liver. 

7517 ................................................. Congenital anomalies of pancreas. 

7530 ................................................. Renal agenesis and dysgenesis. 

75310 ............................................... Cystic kidney disease, unspecified. 

75311 ............................................... Congenital single renal cyst. 

75312 ............................................... Polycystic kidney, unspecified type. 

75313 ............................................... Polycystic kidney, autosomal dominant. 

75314 ............................................... Polycystic kidney, autosomal recessive. 

75315 ............................................... Renal dysplasia. 

75316 ............................................... Medullary cystic kidney. 

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25050 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

75317 ............................................... Medullary sponge kidney. 

75319 ............................................... Other specified cystic kidney disease. 

75320 ............................................... Unspecified obstructive defect of renal pelvis and ureter. 

75321 ............................................... Congenital obstruction of ureteropelvic junction. 

75322 ............................................... Congenital obstruction of ureterovesical junction. 

75323 ............................................... Congenital ureterocele. 

75329 ............................................... Other obstructive defect of renal pelvis and ureter. 

7535 ................................................. Exstrophy of urinary bladder. 

7536 ................................................. Congenital atresia and stenosis of urethra and bladder neck. 

7542 ................................................. Congenital musculoskeletal deformities of spine. 

75489 ............................................... Other specified nonteratogenic anomalies. 

75613 ............................................... Absence of vertebra, congenital. 

7563 ................................................. Other congenital anomalies of ribs and sternum. 

75651 ............................................... Osteogenesis imperfecta. 

75652 ............................................... Osteopetrosis. 

75683 ............................................... Ehlers-danlos syndrome. 

7581 ................................................. Patau’s syndrome. 

7582 ................................................. Edwards’ syndrome. 

75831 ............................................... Cri-du-chat syndrome. 

75833 ............................................... Other microdeletions. 

75839 ............................................... Other autosomal deletions. 

7590 ................................................. Anomalies of spleen, congenital. 

7593 ................................................. Situs inversus. 

7595 ................................................. Tuberous sclerosis. 

7596 ................................................. Other congenital hamartoses, not elsewhere classified. 

7597 ................................................. Multiple congenital anomalies, so described. 

75981 ............................................... Prader-willi syndrome. 

75982 ............................................... Marfan syndrome. 

75989 ............................................... Other specified congenital anomalies. 

76711 ............................................... Epicranial subaponeurotic hemorrhage (massive). 

7704 ................................................. Primary atelectasis of newborn. 

7705 ................................................. Other and unspecified atelectasis of newborn. 

77081 ............................................... Primary apnea of newborn. 

77082 ............................................... Other apnea of newborn. 

77083 ............................................... Cyanotic attacks of newborn. 

7710 ................................................. Congenital rubella. 

7714 ................................................. Omphalitis of the newborn. 

7715 ................................................. Neonatal infective mastitis. 

77182 ............................................... Urinary tract infection of newborn. 

77183 ............................................... Bacteremia of newborn. 

77189 ............................................... Other infections specific to the perinatal period. 

77210 ............................................... Intraventricular hemorrhage unspecified grade. 

77211 ............................................... Intraventricular hemorrhage grade i. 

77212 ............................................... Intraventricular hemorrhage grade ii. 

7725 ................................................. Adrenal hemorrhage of fetus or newborn. 

7751 ................................................. Neonatal diabetes mellitus. 

7752 ................................................. Neonatal myasthenia gravis. 

7753 ................................................. Neonatal thyrotoxicosis. 

7754 ................................................. Hypocalcemia and hypomagnesemia of newborn. 

77581 ............................................... Other acidosis of newborn. 

77589 ............................................... Other neonatal endocrine and metabolic disturbances. 

7760 ................................................. Hemorrhagic disease of newborn. 

7763 ................................................. Other transient neonatal disorders of coagulation. 

7765 ................................................. Congenital anemia. 

7766 ................................................. Anemia of prematurity. 

7774 ................................................. Transitory ileus of newborn. 

7781 ................................................. Sclerema neonatorum. 

7785 ................................................. Other and unspecified edema of newborn. 

7794 ................................................. Drug reactions and intoxications specific to newborn. 

7795 ................................................. Drug withdrawal syndrome in newborn. 

78001 ............................................... Coma. 

78003 ............................................... Persistent vegetative state. 

7801 ................................................. Hallucinations. 

78031 ............................................... Febrile convulsions (simple), unspecified. 

78032 ............................................... Complex febrile convulsions. 

7814 ................................................. Transient paralysis of limb. 

7816 ................................................. Meningismus. 

7817 ................................................. Tetany. 

7818 ................................................. Neurological neglect syndrome. 

7824 ................................................. Jaundice, unspecified, not of newborn. 

7843 ................................................. Aphasia. 

7854 ................................................. Gangrene. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25051 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

78550 ............................................... Shock, unspecified. 

78604 ............................................... Cheyne-stokes respiration. 

7863 ................................................. Hemoptysis. 

7888 ................................................. Extravasation of urine. 

78951 ............................................... Malignant ascites. 

78959 ............................................... Other ascites. 

79001 ............................................... Precipitous drop in hematocrit. 

7907 ................................................. Bacteremia. 

7911 ................................................. Chyluria. 

7913 ................................................. Myoglobinuria. 

79901 ............................................... Asphyxia. 

7994 ................................................. Cachexia. 

80000 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with state of consciousness unspecified. 

80001 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with no loss of consciousness. 

80002 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with brief (less than one hour) loss of consciousness. 

80006 ............................................... Closed fracture of vault of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration. 

80009 ............................................... Closed fracture of vault of skull without mention of intracranial injury, with concussion, unspecified. 

80040 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. 

80041 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. 

80042 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of 

consciousness. 

80046 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. 

80049 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80100 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with state of consciousness unspecified. 

80101 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness. 

80102 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with brief (less than one hour) loss of consciousness. 

80106 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration. 

80109 ............................................... Closed fracture of base of skull without mention of intra cranial injury, with concussion, unspecified. 

80140 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. 

80141 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. 

80142 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of 

consciousness. 

80146 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. 

80149 ............................................... Closed fracture of base of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. 

8021 ................................................. Open fracture of nasal bones. 

80220 ............................................... Closed fracture of unspecified site of mandible. 

80221 ............................................... Closed fracture of condylar process of mandible. 

80222 ............................................... Closed fracture of subcondylar process of mandible. 

80223 ............................................... Closed fracture of coronoid process of mandible. 

80224 ............................................... Closed fracture of unspecified part of ramus of mandible. 

80225 ............................................... Closed fracture of angle of jaw. 

80226 ............................................... Closed fracture of symphysis of body of mandible. 

80227 ............................................... Closed fracture of alveolar border of body of mandible. 

80228 ............................................... Closed fracture of other and unspecified part of body of mandible. 

80229 ............................................... Closed fracture of multiple sites of mandible. 

80230 ............................................... Open fracture of unspecified site of mandible. 

80231 ............................................... Open fracture of condylar process of mandible. 

80232 ............................................... Open fracture of subcondylar process of mandible. 

80233 ............................................... Open fracture of coronoid process of mandible. 

80234 ............................................... Open fracture of unspecified part of ramus of mandible. 

80235 ............................................... Open fracture of angle of jaw. 

80236 ............................................... Open fracture of symphysis of body of mandible. 

80237 ............................................... Open fracture of alveolar border of body of mandible. 

80238 ............................................... Open fracture of body of mandible, other and unspecified. 

80239 ............................................... Open fracture of multiple sites of mandible. 

8024 ................................................. Closed fracture of malar and maxillary bones. 

8025 ................................................. Open fracture of malar and maxillary bones. 

8026 ................................................. Closed fracture of orbital floor (blow-out). 

8027 ................................................. Open fracture of orbital floor (blow-out). 

8028 ................................................. Closed fracture of other facial bones. 

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25052 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

8029 ................................................. Open fracture of other facial bones. 

80300 ............................................... Other closed skull fracture without mention of intracranial injury, with state of consciousness unspecified. 

80301 ............................................... Other closed skull fracture without mention of intracranial injury, with no loss of consciousness. 

80302 ............................................... Other closed skull fracture without mention of intracranial injury, with brief (less than one hour) loss of consciousness. 

80306 ............................................... Other closed skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration. 

80309 ............................................... Other closed skull fracture without mention of intracranial injury, with concussion, unspecified. 

80340 ............................................... Other closed skull fracture with intracranial injury of other and unspecified nature, with state of consciousness unspecified. 

80341 ............................................... Other closed skull fracture with intracranial injury of other and unspecified nature, with no loss of consciousness. 

80342 ............................................... Other closed skull fracture with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. 

80346 ............................................... Other site of closed skull fracture with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. 

80349 ............................................... Other site of closed skull fracture with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80400 ............................................... Closed fractures involving skull or face with other bones, without mention of intracranial injury, with state of consciousness unspecified. 

80401 ............................................... Closed fractures involving skull or face with other bones, without mention of intracranial injury, with no loss of consciousness. 

80402 ............................................... Closed fractures involving skull or face with other bones, without mention of intracranial injury, with brief (less than one hour) 

loss of consciousness. 

80406 ............................................... Closed fractures involving skull of face with other bones, without mention of intracranial injury, with loss of consciousness of 

unspecified duration. 

80409 ............................................... Closed fractures involving skull of face with other bones, without mention of intracranial injury, with concussion, unspecified. 

80440 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with state of 

consciousness unspecified. 

80441 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with no loss of 

consciousness. 

80442 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with brief (less 

than one hour) loss of consciousness. 

80446 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with loss of 

consciousness of unspecified duration. 

80449 ............................................... Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80450 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with state of consciousness unspecified. 

80451 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with no loss of consciousness. 

80452 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with brief (less than one hour) 

loss of consciousness. 

80456 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with loss of consciousness of unspecified duration. 

80459 ............................................... Open fractures involving skull or face with other bones, without mention of intracranial injury, with concussion, unspecified. 

80490 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with state of 

consciousness unspecified. 

80491 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with no loss of 

consciousness. 

80492 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with brief (less 

than one hour) loss of consciousness. 

80496 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. 

80499 ............................................... Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with concussion, unspecified. 

80500 ............................................... Closed fracture of cervical vertebra, unspecified level. 

80501 ............................................... Closed fracture of first cervical vertebra. 

80502 ............................................... Closed fracture of second cervical vertebra. 

80503 ............................................... Closed fracture of third cervical vertebra. 

80504 ............................................... Closed fracture of fourth cervical vertebra. 

80505 ............................................... Closed fracture of fifth cervical vertebra. 

80506 ............................................... Closed fracture of sixth cervical vertebra. 

80507 ............................................... Closed fracture of seventh cervical vertebra. 

80508 ............................................... Closed fracture of multiple cervical vertebrae. 

8052 ................................................. Closed fracture of dorsal (thoracic) vertebra without mention of spinal cord injury. 

8054 ................................................. Closed fracture of lumbar vertebra without mention of spinal cord injury. 

8056 ................................................. Closed fracture of sacrum and coccyx without mention of spinal cord injury. 

8058 ................................................. Closed fracture of unspecified part of vertebral column without mention of spinal cord injury. 

80700 ............................................... Closed fracture of rib(s), unspecified. 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25053 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

80701 ............................................... Closed fracture of one rib. 

80702 ............................................... Closed fracture of two ribs. 

80703 ............................................... Closed fracture of three ribs. 

80704 ............................................... Closed fracture of four ribs. 

80705 ............................................... Closed fracture of five ribs. 

80706 ............................................... Closed fracture of six ribs. 

80707 ............................................... Closed fracture of seven ribs. 

80708 ............................................... Closed fracture of eight or more ribs. 

80709 ............................................... Closed fracture of multiple ribs, unspecified. 

8072 ................................................. Closed fracture of sternum. 

8082 ................................................. Closed fracture of pubis. 

80841 ............................................... Closed fracture of ilium. 

80842 ............................................... Closed fracture of ischium. 

80843 ............................................... Multiple closed pelvic fractures with disruption of pelvic circle. 

80849 ............................................... Closed fracture of other specified part of pelvis. 

8088 ................................................. Unspecified closed fracture of pelvis. 

8090 ................................................. Fracture of bones of trunk, closed. 

81010 ............................................... Open fracture of clavicle, unspecified part. 

81011 ............................................... Open fracture of sternal end of clavicle. 

81012 ............................................... Open fracture of shaft of clavicle. 

81013 ............................................... Open fracture of acromial end of clavicle. 

81110 ............................................... Open fracture of scapula, unspecified part. 

81111 ............................................... Open fracture of acromial process of scapula. 

81112 ............................................... Open fracture of coracoid process. 

81113 ............................................... Open fracture of glenoid cavity and neck of scapula. 

81119 ............................................... Open fracture of other part of scapula. 

81200 ............................................... Fracture of unspecified part of upper end of humerus, closed. 

81201 ............................................... Fracture of surgical neck of humerus, closed. 

81202 ............................................... Fracture of anatomical neck of humerus, closed. 

81203 ............................................... Fracture of greater tuberosity of humerus, closed. 

81209 ............................................... Other closed fractures of upper end of humerus. 

81220 ............................................... Fracture of unspecified part of humerus, closed. 

81221 ............................................... Fracture of shaft of humerus, closed. 

81240 ............................................... Fracture of unspecified part of lower end of humerus, closed. 

81241 ............................................... Supracondylar fracture of humerus, closed. 

81242 ............................................... Fracture of lateral condyle of humerus, closed. 

81243 ............................................... Fracture of medial condyle of humerus, closed. 

81244 ............................................... Fracture of unspecified condyle(s) of humerus, closed. 

81249 ............................................... Other closed fractures of lower end of humerus. 

81320 ............................................... Fracture of shaft of radius or ulna, unspecified, closed. 

81321 ............................................... Fracture of shaft of radius (alone), closed. 

81322 ............................................... Fracture of shaft of ulna (alone), closed. 

81323 ............................................... Fracture of shaft of radius with ulna, closed. 

81340 ............................................... Closed fracture of lower end of forearm, unspecified. 

81341 ............................................... Colles’ fracture, closed. 

81342 ............................................... Other closed fractures of distal end of radius (alone). 

81343 ............................................... Fracture of distal end of ulna (alone), closed. 

81344 ............................................... Fracture of lower end of radius with ulna, closed. 

81345 ............................................... Torus fracture of radius. 

81380 ............................................... Closed fracture of unspecified part of forearm. 

81382 ............................................... Fracture of unspecified part of ulna (alone), closed. 

81383 ............................................... Fracture of unspecified part of radius with ulna, closed. 

81410 ............................................... Open fracture of carpal bone, unspecified. 

81411 ............................................... Open fracture of navicular (scaphoid) bone of wrist. 

81412 ............................................... Open fracture of lunate (semilunar) bone of wrist. 

81413 ............................................... Open fracture of triquetral (cuneiform) bone of wrist. 

81414 ............................................... Open fracture of pisiform bone of wrist. 

81415 ............................................... Open fracture of trapezium bone (larger multangular) of wrist. 

81416 ............................................... Open fracture of trapezoid bone (smaller multangular) of wrist. 

81417 ............................................... Open fracture of capitate bone (os magnum) of wrist. 

81418 ............................................... Open fracture of hamate (unciform) bone of wrist. 

81419 ............................................... Open fracture of other bone of wrist. 

81510 ............................................... Open fracture of metacarpal bone(s), site unspecified. 

81511 ............................................... Open fracture of base of thumb (first) metacarpal. 

81512 ............................................... Open fracture of base of other metacarpal bone(s). 

81513 ............................................... Open fracture of shaft of metacarpal bone(s). 

81514 ............................................... Open fracture of neck of metacarpal bone(s). 

81519 ............................................... Open fracture of multiple sites of metacarpus. 

81610 ............................................... Open fracture of phalanx or phalanges of hand, unspecified. 

81611 ............................................... Open fracture of middle or proximal phalanx or phalanges of hand. 

81612 ............................................... Open fracture of distal phalanx or phalanges of hand. 

81613 ............................................... Open fracture of multiple sites of phalanx or phalanges of hand. 

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25054 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

8171 ................................................. Multiple open fractures of hand bones. 

8181 ................................................. Ill-defined open fractures of upper limb. 

8190 ................................................. Multiple closed fractures involving both upper limbs, and upper limb with rib(s) and sternum. 

8191 ................................................. Multiple open fractures involving both upper limbs, and upper limb with rib(s) and sternum. 

82120 ............................................... Fracture of lower end of femur, unspecified part, closed. 

82121 ............................................... Fracture of femoral condyle, closed. 

82122 ............................................... Fracture of lower epiphysis of femur, closed. 

82123 ............................................... Supracondylar fracture of femur, closed. 

82129 ............................................... Other fracture of lower end of femur, closed. 

8220 ................................................. Closed fracture of patella. 

8221 ................................................. Open fracture of patella. 

82300 ............................................... Closed fracture of upper end of tibia. 

82302 ............................................... Closed fracture of upper end of fibula with tibia. 

82320 ............................................... Closed fracture of shaft of tibia. 

82322 ............................................... Closed fracture of shaft of fibula with tibia. 

82340 ............................................... Torus fracture, tibia alone. 

82342 ............................................... Torus fracture, fibula with tibia. 

82380 ............................................... Closed fracture of unspecified part of tibia. 

82382 ............................................... Closed fracture of unspecified part of fibula with tibia. 

8241 ................................................. Fracture of medial malleolus, open. 

8243 ................................................. Fracture of lateral malleolus, open. 

8245 ................................................. Bimalleolar fracture, open. 

8247 ................................................. Trimalleolar fracture, open. 

8249 ................................................. Unspecified fracture of ankle, open. 

8251 ................................................. Fracture of calcaneus, open. 

82530 ............................................... Fracture of unspecified bone(s) of foot (except toes), open. 

82531 ............................................... Fracture of astragalus, open. 

82532 ............................................... Fracture of navicular (scaphoid) bone of foot, open. 

82533 ............................................... Fracture of cuboid bone, open. 

82534 ............................................... Fracture of cuneiform bone of foot, open. 

82535 ............................................... Fracture of metatarsal bone(s), open. 

82539 ............................................... Other fractures of tarsal and metatarsal bones, open. 

8271 ................................................. Other, multiple and ill-defined fractures of lower limb, open. 

8301 ................................................. Open dislocation of jaw. 

83110 ............................................... Open dislocation of shoulder, unspecified. 

83111 ............................................... Open anterior dislocation of humerus. 

83112 ............................................... Open posterior dislocation of humerus. 

83113 ............................................... Open inferior dislocation of humerus. 

83114 ............................................... Open dislocation of acromioclavicular (joint). 

83119 ............................................... Open dislocation of other site of shoulder. 

83210 ............................................... Open dislocation of elbow, unspecified site. 

83211 ............................................... Open anterior dislocation of elbow. 

83212 ............................................... Open posterior dislocation of elbow. 

83213 ............................................... Open medial dislocation of elbow. 

83214 ............................................... Open lateral dislocation of elbow. 

83219 ............................................... Open dislocation of other site of elbow. 

83310 ............................................... Open dislocation of wrist, unspecified part. 

83311 ............................................... Open dislocation of radioulnar (joint), distal. 

83312 ............................................... Open dislocation of radiocarpal (joint). 

83313 ............................................... Open dislocation of midcarpal (joint). 

83314 ............................................... Open dislocation of carpometacarpal (joint). 

83315 ............................................... Open dislocation of metacarpal (bone), proximal end. 

83319 ............................................... Open dislocation of other part of wrist. 

83500 ............................................... Closed dislocation of hip, unspecified site. 

83501 ............................................... Closed posterior dislocation of hip. 

83502 ............................................... Closed obturator dislocation of hip. 

83503 ............................................... Other closed anterior dislocation of hip. 

8364 ................................................. Dislocation of patella, open. 

83660 ............................................... Dislocation of knee, unspecified part, open. 

83661 ............................................... Anterior dislocation of tibia, proximal end, open. 

83662 ............................................... Posterior dislocation of tibia, proximal end, open. 

83663 ............................................... Medial dislocation of tibia, proximal end, open. 

83664 ............................................... Lateral dislocation of tibia, proximal end, open. 

83669 ............................................... Other dislocation of knee, open. 

8371 ................................................. Open dislocation of ankle. 

83900 ............................................... Closed dislocation, cervical vertebra, unspecified. 

83901 ............................................... Closed dislocation, first cervical vertebra. 

83902 ............................................... Closed dislocation, second cervical vertebra. 

83903 ............................................... Closed dislocation, third cervical vertebra. 

83904 ............................................... Closed dislocation, fourth cervical vertebra. 

83905 ............................................... Closed dislocation, fifth cervical vertebra. 

83906 ............................................... Closed dislocation, sixth cervical vertebra. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25055 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

83907 ............................................... Closed dislocation, seventh cervical vertebra. 

83908 ............................................... Closed dislocation, multiple cervical vertebrae. 

83951 ............................................... Open dislocation, coccyx. 

83952 ............................................... Open dislocation, sacrum. 

83961 ............................................... Closed dislocation, sternum. 

83979 ............................................... Open dislocation, other location. 

8399 ................................................. Open dislocation, multiple and ill-defined sites. 

85011 ............................................... Concussion, with loss of consciousness of 30 minutes or less. 

85012 ............................................... Concussion, with loss of consciousness from 31 to 59 minutes. 

8502 ................................................. Concussion with moderate loss of consciousness. 

8503 ................................................. Concussion with prolonged loss of consciousness and return to pre-existing conscious level. 

8505 ................................................. Concussion with loss of consciousness of unspecified duration. 

85102 ............................................... Cortex (cerebral) contusion without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. 

85103 ............................................... Cortex (cerebral) contusion without mention of open intracranial wound, with moderate (1-24 hours) loss of consciousness. 

85104 ............................................... Cortex (cerebral) contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-exisiting conscious level. 

85106 ............................................... Cortex (cerebral) contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85142 ............................................... Cerebellar or brain stem contusion without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. 

85143 ............................................... Cerebellar or brain stem contusion without mention of open intracranial wound, with moderate (1-24 hours) loss of conscious- ness. 

85144 ............................................... Cerebellar or brain stem contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss consciousness and return to pre-existing conscious level. 

85146 ............................................... Cerebellar or brain stem contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration. 

85402 ............................................... Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with brief (less than one hour) 

loss of consciousness. 

85403 ............................................... Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with moderate (1-24 hours) loss 

of consciousness. 

85404 ............................................... Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with prolonged (more than 24 

hours) loss of consciousness and return to pre-existing conscious level. 

85406 ............................................... Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with loss of consciousness of 

unspecified duration. 

8600 ................................................. Traumatic pneumothorax without mention of open wound into thorax. 

86100 ............................................... Unspecified injury of heart without mention of open wound into thorax. 

86101 ............................................... Contusion of heart without mention of open wound into thorax. 

86120 ............................................... Unspecified injury of lung without open wound into thorax. 

86121 ............................................... Contusion of lung without open wound into thorax. 

8620 ................................................. Injury to diaphragm without mention of open wound into cavity. 

86229 ............................................... Injury to other specified intrathoracic organs without mention of open wound into cavity. 

8628 ................................................. Injury to multiple and unspecified intrathoracic organs without mention of open wound into cavity. 

8630 ................................................. Injury to stomach without mention of open wound into cavity. 

86320 ............................................... Injury to small intestine, unspecified site, without open wound into cavity. 

86321 ............................................... Injury to duodenum without open wound into cavity. 

86329 ............................................... Other injury to small intestine without open wound into cavity. 

86340 ............................................... Injury to colon, unspecified site, without mention of open wound into cavity. 

86341 ............................................... Injury to ascending (right) colon without open wound into cavity. 

86342 ............................................... Injury to transverse colon without open wound into cavity. 

86343 ............................................... Injury to descending (left) colon without open wound into cavity. 

86344 ............................................... Injury to sigmoid colon without open wound into cavity. 

86345 ............................................... Injury to rectum without open wound into cavity. 

86346 ............................................... Injury to multiple sites in colon and rectum without open wound into cavity. 

86349 ............................................... Other injury to colon and rectum, without open wound into cavity. 

86380 ............................................... Injury to gastrointestinal tract, unspecified site, without open wound into cavity. 

86381 ............................................... Injury to pancreas head without mention of open wound into cavity. 

86382 ............................................... Injury to pancreas body without mention of open wound into cavity. 

86383 ............................................... Injury to pancreas tail without mention of open wound into cavity. 

86384 ............................................... Injury to pancreas, multiple and unspecified sites, without open wound into cavity. 

86385 ............................................... Injury to appendix without open wound into cavity. 

86389 ............................................... Injury to other and unspecified gastrointestinal sites without open wound into cavity. 

86400 ............................................... Unspecified injury to liver without mention of open wound into cavity. 

86401 ............................................... Hematoma and contusion of liver without mention of open wound into cavity. 

86402 ............................................... Laceration of liver, minor, without mention of open wound into cavity. 

86405 ............................................... Laceration of liver, unspecified, without mention of open wound into cavity. 

86409 ............................................... Other injury to liver without mention of open wound into cavity. 

86500 ............................................... Unspecified injury to spleen without mention of open wound into cavity. 

86501 ............................................... Hematoma of spleen, without rupture of capsule, without mention of open wound into cavity. 

86502 ............................................... Capsular tears to spleen, without major disruption of parenchyma, without mention of open wound into cavity. 

86509 ............................................... Other injury into spleen without mention of open wound into cavity. 

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25056 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

86600 ............................................... Unspecified injury to kidney without mention of open wound into cavity. 

86601 ............................................... Hematoma of kidney, without rupture of capsule, without mention of open wound into cavity. 

86602 ............................................... Laceration of kidney without mention of open wound into cavity. 

8670 ................................................. Injury to bladder and urethra without mention of open wound into cavity. 

8672 ................................................. Injury to ureter without mention of open wound into cavity. 

8674 ................................................. Injury to uterus without mention of open wound into cavity. 

8676 ................................................. Injury to other specified pelvic organs without mention of open wound into cavity. 

8678 ................................................. Injury to unspecified pelvic organ without mention of open wound into cavity. 

86800 ............................................... Injury to unspecified intra-abdominal organ without mention of open wound into cavity. 

86801 ............................................... Injury to adrenal gland without mention of open wound into cavity. 

86802 ............................................... Injury to bile duct and gallbladder without mention of open wound into cavity. 

86803 ............................................... Injury to peritoneum without mention of open wound into cavity. 

86804 ............................................... Injury to retroperitoneum without mention of open wound into cavity. 

86809 ............................................... Injury to other and multiple intra-abdominal organs without mention of open wound into cavity. 

8690 ................................................. Internal injury to unspecified or ill-defined organs without mention of open wound into cavity. 

8702 ................................................. Laceration of eyelid involving lacrimal passages. 

8703 ................................................. Penetrating wound of orbit, without mention of foreign body. 

8704 ................................................. Penetrating wound of orbit with foreign body. 

8708 ................................................. Other specified open wounds of ocular adnexa. 

8709 ................................................. Unspecified open wound of ocular adnexa. 

8710 ................................................. Ocular laceration without prolapse of intraocular tissue. 

8711 ................................................. Ocular laceration with prolapse or exposure of intraocular tissue. 

8712 ................................................. Rupture of eye with partial loss of intraocular tissue. 

8713 ................................................. Avulsion of eye. 

8715 ................................................. Penetration of eyeball with magnetic foreign body. 

8716 ................................................. Penetration of eyeball with (nonmagnetic) foreign body. 

8719 ................................................. Unspecified open wound of eyeball. 

87212 ............................................... Open wound of auditory canal, complicated. 

87261 ............................................... Open wound of ear drum, uncomplicated. 

87262 ............................................... Open wound of ossicles, uncomplicated. 

87263 ............................................... Open wound of eustachian tube, uncomplicated. 

87264 ............................................... Open wound of cochlea, uncomplicated. 

87269 ............................................... Open wound of other and multiple sites, uncomplicated. 

87271 ............................................... Open wound of ear drum, complicated. 

87272 ............................................... Open wound of ossicles, complicated. 

87273 ............................................... Open wound of eustachian tube, complicated. 

87274 ............................................... Open wound of cochlea, complicated. 

87279 ............................................... Open wound of other and multiple sites, complicated. 

87323 ............................................... Open wound of nasal sinus, uncomplicated. 

87333 ............................................... Open wound of nasal sinus, complicated. 

8742 ................................................. Open wound of thyroid gland, without mention of complication. 

8743 ................................................. Open wound of thyroid gland, complicated. 

8744 ................................................. Open wound of pharynx, without mention of complication. 

8745 ................................................. Open wound of pharynx, complicated. 

8750 ................................................. Open wound of chest (wall), without mention of complication. 

8751 ................................................. Open wound of chest (wall), complicated. 

88020 ............................................... Open wound of shoulder region, with tendon involvement. 

88021 ............................................... Open wound of scapular region, with tendon involvement. 

88022 ............................................... Open wound of axillary region, with tendon involvement. 

88023 ............................................... Open wound of upper arm, with tendon involvement. 

88029 ............................................... Open wound of multiple sites of shoulder and upper arm, with tendon involvement. 

88120 ............................................... Open wound of forearm, with tendon involvement. 

88121 ............................................... Open wound of elbow, with tendon involvement. 

88122 ............................................... Open wound of wrist, with tendon involvement. 

8822 ................................................. Open wound of hand except fingers alone, with tendon involvement. 

8832 ................................................. Open wound of fingers, with tendon involvement. 

8842 ................................................. Multiple and unspecified open wound of upper limb, with tendon involvement. 

8870 ................................................. Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, without mention of complication. 

8871 ................................................. Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, complicated. 

8872 ................................................. Traumatic amputation of arm and hand (complete) (partial), unilateral, at or above elbow, without mention of complication. 

8873 ................................................. Traumatic amputation of arm and hand (complete) (partial), unilateral, at or above elbow, complicated. 

8874 ................................................. Traumatic amputation of arm and hand (complete) (partial), unilateral, level not specified, without mention of complication. 

8875 ................................................. Traumatic amputation of arm and hand (complete) (partial), unilateral, level not specified, complicated. 

8902 ................................................. Open wound of hip and thigh, with tendon involvement. 

8912 ................................................. Open wound of knee, leg (except thigh), and ankle, with tendon involvement. 

8922 ................................................. Open wound of foot except toe(s) alone, with tendon involvement. 

8932 ................................................. Open wound of toe(s), with tendon involvement. 

8942 ................................................. Multiple and unspecified open wound of lower limb, with tendon involvement. 

8960 ................................................. Traumatic amputation of foot (complete) (partial), unilateral, without mention of complication. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25057 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

8961 ................................................. Traumatic amputation of foot (complete) (partial), unilateral, complicated. 

8970 ................................................. Traumatic amputation of leg(s) (complete) (partial), unilateral, below knee, without mention of complication. 

8971 ................................................. Traumatic amputation of leg(s) (complete) (partial), unilateral, below knee, complicated. 

8972 ................................................. Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, without mention of complication. 

8973 ................................................. Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, complicated. 

8974 ................................................. Traumatic amputation of leg(s) (complete) (partial), unilateral, level not specified, without mention of complication. 

8975 ................................................. Traumatic amputation of leg(s) (complete) (partial), unilateral, level not specified, complicated. 

90000 ............................................... Injury to carotid artery, unspecified. 

90001 ............................................... Injury to common carotid artery. 

90002 ............................................... Injury to external carotid artery. 

90003 ............................................... Injury to internal carotid artery. 

9001 ................................................. Injury to internal jugular vein. 

90081 ............................................... Injury to external jugular vein. 

90082 ............................................... Injury to multiple blood vessels of head and neck. 

90089 ............................................... Injury to other specified blood vessels of head and neck. 

9009 ................................................. Injury to unspecified blood vessel of head and neck. 

90181 ............................................... Injury to intercostal artery or vein. 

90182 ............................................... Injury to internal mammary artery or vein. 

90189 ............................................... Injury to other specified blood vessels of thorax. 

9019 ................................................. Injury to unspecified blood vessel of thorax. 

90255 ............................................... Injury to uterine artery. 

90256 ............................................... Injury to uterine vein. 

90281 ............................................... Injury to ovarian artery. 

90282 ............................................... Injury to ovarian vein. 

90289 ............................................... Injury to other specified blood vessels of abdomen and pelvis. 

9029 ................................................. Injury to unspecified blood vessel of abdomen and pelvis. 

9031 ................................................. Injury to brachial blood vessels. 

9032 ................................................. Injury to radial blood vessels. 

9033 ................................................. Injury to ulnar blood vessels. 

9034 ................................................. Injury to palmar artery. 

9035 ................................................. Injury to digital blood vessels. 

9038 ................................................. Injury to other specified blood vessels of upper extremity. 

9039 ................................................. Injury to unspecified blood vessel of upper extremity. 

9043 ................................................. Injury to saphenous veins. 

90450 ............................................... Injury to tibial vessel(s), unspecified. 

90451 ............................................... Injury to anterior tibial artery. 

90452 ............................................... Injury to anterior tibial vein. 

90453 ............................................... Injury to posterior tibial artery. 

90454 ............................................... Injury to posterior tibial vein. 

9046 ................................................. Injury to deep plantar blood vessels. 

9047 ................................................. Injury to other specified blood vessels of lower extremity. 

9048 ................................................. Injury to unspecified blood vessel of lower extremity. 

9049 ................................................. Injury to blood vessels of unspecified site. 

9251 ................................................. Crushing injury of face and scalp. 

9252 ................................................. Crushing injury of neck. 

92800 ............................................... Crushing injury of thigh. 

92801 ............................................... Crushing injury of hip. 

9340 ................................................. Foreign body in trachea. 

9341 ................................................. Foreign body in main bronchus. 

9348 ................................................. Foreign body in other specified parts bronchus and lung. 

9405 ................................................. Burn with resulting rupture and destruction of eyeball. 

94130 ............................................... Full-thickness skin loss due to burn (third degree nos) of unspecified site of face and head. 

94131 ............................................... Full-thickness skin loss due to burn (third degree nos) of ear (any part). 

94132 ............................................... Full-thickness skin loss due to burn (third degree nos) of of eye (with other parts of face, head, and neck). 

94133 ............................................... Full-thickness skin loss due to burn (third degree nos) of lip(s). 

94134 ............................................... Full-thickness skin loss due to burn (third degree nos) of chin. 

94135 ............................................... Full-thickness skin loss due to burn (third degree nos) of nose (septum). 

94136 ............................................... Full-thickness skin loss due to burn (third degree nos) of scalp (any part). 

94137 ............................................... Full-thickness skin loss due to burn (third degree nos) of forehead and cheek. 

94138 ............................................... Full-thickness skin loss due to burn (third degree nos) of neck. 

94139 ............................................... Full-thickness skin loss due to burn (third degree nos) of multiple sites (except with eye) of face, head, and neck. 

94140 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of face and head, without mention of 

loss of body part. 

94141 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), without mention of loss of ear. 

94142 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), without 

mention of loss of body part. 

94143 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), without mention of loss of lip(s). 

94144 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of chin, without mention of loss of chin. 

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25058 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

94145 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), without mention of loss of nose. 

94146 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), without mention of loss of scalp. 

94147 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, without mention of loss of forehead and cheek. 

94148 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of neck, without mention of loss of neck. 

94149 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except with eye) of face, head, and neck, 

without mention of loss of a body part. 

94150 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of face and head, unspecified site, with loss of body part. 

94151 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), with loss of ear. 

94152 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), with loss 

of a body part. 

94153 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), with loss of lip(s). 

94154 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of chin, with loss of chin. 

94155 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), with loss of nose. 

94156 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), with loss of scalp. 

94157 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, with loss of forehead and cheek. 

94158 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of neck, with loss of neck. 

94159 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except eye) of face, head, and neck, with 

loss of a body part. 

94230 ............................................... Full-thickness skin loss due to burn (third degree nos) of unspecified site of trunk. 

94231 ............................................... Full-thickness skin loss due to burn (third degree nos) of breast. 

94232 ............................................... Full-thickness skin loss due to burn (third degree nos) of chest wall, excluding breast and nipple. 

94233 ............................................... Full-thickness skin loss due to burn (third degree nos) of abdominal wall. 

94234 ............................................... Full-thickness skin loss due to burn (third degree nos) of back (any part).

94235 ............................................... Full-thickness skin loss due to burn (third degree nos) of genitalia. 

94239 ............................................... Full-thickness skin loss due to burn (third degree nos) of other and multiple sites of trunk. 

94240 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of trunk, unspecified site, without mention of loss of body 

part. 

94241 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of breast, without mention of loss of breast. 

94242 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of chest wall, excluding breast and nipple, without mention 

of loss of chest wall. 

94243 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of abdominal wall, without mention of loss of abdominal 

wall. 

94244 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of back (any part), without mention of loss of back. 

94245 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of genitalia, without mention of loss of genitalia. 

94249 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of other and multiple sites of trunk, without mention of loss 

of body part. 

94250 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of trunk, with loss of body part. 

94251 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of breast, with loss of breast. 

94252 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of chest wall, excluding breast and nipple, with loss of 

chest wall. 

94253 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of abdominal wall with loss of abdominal wall. 

94254 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of back (any part), with loss of back. 

94255 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of genitalia, with loss of genitalia. 

94259 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of other and multiple sites of trunk, with loss of a body 

part. 

94330 ............................................... Full-thickness skin loss due to burn (third degree nos) of unspecified site of upper limb. 

94331 ............................................... Full-thickness skin loss due to burn (third degree nos) of forearm. 

94332 ............................................... Full-thickness skin loss due to burn (third degree nos) of elbow. 

94333 ............................................... Full-thickness skin loss due to burn (third degree nos) of upper arm. 

94334 ............................................... Full-thickness skin loss due to burn (third degree nos) of axilla. 

94335 ............................................... Full-thickness skin loss due to burn (third degree nos) of shoulder. 

94336 ............................................... Full-thickness skin loss due to burn (third degree nos) of scapular region.

94339 ............................................... Full-thickness skin loss due to burn (third degree nos) of multiple sites of upper limb, except wrist and hand. 

94340 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of upper limb, without mention of loss 

of a body part. 

94341 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of forearm, without mention of loss of forearm. 

94342 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of elbow, without mention of loss of elbow. 

94343 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of upper arm, without mention of loss of upper arm. 

94344 ............................................... Deep necrosis of underlying tissues due to burn of axilla, without mention of loss of axilla. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25059 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

94345 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of shoulder, without mention of loss of shoulder. 

94346 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of scapular region, without mention of loss of scapula. 

94349 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of upper limb, except wrist and hand, 

without mention of loss of upper limb. 

94350 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of upper limb, with loss of a body part. 

94351 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of forearm, with loss of forearm. 

94352 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of elbow, with loss of elbow. 

94353 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of upper arm, with loss of upper arm. 

94354 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of axilla, with loss of axilla. 

94355 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of shoulder, with loss of shoulder. 

94356 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of scapular region, with loss of scapula. 

94359 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of upper limb, except wrist and hand, with 

loss of upper limb. 

94430 ............................................... Full-thickness skin loss due to burn (third degree nos) of unspecified site of hand. 

94431 ............................................... Full-thickness skin loss due to burn (third degree nos) of single digit (finger (nail)) other than thumb. 

94432 ............................................... Full-thickness skin loss due to burn (third degree nos) of thumb (nail). 

94433 ............................................... Full-thickness skin loss due to burn (third degree nos) of two or more digits of hand, not including thumb. 

94434 ............................................... Full-thickness skin loss due to burn (third degree nos) of two or more digits of hand including thumb. 

94435 ............................................... Full-thickness skin loss due to burn (third degree nos) of palm of hand. 

94436 ............................................... Full-thickness skin loss due to burn (third degree nos) of back of hand. 

94437 ............................................... Full-thickness skin loss due to burn (third degree nos) of wrist. 

94438 ............................................... Full-thickness skin loss due to burn (third degree nos) of multiple sites of wrist(s) and hand(s). 

94440 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of hand, without mention of loss of 

hand. 

94441 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of single digit (finger (nail)) other than thumb, without 

mention of loss of finger. 

94442 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of thumb (nail), without mention of loss of thumb. 

94443 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand, not including thumb, without 

mention of fingers. 

94444 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand including thumb, without 

mention of loss of fingers. 

94445 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of palm of hand, without mention of loss of palm. 

94446 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of back of hand, without mention of loss of back of hand. 

94447 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of wrist, without mention of loss of wrist. 

94448 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of wrist(s) and hand(s), without mention of 

loss of a body part. 

94450 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of hand, with loss of hand. 

94451 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of single digit (finger (nail)) other than thumb, with loss of 

finger. 

94452 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of thumb (nail), with loss of thumb. 

94453 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand, not including thumb, with 

loss of fingers. 

94454 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand including thumb, with loss of 

fingers. 

94455 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of palm of hand, with loss of palm of hand. 

94456 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of back of hand, with loss of back of hand. 

94457 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of wrist, with loss of wrist. 

94458 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of wrist(s) and hand(s), with loss of a 

body part. 

94530 ............................................... Full-thickness skin loss due to burn (third degree nos) of unspecified site of lower limb. 

94531 ............................................... Full-thickness skin loss due to burn (third degree nos) of toe(s) (nail). 

94532 ............................................... Full-thickness skin loss due to burn (third degree nos) of foot. 

94533 ............................................... Full-thickness skin loss due to burn (third degree nos) of ankle. 

94534 ............................................... Full-thickness skin loss due to burn (third degree nos) of lower leg. 

94535 ............................................... Full-thickness skin loss due to burn (third degree nos) of knee. 

94536 ............................................... Full-thickness skin loss due to burn (third degree nos) of thigh (any part). 

94539 ............................................... Full-thickness skin loss due to burn (third degree nos) of multiple sites of lower limb(s). 

94540 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of lower limb (leg), without mention of 

loss of a body part. 

94541 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of toe(s) (nail), without mention of loss of toe(s). 

94542 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of foot, without mention of loss of foot. 

94543 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of ankle, without mention of loss of ankle. 

mmaher on DSK3CLS3C1PROD with $$_JOB

25060 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

94544 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of lower leg, without mention of loss of lower leg. 

94545 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of knee, without mention of loss of knee. 

94546 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of thigh (any part), without mention of loss of thigh. 

94549 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of lower limb(s), without mention of loss of 

a body part. 

94550 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site lower limb (leg), with loss of a body 

part. 

94551 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of toe(s) (nail), with loss of toe(s). 

94552 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of foot, with loss of foot. 

94553 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of ankle, with loss of ankle. 

94554 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of lower leg, with loss of lower leg. 

94555 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of knee, with loss of knee. 

94556 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of thigh (any part), with loss of thigh. 

94559 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of lower limb(s), with loss of a body part. 

9463 ................................................. Full-thickness skin loss due to burn (third degree nos) of multiple specified sites. 

9464 ................................................. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple specified sites, without mention of loss of a 

body part. 

9465 ................................................. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple specified sites, with loss of a body part. 

9471 ................................................. Burn of larynx, trachea, and lung. 

9472 ................................................. Burn of esophagus. 

9473 ................................................. Burn of gastrointestinal tract. 

9474 ................................................. Burn of vagina and uterus. 

94810 ............................................... Burn (any degree) involving 10-19 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94811 ............................................... Burn (any degree) involving 10-19 percent of body surface with third degree burn of 10-19%. 

94820 ............................................... Burn (any degree) involving 20-29 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94830 ............................................... Burn (any degree) involving 30-39 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94840 ............................................... Burn (any degree) involving 40-49 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94850 ............................................... Burn (any degree) involving 50-59 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94860 ............................................... Burn (any degree) involving 60-69 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94870 ............................................... Burn (any degree) involving 70-79 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94880 ............................................... Burn (any degree) involving 80-89 percent of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

94890 ............................................... Burn (any degree) involving 90 percent or more of body surface with third degree burn of less than 10 percent or unspecified 

amount. 

9493 ................................................. Full-thickness skin loss due to burn (third degree nos), unspecified site.

9494 ................................................. Deep necrosis of underlying tissue due to burn (deep third degree), unspecified site without mention of loss of a body part. 

9495 ................................................. Deep necrosis of underlying tissues due to burn (deep third degree, unspecified site with loss of a body part. 

9500 ................................................. Optic nerve injury. 

9501 ................................................. Injury to optic chiasm. 

9502 ................................................. Injury to optic pathways. 

9503 ................................................. Injury to visual cortex. 

9509 ................................................. Injury to unspecified optic nerve and pathways. 

9510 ................................................. Injury to oculomotor nerve. 

9511 ................................................. Injury to trochlear nerve. 

9512 ................................................. Injury to trigeminal nerve. 

9513 ................................................. Injury to abducens nerve. 

9514 ................................................. Injury to facial nerve. 

9515 ................................................. Injury to acoustic nerve. 

9516 ................................................. Injury to accessory nerve. 

9517 ................................................. Injury to hypoglossal nerve. 

9518 ................................................. Injury to other specified cranial nerves. 

9519 ................................................. Injury to unspecified cranial nerve. 

9582 ................................................. Secondary and recurrent hemorrhage as an early complication of trauma. 

9583 ................................................. Posttraumatic wound infection not elsewhere classified. 

9587 ................................................. Traumatic subcutaneous emphysema. 

95890 ............................................... Compartment syndrome, unspecified. 

95891 ............................................... Traumatic compartment syndrome of upper extremity. 

95892 ............................................... Traumatic compartment syndrome of lower extremity. 

95893 ............................................... Traumatic compartment syndrome of abdomen. 

95899 ............................................... Traumatic compartment syndrome of other sites. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25061 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

9910 ................................................. Frostbite of face. 

9911 ................................................. Frostbite of hand. 

9912 ................................................. Frostbite of foot. 

9913 ................................................. Frostbite of other and unspecified sites. 

9914 ................................................. Immersion foot. 

9920 ................................................. Heat stroke and sunstroke. 

9933 ................................................. Caisson disease. 

9941 ................................................. Drowning and nonfatal submersion. 

9947 ................................................. Asphyxiation and strangulation. 

9950 ................................................. Other anaphylactic shock, not elsewhere classified. 

9954 ................................................. Shock due to anesthesia, not elsewhere classified. 

99550 ............................................... Unspecified child abuse. 

99551 ............................................... Child emotional/psychological abuse. 

99552 ............................................... Child neglect (nutritional). 

99553 ............................................... Child sexual abuse. 

99554 ............................................... Child physical abuse. 

99555 ............................................... Shaken baby syndrome. 

99559 ............................................... Other child abuse and neglect. 

99560 ............................................... Anaphylactic shock due to unspecified food. 

99561 ............................................... Anaphylactic shock due to peanuts. 

99562 ............................................... Anaphylactic shock due to crustaceans. 

99563 ............................................... Anaphylactic shock due to fruits and vegetables. 

99564 ............................................... Anaphylactic shock due to tree nuts and seeds. 

99565 ............................................... Anaphylactic shock due to fish. 

99566 ............................................... Anaphylactic shock due to food additives. 

99567 ............................................... Anaphylactic shock due to milk products. 

99568 ............................................... Anaphylactic shock due to eggs. 

99569 ............................................... Anaphylactic shock due to other specified food. 

99580 ............................................... Unspecified adult maltreatment. 

99581 ............................................... Adult physical abuse. 

99583 ............................................... Adult sexual abuse. 

99584 ............................................... Adult neglect (nutritional). 

99585 ............................................... Other adult abuse and neglect. 

99586 ............................................... Malignant hyperthermia. 

99590 ............................................... Systemic inflammatory response syndrome, unspecified. 

99593 ............................................... Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction. 

99600 ............................................... Mechanical complications of unspecified cardiac device, implant, and graft.

99601 ............................................... Mechanical complication due to cardiac pacemaker (electrode). 

99602 ............................................... Mechanical complication due to heart valve prosthesis. 

99603 ............................................... Mechanical complication due to coronary bypass graft. 

99604 ............................................... Mechanical complication of automatic implantable cardiac defibrillator. 

99609 ............................................... Other mechanical complication of cardiac device, implant, and graft. 

9961 ................................................. Mechanical complication of other vascular device, implant, and graft. 

9962 ................................................. Mechanical complication of nervous system device, implant, and graft. 

99630 ............................................... Mechanical complication of unspecified genitourinary device, implant, and graft. 

99639 ............................................... Other mechanical complication of genitourinary device, implant, and graft. 

99640 ............................................... Unspecified mechanical complication of internal orthopedic device, implant, and graft. 

99641 ............................................... Mechanical loosening of prosthetic joint. 

99642 ............................................... Dislocation of prosthetic joint. 

99643 ............................................... Prosthetic joint implant failure. 

99644 ............................................... Peri-prosthetic fracture around prosthetic joint. 

99645 ............................................... Peri-prosthetic osteolysis. 

99646 ............................................... Articular bearing surface wear of prosthetic joint. 

99647 ............................................... Other mechanical complication of prosthetic joint implant. 

99649 ............................................... Other mechanical complication of other internal orthopedic device, implant, and graft. 

99651 ............................................... Mechanical complication of prosthetic corneal graft. 

99652 ............................................... Mechanical complication of prosthetic graft of other tissue, not elsewhere classified. 

99653 ............................................... Mechanical complication of prosthetic ocular lens prosthesis. 

99654 ............................................... Mechanical complication of breast prosthesis. 

99655 ............................................... Mechanical complication due to artificial skin graft and decellularized allodermis. 

99656 ............................................... Mechanical complication due to peritoneal dialysis catheter. 

99657 ............................................... COMPLICATION, DUE TO INSULIN PUMP. 

99659 ............................................... Mechanical complication of other implant and internal device, not elsewhere classfied. 

99660 ............................................... Infection and inflammatory reaction due to unspecified device, implant, and graft. 

99661 ............................................... Infection and inflammatory reaction due to cardiac device, implant, and graft. 

99662 ............................................... Infection and inflammatory reaction due to other vascular device, implant, and graft. 

99663 ............................................... Infection and inflammatory reaction due to nervous system device, implant, and graft. 

99664 ............................................... Infection and inflammatory reaction due to indwelling urinary catheter. 

99665 ............................................... Infection and inflammatory reaction due to other genitourinary device, implant, and graft. 

99666 ............................................... Infection and inflammatory reaction due to internal joint prosthesis. 

99667 ............................................... Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft. 

99668 ............................................... Infection and inflammatory reaction due to peritoneal dialysis catheter. 

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25062 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

99669 ............................................... Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft. 

99671 ............................................... Other complications due to heart valve prosthesis. 

99672 ............................................... Other complications due to other cardiac device, implant, and graft. 

99673 ............................................... Other complications due to renal dialysis device, implant, and graft. 

99674 ............................................... Other complications due to other vascular device, implant, and graft. 

99675 ............................................... Other complications due to nervous system device, implant, and graft. 

99676 ............................................... Other complications due to genitourinary device, implant, and graft. 

99677 ............................................... Other complications due to internal joint prosthesis. 

99678 ............................................... Other complications due to other internal orthopedic device, implant, and graft. 

99679 ............................................... Other complications due to other internal prosthetic device, implant, and graft. 

99680 ............................................... Complications of unspecified transplanted organ. 

99681 ............................................... Complications of transplanted kidney. 

99682 ............................................... Complications of transplanted liver. 

99683 ............................................... Complications of transplanted heart. 

99684 ............................................... Complications of transplanted lung. 

99685 ............................................... Complications of transplanted bone marrow. 

99686 ............................................... Complications of transplanted pancreas. 

99687 ............................................... Complications of transplanted organ, intestine. 

99689 ............................................... Complications of other specified transplanted organ. 

99690 ............................................... Complications of unspecified reattached extremity. 

99691 ............................................... Complications of reattached forearm. 

99692 ............................................... Complications of reattached hand. 

99693 ............................................... Complications of reattached finger(s). 

99694 ............................................... Complications of reattached upper extremity, other and unspecified. 

99695 ............................................... Complication of reattached foot and toe(s). 

99696 ............................................... Complication of reattached lower extremity, other and unspecified. 

99699 ............................................... Complication of other specified reattached body part. 

99701 ............................................... Central nervous system complication. 

99702 ............................................... Iatrogenic cerebrovascular infarction or hemorrhage. 

99709 ............................................... Other nervous system complications. 

9971 ................................................. Cardiac complications, not elsewhere classified. 

9972 ................................................. Peripheral vascular complications, not elsewhere classified. 

9973 ................................................. Respiratory complications, not elsewhere classified. 

9974 ................................................. Digestive system complications, not elsewhere classified. 

99762 ............................................... Infection (chronic) of amputation stump. 

99771 ............................................... Vascular complications of mesenteric artery. 

99772 ............................................... Vascular complications of renal artery. 

99779 ............................................... Vascular complications of other vessels. 

99799 ............................................... Complications affecting other specified body systems, not elsewhere classified. 

9980 ................................................. Postoperative shock, not elsewhere classified. 

99811 ............................................... Hemorrhage complicating a procedure. 

99812 ............................................... Hematoma complicating a procedure. 

99813 ............................................... Seroma complicating a procedure. 

9982 ................................................. Accidental puncture or laceration during a procedure, not elsewhere classified. 

99831 ............................................... Disruption of internal operation wound. 

99832 ............................................... Disruption of external operation wound. 

9984 ................................................. Foreign body accidentally left during a procedure, not elsewhere classified. 

99851 ............................................... Infected postoperative seroma. 

99859 ............................................... Other postoperative infection. 

9986 ................................................. Persistent postoperative fistula, not elsewhere classified. 

9987 ................................................. Acute reaction to foreign substance accidentally left during a procedure, not elsewhere classified. 

99883 ............................................... Non-healing surgical wound. 

9990 ................................................. Generalized vaccinia as a complication of medical care, not elsewhere classified. 

9992 ................................................. Other vascular complications of medical care, not elsewhere classified. 

9993 ................................................. Other infection due to medical care, not elsewhere classified. 

9994 ................................................. Anaphylactic shock due to serum, not elsewhere classified. 

9995 ................................................. Other serum reaction, not elsewhere classified. 

9996 ................................................. Abo incompatibility reaction, not elsewhere classified. 

9997 ................................................. Rh incompatibility reaction, not elsewhere classified. 

9998 ................................................. Other transfusion reaction, not elsewhere classified. 

V420 ................................................. Kidney replaced by transplant. 

V421 ................................................. Heart replaced by transplant. 

V426 ................................................. Lung replaced by transplant. 

V427 ................................................. Liver replaced by transplant. 

V4281 ............................................... Bone marrow replaced by transplant. 

V4282 ............................................... Peripheral stem cells replaced by transplant. 

V4283 ............................................... Pancreas replaced by transplant. 

V4284 ............................................... Organ or tissue replaced by transplant, intestines. 

V4321 ............................................... Organ or tissue replaced by other means, heart assist device. 

V4322 ............................................... Organ or tissue replaced by other means, fully implantable artificial heart. 

V4611 ............................................... Dependence on respirator, status. 

V4612 ............................................... Encounter for respirator dependence during power failure. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25063 

TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued 

Diagnosis code Code title 

V4613 ............................................... Encounter for weaning from respirator [ventilator]. 

V4614 ............................................... Mechanical complication of respirator [ventilator]. 

V551 ................................................. Attention to gastrostomy. 

V6284 ............................................... Suicidal ideation. 

V850 ................................................. Body Mass Index less than 19, adult. 

V854 ................................................. Body Mass Index 40 and over, adult. 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

1 .................................................................... 24,941 9.4334 2 4 7 12 19 

2 .................................................................... 9,519 4.2485 1 2 3 6 8 

3 .................................................................... 3 31.6667 2 2 42 51 51 

6 .................................................................... 254 2.9409 1 1 2 4 6 

7 .................................................................... 14,373 9.0353 2 4 7 11 18 

8 .................................................................... 3,072 2.7119 1 1 2 3 6 

9 .................................................................... 1,749 5.7616 1 2 4 7 11 

10 .................................................................. 18,799 5.7674 2 3 4 7 11 

11 .................................................................. 2,768 3.6120 1 2 3 5 7 

12 .................................................................. 56,172 5.3189 2 3 4 6 10 

13 .................................................................. 7,636 4.8707 2 3 4 6 8 

14 .................................................................. 262,424 5.2666 2 3 4 6 10 

15 .................................................................. 13,780 3.8482 1 2 3 5 7 

16 .................................................................. 20,050 6.2493 2 3 5 8 12 

17 .................................................................. 3,109 3.2078 1 1 2 4 6 

18 .................................................................. 33,745 5.1228 2 3 4 6 10 

19 .................................................................. 7,451 3.3182 1 2 3 4 6 

21 .................................................................. 2,071 6.1772 2 3 5 8 12 

22 .................................................................. 3,366 5.1242 2 2 4 6 10 

23 .................................................................. 10,269 3.7083 1 2 3 5 7 

26 .................................................................. 32 2.8750 1 1 2 4 7 

27 .................................................................. 6,179 4.6716 1 1 3 6 10 

28 .................................................................. 21,197 5.4894 1 2 4 7 11 

29 .................................................................. 6,674 3.0853 1 1 3 4 6 

31 .................................................................. 4,986 3.7706 1 2 3 5 7 

32 .................................................................. 1,691 2.2389 1 1 2 3 4 

34 .................................................................. 29,326 4.6962 1 2 4 6 9 

35 .................................................................. 7,738 2.9340 1 1 2 4 5 

36 .................................................................. 270 1.9370 1 1 1 2 4 

37 .................................................................. 1,171 4.1076 1 1 3 5 9 

38 .................................................................. 52 2.3846 1 1 2 3 4 

39 .................................................................. 274 2.2336 1 1 1 2 5 

40 .................................................................. 1,098 4.4791 1 2 4 5 9 

42 .................................................................. 1,470 2.5966 1 1 1 3 6 

43 .................................................................. 127 3.0236 1 1 2 4 5 

44 .................................................................. 1,261 4.8882 2 3 4 6 9 

45 .................................................................. 2,846 2.9301 1 2 2 4 5 

46 .................................................................. 4,002 3.9725 1 2 3 5 8 

47 .................................................................. 1,258 2.9754 1 1 2 4 6 

49 .................................................................. 2,449 4.2450 1 2 3 5 8 

50 .................................................................. 1,973 1.7988 1 1 1 2 3 

51 .................................................................. 177 2.7910 1 1 1 3 6 

52 .................................................................. 181 1.5304 1 1 1 2 2 

53 .................................................................. 1,896 3.8745 1 1 2 5 9 

55 .................................................................. 1,234 2.7626 1 1 1 3 6 

56 .................................................................. 369 2.5799 1 1 2 3 5 

57 .................................................................. 732 3.4549 1 1 2 4 7 

58 .................................................................. 1 1.0000 1 1 1 1 1 

59 .................................................................. 111 2.4414 1 1 1 3 4 

60 .................................................................. 5 3.4000 1 1 1 6 8 

61 .................................................................. 212 5.8821 1 1 4 7 13 

62 .................................................................. 1 4.0000 4 4 4 4 4 

63 .................................................................. 2,551 4.5468 1 2 3 6 10 

64 .................................................................. 3,044 6.0798 1 2 4 8 13 

65 .................................................................. 39,254 2.7302 1 1 2 3 5 

66 .................................................................. 7,743 3.2033 1 1 2 4 6 

67 .................................................................. 348 3.6063 1 2 3 4 7 

68 .................................................................. 14,437 3.7100 1 2 3 5 7 

mmaher on DSK3CLS3C1PROD with $$_JOB

25064 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

69 .................................................................. 3,512 2.7958 1 2 2 4 5 

70 .................................................................. 22 2.4545 1 1 2 3 4 

71 .................................................................. 64 3.8125 1 2 3 5 7 

72 .................................................................. 1,377 3.3834 1 2 3 4 6 

73 .................................................................. 9,817 4.3653 1 2 3 6 8 

75 .................................................................. 46,052 9.3570 3 4 7 12 19 

76 .................................................................. 45,066 10.1322 3 5 8 13 19 

77 .................................................................. 1,766 4.4077 1 2 4 6 9 

78 .................................................................. 52,142 5.9448 2 4 5 7 10 

79 .................................................................. 149,996 7.8785 3 4 6 10 15 

80 .................................................................. 5,865 5.2055 2 3 4 6 10 

81 .................................................................. 8 3.1250 1 2 3 3 4 

82 .................................................................. 60,815 6.5333 2 3 5 8 13 

83 .................................................................. 7,094 5.0369 2 3 4 6 9 

84 .................................................................. 1,294 3.0077 1 2 3 4 5 

85 .................................................................. 22,232 6.1018 2 3 5 8 12 

86 .................................................................. 1,423 3.3710 1 2 3 4 7 

87 .................................................................. 104,584 6.2374 2 3 5 8 12 

88 .................................................................. 375,666 4.7615 2 3 4 6 9 

89 .................................................................. 468,634 5.3910 2 3 4 7 10 

90 .................................................................. 33,813 3.5880 1 2 3 4 6 

91 .................................................................. 42 5.1667 1 2 3 6 8 

92 .................................................................. 15,894 5.8223 2 3 5 7 11 

93 .................................................................. 1,094 3.5932 1 2 3 5 7 

94 .................................................................. 13,571 5.8596 2 3 5 8 11 

95 .................................................................. 1,396 3.4362 1 2 3 4 7 

96 .................................................................. 52,187 4.1808 1 2 3 5 8 

97 .................................................................. 20,991 3.2644 1 2 3 4 6 

98 .................................................................. 11 4.6364 1 2 4 6 7 

99 .................................................................. 20,681 3.0888 1 1 2 4 6 

100 ................................................................ 5,367 2.0781 1 1 2 3 4 

101 ................................................................ 24,043 4.1874 1 2 3 5 8 

102 ................................................................ 4,155 2.4363 1 1 2 3 5 

103 ................................................................ 957 36.6813 8 13 25 46 80 

104 ................................................................ 19,277 14.5529 6 8 12 18 26 

105 ................................................................ 31,935 9.9262 4 6 8 11 18 

106 ................................................................ 3,273 10.9050 5 7 9 13 19 

108 ................................................................ 9,206 10.4328 4 6 8 13 19 

110 ................................................................ 56,354 7.8017 1 3 6 10 16 

111 ................................................................ 10,370 2.7754 1 1 2 4 6 

113 ................................................................ 30,526 12.4437 4 6 10 15 24 

114 ................................................................ 7,216 8.1332 2 4 7 10 16 

117 ................................................................ 7,054 4.0186 1 1 2 5 9 

118 ................................................................ 7,940 3.0072 1 1 2 4 7 

119 ................................................................ 788 5.5063 1 1 4 8 12 

120 ................................................................ 30,139 9.0112 1 3 6 12 19 

121 ................................................................ 131,942 5.9604 2 3 5 8 11 

122 ................................................................ 47,504 3.2315 1 1 3 4 6 

123 ................................................................ 24,024 4.6391 1 1 3 6 11 

124 ................................................................ 110,702 4.4070 1 2 3 6 9 

125 ................................................................ 85,159 2.6783 1 1 2 3 5 

126 ................................................................ 5,156 10.7455 3 6 8 13 20 

127 ................................................................ 627,657 5.0473 2 3 4 6 9 

128 ................................................................ 3,363 4.9854 2 3 4 6 8 

129 ................................................................ 3,233 2.6087 1 1 1 3 6 

130 ................................................................ 83,923 5.2374 1 3 4 7 10 

131 ................................................................ 20,275 3.6403 1 2 3 5 6 

132 ................................................................ 84,452 2.7444 1 1 2 3 5 

133 ................................................................ 4,929 2.0801 1 1 2 3 4 

134 ................................................................ 37,743 3.0024 1 1 2 4 6 

135 ................................................................ 6,937 4.2093 1 2 3 5 8 

136 ................................................................ 893 2.4894 1 1 2 3 5 

138 ................................................................ 206,453 3.8403 1 2 3 5 7 

139 ................................................................ 67,628 2.3918 1 1 2 3 4 

140 ................................................................ 24,872 2.3395 1 1 2 3 4 

141 ................................................................ 125,207 3.3954 1 2 3 4 6 

142 ................................................................ 44,070 2.4524 1 1 2 3 4 

143 ................................................................ 220,824 2.1144 1 1 2 3 4 

144 ................................................................ 105,937 5.8550 1 2 4 7 12 

145 ................................................................ 4,992 2.5032 1 1 2 3 5 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25065 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

146 ................................................................ 9,704 9.6600 4 6 8 11 17 

147 ................................................................ 2,408 5.3218 2 4 5 7 8 

149 ................................................................ 18,456 5.4416 3 4 5 7 8 

150 ................................................................ 23,405 10.4474 3 6 9 13 19 

151 ................................................................ 5,118 4.9334 1 2 4 7 9 

152 ................................................................ 4,885 7.8047 3 4 6 9 14 

153 ................................................................ 1,840 4.7315 2 3 4 6 7 

155 ................................................................ 5,761 3.7808 1 2 3 5 8 

156 ................................................................ 3 19.0000 2 2 16 39 39 

157 ................................................................ 8,102 5.5242 1 2 4 7 11 

158 ................................................................ 3,241 2.6245 1 1 2 3 5 

159 ................................................................ 18,979 5.0830 1 2 4 6 10 

160 ................................................................ 10,791 2.5814 1 1 2 3 5 

161 ................................................................ 9,709 4.5090 1 2 3 6 9 

162 ................................................................ 4,384 2.0739 1 1 2 3 4 

163 ................................................................ 7 4.7143 2 3 4 5 7 

164 ................................................................ 5,991 7.6306 3 4 6 9 14 

165 ................................................................ 2,312 3.8824 1 2 4 5 7 

166 ................................................................ 5,472 4.2149 1 2 3 5 8 

167 ................................................................ 4,821 2.0797 1 1 2 3 4 

168 ................................................................ 1,635 4.5976 1 2 3 6 9 

169 ................................................................ 846 2.1572 1 1 2 3 4 

170 ................................................................ 17,758 10.3417 2 5 8 13 21 

171 ................................................................ 1,371 3.9081 1 2 3 5 8 

172 ................................................................ 32,071 6.7286 2 3 5 8 13 

173 ................................................................ 1,902 3.4332 1 1 3 4 7 

174 ................................................................ 239,405 4.6424 2 3 4 6 8 

175 ................................................................ 24,762 2.8116 1 2 2 4 5 

176 ................................................................ 13,258 5.0499 2 3 4 6 9 

177 ................................................................ 7,710 4.4132 2 2 4 5 8 

178 ................................................................ 2,265 3.1007 1 2 3 4 5 

179 ................................................................ 14,563 5.7533 2 3 4 7 11 

180 ................................................................ 89,516 5.2296 2 3 4 6 10 

181 ................................................................ 23,153 3.2759 1 2 3 4 6 

182 ................................................................ 281,768 4.0590 1 2 3 5 8 

183 ................................................................ 72,273 2.8170 1 1 2 4 5 

184 ................................................................ 78 3.6026 1 2 2 4 7 

185 ................................................................ 5,963 4.4223 1 2 3 6 9 

186 ................................................................ 4 4.7500 3 3 3 6 7 

187 ................................................................ 635 3.9984 1 2 3 5 8 

188 ................................................................ 84,689 5.2986 1 2 4 7 10 

189 ................................................................ 11,667 2.9734 1 1 2 4 6 

190 ................................................................ 8 5.2500 1 2 3 5 9 

191 ................................................................ 10,210 12.1666 3 6 9 15 25 

192 ................................................................ 1,287 5.2883 1 3 5 7 9 

193 ................................................................ 3,705 12.0302 4 6 10 15 22 

194 ................................................................ 425 6.6165 3 4 6 8 11 

195 ................................................................ 2,428 10.2105 4 6 9 13 18 

196 ................................................................ 498 5.5542 2 3 5 7 9 

197 ................................................................ 15,180 8.9159 3 5 7 11 16 

198 ................................................................ 3,553 4.2651 2 3 4 5 7 

199 ................................................................ 1,320 8.7841 2 3 6 11 19 

200 ................................................................ 884 10.3801 2 4 7 13 21 

201 ................................................................ 2,591 13.0475 3 6 10 17 26 

202 ................................................................ 26,311 6.0668 2 3 5 8 12 

203 ................................................................ 30,311 6.3680 2 3 5 8 13 

204 ................................................................ 66,617 5.3058 2 3 4 6 10 

205 ................................................................ 31,699 5.7534 2 3 4 7 11 

206 ................................................................ 1,725 3.8458 1 2 3 5 7 

207 ................................................................ 37,546 5.1840 2 2 4 6 10 

208 ................................................................ 8,523 2.8941 1 1 2 4 5 

210 ................................................................ 126,659 6.5368 3 4 5 7 11 

211 ................................................................ 23,197 4.5195 3 3 4 5 7 

212 ................................................................ 6 4.6667 1 1 2 8 8 

213 ................................................................ 8,062 9.2446 2 4 7 12 18 

216 ................................................................ 19,672 5.4472 1 1 3 8 12 

217 ................................................................ 14,549 11.8718 3 5 8 15 24 

218 ................................................................ 30,810 5.4129 2 3 4 7 10 

219 ................................................................ 19,731 3.1027 1 2 3 4 5 

220 ................................................................ 4 6.5000 1 1 2 4 19 

mmaher on DSK3CLS3C1PROD with $$_JOB

25066 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

223 ................................................................ 11,839 3.3929 1 1 3 4 7 

224 ................................................................ 8,611 1.9527 1 1 1 2 4 

225 ................................................................ 6,109 5.1627 1 2 4 7 11 

226 ................................................................ 7,188 6.3445 1 3 4 8 13 

227 ................................................................ 4,669 2.5740 1 1 2 3 5 

228 ................................................................ 2,587 4.2041 1 1 3 6 9 

229 ................................................................ 951 2.3060 1 1 2 3 5 

230 ................................................................ 2,423 5.7693 1 2 4 7 12 

232 ................................................................ 465 2.9441 1 1 2 3 7 

233 ................................................................ 22,278 5.9501 1 2 5 8 12 

234 ................................................................ 10,535 2.4870 1 1 1 3 6 

235 ................................................................ 4,464 4.5459 1 2 4 6 8 

236 ................................................................ 41,174 4.3733 2 3 4 5 8 

237 ................................................................ 1,818 3.7041 1 2 3 5 7 

238 ................................................................ 9,430 7.9829 3 4 6 9 15 

239 ................................................................ 37,225 5.9285 2 3 5 7 11 

240 ................................................................ 12,432 6.4345 2 3 5 8 13 

241 ................................................................ 2,370 3.5924 1 2 3 4 6 

242 ................................................................ 2,575 6.3763 2 3 5 8 12 

243 ................................................................ 97,388 4.4757 1 2 4 6 8 

244 ................................................................ 16,696 4.3404 1 2 4 5 8 

245 ................................................................ 5,092 3.0330 1 1 3 4 6 

246 ................................................................ 1,268 3.5804 1 2 3 4 7 

247 ................................................................ 21,168 3.3470 1 2 3 4 6 

248 ................................................................ 17,364 4.7551 2 3 4 6 8 

249 ................................................................ 13,232 3.9306 1 1 3 5 8 

250 ................................................................ 4,411 3.8601 1 2 3 5 7 

251 ................................................................ 1,877 2.7475 1 1 3 3 5 

253 ................................................................ 25,596 4.5348 2 3 4 5 8 

254 ................................................................ 9,175 3.0765 1 2 3 4 5 

255 ................................................................ 1 3.0000 3 3 3 3 3 

256 ................................................................ 7,625 5.0515 1 2 4 6 10 

257 ................................................................ 12,191 2.5461 1 1 2 3 5 

258 ................................................................ 10,164 1.6868 1 1 1 2 3 

259 ................................................................ 2,447 2.9918 1 1 1 3 7 

260 ................................................................ 1,978 1.3519 1 1 1 1 2 

261 ................................................................ 1,466 2.1296 1 1 1 2 4 

262 ................................................................ 562 4.8986 1 2 4 6 10 

263 ................................................................ 20,802 10.1605 3 5 7 12 20 

264 ................................................................ 3,458 5.9974 2 3 5 7 11 

265 ................................................................ 3,941 6.3144 1 2 4 8 14 

266 ................................................................ 2,095 3.0897 1 1 2 4 6 

267 ................................................................ 213 4.9437 1 2 3 5 9 

268 ................................................................ 993 3.3625 1 1 2 4 7 

269 ................................................................ 11,402 8.0560 2 4 6 10 16 

270 ................................................................ 2,537 3.7040 1 1 3 5 7 

271 ................................................................ 19,773 6.7454 2 3 5 8 12 

272 ................................................................ 5,748 5.6475 2 3 4 7 10 

273 ................................................................ 1,091 3.7993 1 2 3 5 7 

274 ................................................................ 2,206 6.1215 2 3 5 8 12 

275 ................................................................ 176 2.8750 1 1 2 4 6 

276 ................................................................ 1,437 4.4628 1 2 4 6 8 

277 ................................................................ 121,125 5.3596 2 3 4 7 10 

278 ................................................................ 31,136 3.8929 2 2 3 5 7 

279 ................................................................ 9 2.5556 1 1 3 4 4 

280 ................................................................ 19,413 3.9496 1 2 3 5 7 

281 ................................................................ 5,892 2.8130 1 1 3 4 5 

283 ................................................................ 6,796 4.3792 1 2 3 5 8 

284 ................................................................ 1,736 2.9891 1 1 2 4 6 

285 ................................................................ 8,300 9.7928 3 5 8 13 18 

286 ................................................................ 3,003 5.2148 1 2 4 6 10 

287 ................................................................ 4,991 9.5642 3 5 7 11 18 

288 ................................................................ 9,102 3.3196 1 2 2 4 6 

289 ................................................................ 5,813 2.5230 1 1 1 2 5 

290 ................................................................ 12,096 2.0051 1 1 1 2 3 

291 ................................................................ 50 1.5200 1 1 1 2 2 

292 ................................................................ 7,589 10.0137 2 4 8 12 19 

293 ................................................................ 322 4.6863 1 2 3 6 9 

294 ................................................................ 93,724 4.1793 1 2 3 5 8 

295 ................................................................ 4,525 3.6320 1 2 3 4 7 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25067 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

296 ................................................................ 207,831 4.4830 1 2 3 6 8 

297 ................................................................ 35,935 2.9945 1 2 3 4 5 

298 ................................................................ 81 3.3827 1 2 2 4 7 

299 ................................................................ 1,546 5.2523 1 2 4 6 10 

300 ................................................................ 21,703 5.7447 2 3 5 7 11 

301 ................................................................ 3,570 3.3908 1 2 3 4 6 

302 ................................................................ 10,439 7.9171 4 5 6 9 14 

303 ................................................................ 19,565 6.0558 2 3 5 7 11 

304 ................................................................ 13,755 7.8484 2 3 6 10 16 

305 ................................................................ 2,882 2.9139 1 2 2 4 5 

306 ................................................................ 5,206 5.8832 1 2 3 8 14 

307 ................................................................ 1,648 1.9205 1 1 2 2 3 

308 ................................................................ 5,035 5.4111 1 2 3 7 12 

309 ................................................................ 2,761 1.6092 1 1 1 2 3 

310 ................................................................ 24,646 4.5628 1 2 3 6 10 

311 ................................................................ 5,023 1.8176 1 1 1 2 3 

312 ................................................................ 1,369 4.8254 1 1 3 6 10 

313 ................................................................ 480 2.1250 1 1 2 3 4 

315 ................................................................ 34,790 6.7300 1 1 4 9 16 

316 ................................................................ 231,484 5.9894 2 3 5 7 12 

317 ................................................................ 2,498 3.5020 1 1 2 4 7 

318 ................................................................ 5,778 5.7885 1 3 4 7 12 

319 ................................................................ 324 2.7593 1 1 2 4 5 

320 ................................................................ 225,977 4.9150 2 3 4 6 9 

321 ................................................................ 29,439 3.4932 1 2 3 4 6 

322 ................................................................ 79 3.2658 1 2 3 4 6 

323 ................................................................ 19,180 3.0764 1 1 2 4 6 

324 ................................................................ 3,829 1.9128 1 1 1 2 3 

325 ................................................................ 9,248 3.6718 1 2 3 5 7 

326 ................................................................ 2,288 2.5013 1 1 2 3 4 

327 ................................................................ 5 2.6000 1 1 2 2 6 

328 ................................................................ 525 3.4400 1 1 2 4 6 

329 ................................................................ 49 1.6531 1 1 1 2 2 

330 ................................................................ 1 1.0000 1 1 1 1 1 

331 ................................................................ 55,533 5.4057 1 2 4 7 10 

332 ................................................................ 3,151 3.0378 1 1 2 4 6 

333 ................................................................ 301 5.5681 1 2 4 7 13 

334 ................................................................ 9,233 3.9509 1 2 3 5 7 

335 ................................................................ 12,674 2.2587 1 1 2 3 4 

336 ................................................................ 25,171 3.1752 1 1 2 3 7 

337 ................................................................ 19,038 1.7807 1 1 2 2 3 

338 ................................................................ 614 5.5684 1 2 4 8 12 

339 ................................................................ 1,126 5.6536 1 1 3 7 12 

340 ................................................................ 1 1.0000 1 1 1 1 1 

341 ................................................................ 2,792 3.1866 1 1 1 3 7 

342 ................................................................ 458 3.3952 1 1 2 4 7 

344 ................................................................ 2,027 2.9842 1 1 1 3 7 

345 ................................................................ 1,253 5.1875 1 2 3 6 12 

346 ................................................................ 3,369 5.7133 2 3 4 7 11 

347 ................................................................ 207 2.9517 1 1 1 4 6 

348 ................................................................ 4,244 4.0224 1 2 3 5 8 

349 ................................................................ 491 2.5682 1 1 2 3 5 

350 ................................................................ 7,160 4.4365 2 2 4 5 8 

352 ................................................................ 1,127 4.2316 1 2 3 5 9 

353 ................................................................ 2,799 5.7153 2 3 4 6 11 

354 ................................................................ 7,293 5.4880 2 3 4 6 10 

355 ................................................................ 4,614 2.9272 2 2 3 3 4 

356 ................................................................ 21,201 1.8026 1 1 1 2 3 

357 ................................................................ 5,224 7.8335 3 4 6 9 15 

358 ................................................................ 19,606 3.7991 1 2 3 4 7 

359 ................................................................ 26,471 2.2429 1 2 2 3 3 

360 ................................................................ 13,718 2.3371 1 1 2 3 4 

361 ................................................................ 267 3.0749 1 1 2 3 6 

362 ................................................................ 2 1.5000 1 1 2 2 2 

363 ................................................................ 1,787 4.1365 1 2 3 4 9 

364 ................................................................ 1,636 3.8863 1 1 3 5 8 

365 ................................................................ 1,522 7.8160 2 3 5 10 18 

366 ................................................................ 4,653 6.2102 1 3 4 8 13 

367 ................................................................ 414 2.9928 1 1 2 4 6 

368 ................................................................ 4,106 6.5933 2 3 5 8 13 

mmaher on DSK3CLS3C1PROD with $$_JOB

25068 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

369 ................................................................ 3,621 3.1188 1 1 2 4 6 

370 ................................................................ 2,353 5.2660 2 3 4 5 8 

371 ................................................................ 2,785 3.4032 2 3 3 4 5 

372 ................................................................ 1,443 3.2467 2 2 3 3 4 

373 ................................................................ 5,236 2.3067 1 2 2 3 3 

374 ................................................................ 119 2.8824 1 2 2 3 5 

375 ................................................................ 10 5.8000 2 3 4 8 9 

376 ................................................................ 492 3.5691 1 2 2 4 7 

377 ................................................................ 86 5.7326 1 2 3 7 12 

378 ................................................................ 178 2.0674 1 1 2 3 3 

379 ................................................................ 489 2.7607 1 1 2 3 5 

380 ................................................................ 107 2.6449 1 1 1 2 4 

381 ................................................................ 181 2.7017 1 1 1 2 6 

382 ................................................................ 47 2.7021 1 1 1 1 2 

383 ................................................................ 3,004 3.8129 1 1 3 4 7 

384 ................................................................ 125 2.7920 1 1 1 2 5 

386 ................................................................ 1 65.0000 65 65 65 65 65 

389 ................................................................ 1 7.0000 7 7 7 7 7 

390 ................................................................ 7 1.2857 1 1 1 1 2 

392 ................................................................ 1,925 9.1771 2 4 6 11 20 

394 ................................................................ 2,690 6.9978 1 2 5 9 15 

395 ................................................................ 101,460 4.0582 1 2 3 5 8 

396 ................................................................ 15 3.0667 1 2 2 3 6 

397 ................................................................ 15,074 5.1932 1 2 4 7 11 

398 ................................................................ 6,358 5.2378 1 2 4 7 10 

399 ................................................................ 975 3.1241 1 2 2 4 6 

401 ................................................................ 6,310 11.0125 2 5 9 14 22 

402 ................................................................ 1,179 3.9763 1 1 3 5 8 

403 ................................................................ 30,542 7.8445 2 3 6 10 16 

404 ................................................................ 3,385 4.0148 1 2 3 5 8 

406 ................................................................ 2,200 9.6227 2 4 7 12 20 

407 ................................................................ 552 3.4094 1 2 3 4 7 

408 ................................................................ 1,906 8.5661 1 2 5 11 20 

409 ................................................................ 1,500 5.9887 1 3 4 6 13 

410 ................................................................ 27,864 3.7178 1 2 3 4 6 

411 ................................................................ 3 5.0000 1 1 2 12 12 

412 ................................................................ 8 3.0000 1 1 2 5 5 

413 ................................................................ 4,888 6.6970 2 3 5 8 14 

414 ................................................................ 445 3.6584 1 2 3 4 7 

417 ................................................................ 34 6.3235 1 2 4 7 14 

418 ................................................................ 29,239 5.9953 2 3 5 7 11 

419 ................................................................ 17,140 4.2593 1 2 3 5 8 

420 ................................................................ 2,658 3.0865 1 2 3 4 6 

421 ................................................................ 11,406 4.0990 1 2 3 5 8 

422 ................................................................ 54 3.4815 1 2 3 4 7 

423 ................................................................ 8,780 8.1794 2 3 6 10 17 

424 ................................................................ 968 11.1746 1 4 8 14 24 

425 ................................................................ 10,497 3.2223 1 1 2 4 6 

426 ................................................................ 4,577 4.1534 1 2 3 5 8 

427 ................................................................ 1,656 4.4771 1 2 3 5 8 

428 ................................................................ 786 7.4288 1 2 4 8 16 

429 ................................................................ 21,621 5.3979 2 3 4 6 10 

430 ................................................................ 77,784 7.5960 2 3 6 9 15 

431 ................................................................ 376 5.8963 1 2 4 6 11 

432 ................................................................ 424 4.5825 1 2 3 5 8 

433 ................................................................ 4,480 2.9406 1 1 2 3 6 

439 ................................................................ 1,739 8.8902 1 3 5 9 17 

440 ................................................................ 4,793 8.1083 2 3 5 9 17 

441 ................................................................ 745 3.2725 1 1 2 4 7 

442 ................................................................ 18,713 8.6001 2 3 6 10 18 

443 ................................................................ 3,247 3.3760 1 1 3 4 7 

444 ................................................................ 5,714 4.0441 1 2 3 5 8 

445 ................................................................ 2,057 2.6719 1 1 2 3 5 

446 ................................................................ 1 1.0000 1 1 1 1 1 

447 ................................................................ 6,286 2.5021 1 1 2 3 5 

449 ................................................................ 42,005 3.6920 1 1 3 4 7 

450 ................................................................ 7,022 1.9939 1 1 1 2 4 

451 ................................................................ 2 4.0000 2 2 6 6 6 

452 ................................................................ 29,335 4.8062 1 2 3 6 10 

453 ................................................................ 5,041 2.8252 1 1 2 3 5 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25069 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

454 ................................................................ 4,454 4.0624 1 2 3 5 8 

455 ................................................................ 763 2.4862 1 1 2 3 5 

461 ................................................................ 2,190 5.6918 1 2 4 7 13 

462 ................................................................ 8,257 9.4810 4 6 8 11 16 

463 ................................................................ 33,398 3.8312 1 2 3 5 7 

464 ................................................................ 7,481 2.9051 1 1 2 4 5 

465 ................................................................ 189 3.1746 1 1 2 4 6 

466 ................................................................ 1,029 4.0049 1 1 2 4 8 

467 ................................................................ 990 3.7434 1 1 2 3 6 

468 ................................................................ 51,687 12.1152 3 6 10 15 24 

471 ................................................................ 15,315 4.5714 3 3 4 5 7 

473 ................................................................ 8,258 11.7129 2 3 6 15 31 

476 ................................................................ 2,607 9.4941 2 4 8 13 19 

477 ................................................................ 26,467 8.6280 1 3 7 11 18 

479 ................................................................ 28,424 2.2886 1 1 1 3 5 

480 ................................................................ 914 19.3184 6 9 13 23 42 

481 ................................................................ 1,237 21.5618 12 16 20 24 32 

482 ................................................................ 4,697 11.1901 4 6 8 13 21 

484 ................................................................ 446 12.2825 2 6 10 16 23 

485 ................................................................ 3,720 9.4664 4 5 7 11 18 

486 ................................................................ 2,710 12.6207 2 6 10 16 25 

487 ................................................................ 4,989 6.7019 1 3 5 8 13 

488 ................................................................ 830 17.0000 4 7 13 21 35 

489 ................................................................ 13,468 8.2464 2 3 6 10 17 

490 ................................................................ 4,959 5.2503 1 2 4 6 10 

491 ................................................................ 23,713 3.0033 1 2 2 3 5 

492 ................................................................ 3,909 13.6723 3 5 6 23 32 

493 ................................................................ 60,142 5.9490 2 3 5 8 11 

494 ................................................................ 22,403 2.7073 1 1 2 4 5 

495 ................................................................ 363 17.3251 8 10 14 20 29 

496 ................................................................ 4,220 8.4123 3 4 6 10 17 

497 ................................................................ 32,341 5.5152 3 3 4 6 9 

498 ................................................................ 21,707 3.5698 2 3 3 4 6 

499 ................................................................ 34,248 4.0122 1 2 3 5 8 

500 ................................................................ 44,035 2.1007 1 1 2 3 4 

501 ................................................................ 3,031 9.3817 4 5 7 11 17 

502 ................................................................ 688 5.4230 2 3 5 7 9 

503 ................................................................ 5,421 3.8493 1 2 3 5 7 

504 ................................................................ 182 28.9670 9 15 25 40 54 

505 ................................................................ 155 5.9097 1 1 2 6 14 

506 ................................................................ 980 14.7245 3 7 12 19 29 

507 ................................................................ 274 7.3869 1 3 6 11 15 

508 ................................................................ 557 7.3878 2 3 5 9 14 

509 ................................................................ 137 4.5766 1 2 3 5 10 

510 ................................................................ 1,681 6.0684 1 2 4 7 13 

511 ................................................................ 498 3.8313 1 1 3 5 8 

512 ................................................................ 560 11.8982 6 7 9 13 20 

513 ................................................................ 177 10.2486 6 7 9 12 16 

515 ................................................................ 57,719 3.5718 1 1 1 4 9 

518 ................................................................ 24,896 2.4103 1 1 1 3 5 

519 ................................................................ 13,824 4.5428 1 1 2 6 11 

520 ................................................................ 17,200 1.8812 1 1 1 2 4 

521 ................................................................ 30,284 5.3526 2 3 4 6 10 

522 ................................................................ 3,408 10.4745 3 5 8 14 21 

523 ................................................................ 13,997 3.7162 1 2 3 4 6 

524 ................................................................ 103,803 3.0689 1 2 3 4 6 

525 ................................................................ 150 11.9600 1 2 6 15 34 

528 ................................................................ 1,710 16.5509 5 9 15 22 29 

529 ................................................................ 5,094 6.8828 1 2 4 9 16 

530 ................................................................ 3,221 2.8712 1 1 2 3 5 

531 ................................................................ 5,251 9.2400 2 3 7 12 19 

532 ................................................................ 2,973 3.6266 1 1 3 5 7 

533 ................................................................ 40,452 3.5306 1 1 2 4 8 

534 ................................................................ 34,384 1.6709 1 1 1 2 3 

535 ................................................................ 8,642 8.7836 2 4 7 11 17 

536 ................................................................ 7,797 7.1789 2 3 6 9 14 

537 ................................................................ 9,423 6.5040 1 3 5 8 13 

538 ................................................................ 5,014 2.8957 1 1 2 4 6 

539 ................................................................ 4,747 10.5886 2 3 7 14 23 

540 ................................................................ 1,406 3.3940 1 1 2 4 7 

mmaher on DSK3CLS3C1PROD with $$_JOB

25070 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

541 ................................................................ 24,001 40.4864 16 23 34 49 72 

542 ................................................................ 21,753 29.2444 11 17 24 36 51 

543 ................................................................ 5,669 11.3277 2 4 9 16 23 

544 ................................................................ 440,451 4.3239 3 3 4 5 7 

545 ................................................................ 43,688 5.0764 3 3 4 6 8 

546 ................................................................ 3,558 7.8111 3 4 6 9 15 

547 ................................................................ 29,673 12.1403 6 8 10 14 20 

548 ................................................................ 26,417 8.6920 5 6 8 10 13 

549 ................................................................ 12,901 10.1190 5 6 8 12 18 

550 ................................................................ 29,627 6.6683 4 5 6 8 10 

551 ................................................................ 51,141 6.0806 1 2 5 8 12 

552 ................................................................ 78,452 3.3411 1 1 2 4 7 

553 ................................................................ 44,355 8.8636 1 3 7 12 19 

554 ................................................................ 77,753 5.1191 1 2 3 7 11 

555 ................................................................ 37,647 4.6506 1 2 3 6 10 

556 ................................................................ 17,813 1.9014 1 1 1 2 4 

557 ................................................................ 128,804 3.9579 1 2 3 5 8 

558 ................................................................ 184,255 1.7491 1 1 1 2 3 

559 ................................................................ 4,814 6.8467 2 4 5 8 13 

560 ................................................................ 3,365 9.9964 3 5 8 13 19 

561 ................................................................ 2,944 9.4440 3 5 8 12 18 

562 ................................................................ 52,768 4.7011 1 2 4 6 9 

563 ................................................................ 19,974 3.1487 1 2 3 4 6 

564 ................................................................ 16,370 3.3764 1 2 3 4 6 

565 ................................................................ 46,197 14.9311 6 9 13 18 26 

566 ................................................................ 79,447 7.2748 1 3 6 10 14 

567 ................................................................ 9,976 15.6049 6 8 12 19 29 

568 ................................................................ 16,065 11.0504 2 5 9 14 22 

569 ................................................................ 58,700 14.1940 5 8 12 18 26 

570 ................................................................ 68,714 9.8921 4 6 8 12 18 

571 ................................................................ 10,974 4.8136 2 2 4 6 9 

572 ................................................................ 54,656 6.9428 2 4 5 8 13 

573 ................................................................ 6,467 10.8919 4 6 8 12 20 

574 ................................................................ 27,588 5.7540 2 3 4 7 11 

575 ................................................................ 13,709 15.2387 6 8 13 19 27 

576 ................................................................ 295,836 7.0992 2 3 6 9 14 

577 ................................................................ 11,072 2.3475 1 1 1 2 5 

578 ................................................................ 38,795 15.6194 5 8 12 19 29 

579 ................................................................ 19,756 10.6732 3 5 8 13 22 

11,663,472 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

1 .................................................................... 628 43.9968 10 17 32 56 92 

2 .................................................................... 329 22.7173 8 10 15 27 46 

3 .................................................................... 24,007 40.4921 16 23 34 49 72 

4 .................................................................... 21,748 29.2363 11 17 24 36 51 

5 .................................................................... 842 22.5713 7 10 16 28 50 

6 .................................................................... 495 9.9717 5 7 9 11 16 

7 .................................................................... 413 17.3123 8 10 14 20 29 

8 .................................................................... 560 11.8982 6 7 9 13 20 

9 .................................................................... 1,359 21.7454 10 15 20 24 33 

10 .................................................................. 177 10.2486 6 7 9 12 16 

11 .................................................................. 1,290 16.1558 6 8 13 19 28 

12 .................................................................. 1,923 10.9111 4 6 9 13 19 

13 .................................................................. 1,484 7.2352 3 4 7 9 12 

20 .................................................................. 901 19.1088 6 11 18 25 34 

21 .................................................................. 558 15.5430 7 10 14 20 26 

22 .................................................................. 251 9.6096 3 5 9 13 17 

23 .................................................................. 3,113 13.5888 3 6 11 19 27 

24 .................................................................. 2,576 8.5901 1 3 7 12 18 

25 .................................................................. 8,419 13.3480 4 7 11 17 25 

26 .................................................................. 11,628 8.2665 3 4 7 11 15 

27 .................................................................. 14,459 4.6581 1 2 4 6 9 

28 .................................................................. 1,611 14.6629 4 7 11 18 28 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25071 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

29 .................................................................. 2,862 7.6530 2 4 6 10 15 

30 .................................................................. 3,751 3.6726 1 1 3 5 7 

31 .................................................................. 1,058 13.1361 3 5 10 18 26 

32 .................................................................. 2,989 5.7969 1 2 4 7 13 

33 .................................................................. 4,270 3.0745 1 1 2 4 6 

34 .................................................................. 814 7.2715 1 2 5 10 15 

35 .................................................................. 2,510 3.0351 1 1 2 4 7 

36 .................................................................. 7,748 1.6075 1 1 1 2 3 

37 .................................................................. 4,777 8.6847 2 3 7 11 18 

38 .................................................................. 14,603 3.8074 1 1 2 5 9 

39 .................................................................. 55,391 1.8575 1 1 1 2 3 

40 .................................................................. 4,549 13.5997 4 6 10 17 26 

41 .................................................................. 7,720 7.4211 2 4 6 9 14 

42 .................................................................. 5,430 3.6440 1 1 2 5 8 

52 .................................................................. 1,156 6.6678 2 3 5 8 13 

53 .................................................................. 593 3.9949 1 2 3 5 8 

54 .................................................................. 4,665 7.2223 2 3 5 9 14 

55 .................................................................. 16,902 5.0128 1 2 4 6 10 

56 .................................................................. 7,719 7.8009 2 4 6 9 15 

57 .................................................................. 48,453 4.9236 2 3 4 6 9 

58 .................................................................. 789 8.0279 2 4 6 9 16 

59 .................................................................. 2,640 5.2098 2 3 4 6 9 

60 .................................................................. 4,205 4.0587 2 2 4 5 7 

61 .................................................................. 1,340 9.7060 3 5 8 12 19 

62 .................................................................. 2,289 6.3451 3 4 5 8 11 

63 .................................................................. 1,185 4.5823 2 3 4 6 8 

64 .................................................................. 55,567 7.6787 2 4 6 10 15 

65 .................................................................. 112,235 5.3134 2 3 4 7 10 

66 .................................................................. 94,622 3.7946 1 2 3 5 7 

67 .................................................................. 1,383 6.2133 2 3 5 8 12 

68 .................................................................. 12,397 3.5843 1 2 3 5 7 

69 .................................................................. 103,803 3.0689 1 2 3 4 6 

70 .................................................................. 7,093 7.9026 2 4 6 10 15 

71 .................................................................. 10,005 5.6338 2 3 5 7 10 

72 .................................................................. 6,061 3.7703 1 2 3 5 7 

73 .................................................................. 8,660 6.4130 2 3 5 8 13 

74 .................................................................. 32,536 4.3661 1 2 4 5 8 

75 .................................................................. 1,197 7.6115 3 4 6 10 14 

76 .................................................................. 874 4.2128 2 2 3 5 8 

77 .................................................................. 1,101 7.1599 2 3 6 9 14 

78 .................................................................. 1,307 4.5792 2 2 4 6 8 

79 .................................................................. 958 3.5282 1 2 3 4 6 

80 .................................................................. 2,077 4.8681 1 2 4 6 9 

81 .................................................................. 8,192 3.4143 1 2 3 4 6 

82 .................................................................. 1,646 6.3991 1 1 4 9 15 

83 .................................................................. 1,941 5.2849 1 2 4 7 10 

84 .................................................................. 2,592 3.1154 1 1 2 4 6 

85 .................................................................. 5,330 7.9328 2 3 6 10 16 

86 .................................................................. 10,385 5.1475 1 3 4 7 10 

87 .................................................................. 12,156 3.3901 1 2 3 4 6 

88 .................................................................. 717 6.1046 1 3 4 7 12 

89 .................................................................. 2,641 3.7830 1 2 3 5 7 

90 .................................................................. 3,319 2.4760 1 1 2 3 5 

91 .................................................................. 6,678 6.5861 2 3 5 8 13 

92 .................................................................. 14,897 4.4665 1 2 4 6 8 

93 .................................................................. 15,489 3.2219 1 2 3 4 6 

94 .................................................................. 1,521 12.4938 4 7 11 16 23 

95 .................................................................. 1,089 9.1726 3 5 8 12 16 

96 .................................................................. 755 6.1536 2 3 5 8 11 

97 .................................................................. 1,253 11.8164 4 6 10 16 22 

98 .................................................................. 1,048 8.5334 3 5 7 11 15 

99 .................................................................. 643 6.3048 2 3 6 8 11 

100 ................................................................ 15,840 6.2835 2 3 5 8 13 

101 ................................................................ 56,927 3.7154 1 2 3 5 7 

102 ................................................................ 1,352 5.0473 1 2 4 6 10 

103 ................................................................ 15,025 3.2255 1 2 3 4 6 

113 ................................................................ 568 5.6039 1 2 4 7 12 

114 ................................................................ 603 2.6982 1 1 2 3 6 

115 ................................................................ 1,098 4.4791 1 2 4 5 9 

116 ................................................................ 665 3.4602 1 1 2 4 8 

mmaher on DSK3CLS3C1PROD with $$_JOB

25072 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

117 ................................................................ 1,401 1.9807 1 1 1 2 4 

121 ................................................................ 587 5.8245 2 3 5 7 11 

122 ................................................................ 674 4.0727 1 2 3 5 8 

123 ................................................................ 2,846 2.9301 1 2 2 4 5 

124 ................................................................ 679 5.2901 1 2 4 7 11 

125 ................................................................ 4,708 3.4904 1 2 3 4 7 

129 ................................................................ 1,374 5.0786 1 2 4 6 10 

130 ................................................................ 1,075 3.1795 1 1 2 4 6 

131 ................................................................ 655 5.6260 1 2 4 7 11 

132 ................................................................ 728 2.5742 1 1 2 3 5 

133 ................................................................ 1,352 6.3750 1 2 4 8 14 

134 ................................................................ 2,662 2.3020 1 1 1 3 5 

135 ................................................................ 781 6.0948 1 2 4 8 13 

136 ................................................................ 1,115 2.3193 1 1 1 3 5 

137 ................................................................ 1,109 5.4238 1 2 4 7 11 

138 ................................................................ 1,372 2.4249 1 1 2 3 5 

139 ................................................................ 2,150 1.8805 1 1 1 2 3 

146 ................................................................ 687 10.2227 2 4 7 13 20 

147 ................................................................ 1,422 5.7771 1 2 4 7 12 

148 ................................................................ 935 3.4963 1 1 2 5 7 

149 ................................................................ 39,254 2.7302 1 1 2 3 5 

150 ................................................................ 939 5.4494 1 2 4 7 11 

151 ................................................................ 6,804 2.8933 1 1 2 4 5 

152 ................................................................ 2,352 4.6947 1 2 4 6 9 

153 ................................................................ 16,031 3.3617 1 2 3 4 6 

154 ................................................................ 1,843 6.4704 2 3 5 8 12 

155 ................................................................ 4,208 4.5696 1 2 4 6 9 

156 ................................................................ 5,143 3.1808 1 2 3 4 6 

157 ................................................................ 1,145 6.9092 2 3 5 9 14 

158 ................................................................ 3,039 4.4659 1 2 3 6 9 

159 ................................................................ 2,418 3.0790 1 1 2 4 6 

163 ................................................................ 13,433 14.9768 5 8 13 19 27 

164 ................................................................ 18,051 8.3639 3 5 7 10 15 

165 ................................................................ 14,557 5.3898 2 3 5 7 9 

166 ................................................................ 20,293 13.0059 4 7 10 16 24 

167 ................................................................ 20,775 8.1439 3 4 7 10 15 

168 ................................................................ 5,758 5.4139 1 2 5 7 10 

175 ................................................................ 11,958 7.4075 3 4 6 9 13 

176 ................................................................ 40,184 5.5095 2 4 5 7 9 

177 ................................................................ 57,194 9.1881 3 5 8 12 17 

178 ................................................................ 71,205 7.4692 3 4 6 9 14 

179 ................................................................ 27,468 5.6397 2 3 5 7 10 

180 ................................................................ 22,478 7.9687 2 4 7 10 15 

181 ................................................................ 32,170 5.9642 2 3 5 8 12 

182 ................................................................ 6,167 4.2701 1 2 3 6 8 

183 ................................................................ 1,654 7.1826 2 4 6 9 14 

184 ................................................................ 4,141 4.6450 2 3 4 6 8 

185 ................................................................ 2,593 3.2815 1 2 3 4 6 

186 ................................................................ 8,534 7.5378 2 4 6 10 14 

187 ................................................................ 9,970 5.4881 2 3 4 7 11 

188 ................................................................ 5,151 4.1561 1 2 3 5 8 

189 ................................................................ 104,581 6.2368 2 3 5 8 12 

190 ................................................................ 57,046 6.4788 2 3 5 8 12 

191 ................................................................ 121,674 5.1201 2 3 4 6 9 

192 ................................................................ 196,930 4.0420 2 2 3 5 7 

193 ................................................................ 88,072 6.8766 2 4 6 9 13 

194 ................................................................ 266,642 5.3586 2 3 5 7 9 

195 ................................................................ 147,775 4.1514 2 2 4 5 7 

196 ................................................................ 5,143 7.3502 2 4 6 9 14 

197 ................................................................ 6,895 5.4181 2 3 5 7 10 

198 ................................................................ 4,944 4.2945 1 2 4 5 8 

199 ................................................................ 3,258 8.4936 3 4 7 11 16 

200 ................................................................ 8,186 5.1467 1 2 4 7 10 

201 ................................................................ 3,523 4.1198 1 2 3 5 8 

202 ................................................................ 31,594 4.5021 2 2 4 6 8 

203 ................................................................ 41,595 3.4745 1 2 3 4 6 

204 ................................................................ 26,048 2.8805 1 1 2 4 6 

205 ................................................................ 5,777 5.6382 1 3 4 7 11 

206 ................................................................ 22,421 3.4891 1 2 3 4 7 

207 ................................................................ 46,195 14.9298 6 9 13 18 26 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25073 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

208 ................................................................ 79,446 7.2748 1 3 6 10 14 

215 ................................................................ 150 11.9600 1 2 6 15 34 

216 ................................................................ 8,411 18.6918 8 11 16 23 32 

217 ................................................................ 7,610 12.3029 6 8 11 15 20 

218 ................................................................ 3,256 9.1198 5 6 8 11 14 

219 ................................................................ 10,063 14.4558 6 8 11 18 27 

220 ................................................................ 13,483 8.6970 5 6 7 10 14 

221 ................................................................ 8,389 6.4682 4 5 6 7 10 

222 ................................................................ 2,869 13.2426 5 7 11 17 24 

223 ................................................................ 5,773 6.5676 1 3 6 9 13 

224 ................................................................ 1,920 11.5104 4 6 9 14 22 

225 ................................................................ 5,877 5.7638 2 3 5 7 11 

226 ................................................................ 7,049 9.3723 1 3 8 13 19 

227 ................................................................ 50,670 2.7649 1 1 1 3 7 

228 ................................................................ 3,087 14.6317 6 8 12 18 26 

229 ................................................................ 4,130 9.1191 4 6 8 11 15 

230 ................................................................ 1,989 6.6435 3 4 6 8 11 

231 ................................................................ 1,478 13.2104 5 7 11 16 24 

232 ................................................................ 1,795 9.0067 5 6 8 11 14 

233 ................................................................ 16,914 14.2938 7 9 12 17 24 

234 ................................................................ 39,176 8.8853 5 6 8 11 13 

235 ................................................................ 9,630 11.4974 5 7 9 14 21 

236 ................................................................ 32,898 6.6079 4 5 6 8 10 

237 ................................................................ 21,792 11.4604 2 5 9 15 23 

238 ................................................................ 44,932 4.8672 1 2 4 7 10 

239 ................................................................ 13,821 15.5449 5 8 12 19 29 

240 ................................................................ 13,355 10.5939 4 6 8 13 20 

241 ................................................................ 3,350 7.0236 3 4 6 9 13 

242 ................................................................ 17,182 8.9305 3 4 7 11 17 

243 ................................................................ 37,874 5.1880 1 2 4 7 10 

244 ................................................................ 68,296 2.9635 1 1 2 4 6 

245 ................................................................ 6,241 3.3249 1 1 2 4 8 

246 ................................................................ 32,667 6.3103 1 2 5 8 13 

247 ................................................................ 280,392 2.2324 1 1 1 3 5 

248 ................................................................ 5,013 6.5163 1 3 5 9 13 

249 ................................................................ 29,674 2.5339 1 1 2 3 5 

250 ................................................................ 5,740 7.5240 1 3 6 10 15 

251 ................................................................ 39,929 2.9531 1 1 2 4 6 

252 ................................................................ 44,611 8.7554 1 3 6 12 19 

253 ................................................................ 46,868 6.2739 1 2 5 8 13 

254 ................................................................ 59,053 2.9056 1 1 2 4 6 

255 ................................................................ 2,609 9.9279 2 4 8 13 19 

256 ................................................................ 3,833 7.5458 2 4 6 10 14 

257 ................................................................ 774 4.9922 1 2 4 7 10 

258 ................................................................ 598 7.5769 2 3 6 10 15 

259 ................................................................ 7,342 2.6350 1 1 2 3 6 

260 ................................................................ 867 10.1753 2 4 8 13 20 

261 ................................................................ 2,804 3.9675 1 1 3 5 8 

262 ................................................................ 3,383 2.4830 1 1 2 3 5 

263 ................................................................ 788 5.5063 1 1 4 8 12 

264 ................................................................ 30,138 9.0102 1 3 6 12 19 

280 ................................................................ 60,743 7.4498 2 4 6 9 14 

281 ................................................................ 57,742 4.9623 2 3 4 6 9 

282 ................................................................ 60,961 3.2953 1 2 3 4 6 

283 ................................................................ 15,856 5.4845 1 1 3 7 13 

284 ................................................................ 4,912 3.4770 1 1 2 4 8 

285 ................................................................ 3,256 2.2752 1 1 1 3 5 

286 ................................................................ 23,286 7.0619 2 3 6 9 14 

287 ................................................................ 172,575 3.1957 1 1 2 4 6 

288 ................................................................ 3,248 12.2155 4 7 10 15 23 

289 ................................................................ 1,423 8.7850 3 5 7 11 15 

290 ................................................................ 485 6.6536 2 4 6 8 12 

291 ................................................................ 183,811 6.6240 2 3 5 8 13 

292 ................................................................ 217,099 5.0937 2 3 4 6 9 

293 ................................................................ 226,747 3.7248 1 2 3 5 7 

294 ................................................................ 1,705 5.5666 2 3 5 7 9 

295 ................................................................ 1,658 4.3878 2 3 4 6 7 

296 ................................................................ 1,732 3.3256 1 1 1 4 8 

297 ................................................................ 945 1.9725 1 1 1 2 4 

298 ................................................................ 556 1.4568 1 1 1 1 2 

mmaher on DSK3CLS3C1PROD with $$_JOB

25074 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

299 ................................................................ 17,445 6.8633 2 3 6 9 13 

300 ................................................................ 46,825 5.1739 2 3 4 7 9 

301 ................................................................ 39,928 3.7906 1 2 3 5 7 

302 ................................................................ 7,876 4.3526 1 2 3 5 9 

303 ................................................................ 81,505 2.5488 1 1 2 3 5 

304 ................................................................ 2,087 5.2386 1 2 4 7 10 

305 ................................................................ 35,655 2.8710 1 1 2 4 5 

306 ................................................................ 1,379 6.4141 2 3 5 8 12 

307 ................................................................ 6,451 3.4999 1 2 3 4 7 

308 ................................................................ 33,533 5.7559 1 3 4 7 11 

309 ................................................................ 79,767 3.9679 1 2 3 5 7 

310 ................................................................ 160,781 2.7683 1 1 2 4 5 

311 ................................................................ 24,872 2.3395 1 1 2 3 4 

312 ................................................................ 169,277 3.1499 1 2 3 4 6 

313 ................................................................ 220,824 2.1144 1 1 2 3 4 

314 ................................................................ 60,079 7.1189 2 3 5 9 14 

315 ................................................................ 30,738 4.6782 1 2 4 6 9 

316 ................................................................ 20,111 3.0454 1 1 2 4 6 

326 ................................................................ 11,568 17.2235 6 9 14 22 32 

327 ................................................................ 10,903 10.3403 3 6 9 13 19 

328 ................................................................ 9,334 4.6128 1 2 3 6 9 

329 ................................................................ 48,146 15.8920 6 9 13 20 29 

330 ................................................................ 66,316 9.8949 4 6 8 12 17 

331 ................................................................ 31,408 6.1136 3 4 5 7 10 

332 ................................................................ 1,891 14.7361 6 8 12 18 26 

333 ................................................................ 6,198 8.9923 4 6 8 11 15 

334 ................................................................ 4,023 5.7062 2 4 5 7 9 

335 ................................................................ 7,164 14.3626 6 8 12 18 25 

336 ................................................................ 12,520 9.3056 3 5 8 12 16 

337 ................................................................ 8,839 5.6987 2 3 5 8 11 

338 ................................................................ 1,500 10.8567 4 6 9 14 19 

339 ................................................................ 3,195 7.1894 3 4 6 9 12 

340 ................................................................ 3,608 4.2783 2 2 4 6 7 

341 ................................................................ 874 7.2563 2 3 5 10 15 

342 ................................................................ 2,537 4.3532 1 2 3 6 8 

343 ................................................................ 6,882 2.2819 1 1 2 3 4 

344 ................................................................ 899 12.0445 4 6 9 15 23 

345 ................................................................ 2,917 7.3318 3 4 6 9 13 

346 ................................................................ 2,909 5.0248 2 3 5 6 8 

347 ................................................................ 1,568 8.3412 2 4 7 11 16 

348 ................................................................ 3,986 5.5738 1 2 4 7 11 

349 ................................................................ 5,789 3.1036 1 1 2 4 6 

350 ................................................................ 1,669 8.0617 2 4 7 11 16 

351 ................................................................ 3,998 4.6791 1 2 4 6 9 

352 ................................................................ 8,429 2.4582 1 1 2 3 5 

353 ................................................................ 3,184 8.7148 2 4 7 11 17 

354 ................................................................ 9,129 5.0778 1 3 4 7 9 

355 ................................................................ 17,461 2.8775 1 1 2 4 5 

356 ................................................................ 8,367 13.2579 3 6 10 17 26 

357 ................................................................ 8,046 8.1130 2 4 7 10 16 

358 ................................................................ 2,716 4.7128 1 2 4 6 9 

368 ................................................................ 3,052 6.6432 2 3 5 8 13 

369 ................................................................ 4,006 4.7791 2 3 4 6 9 

370 ................................................................ 3,916 3.4229 1 2 3 4 6 

371 ................................................................ 16,846 8.7684 3 4 7 11 17 

372 ................................................................ 22,911 6.8602 3 4 6 8 13 

373 ................................................................ 14,899 5.0055 2 3 4 6 9 

374 ................................................................ 9,417 8.8178 2 4 7 11 17 

375 ................................................................ 19,736 6.0537 2 3 5 8 12 

376 ................................................................ 4,820 4.1102 1 2 3 5 8 

377 ................................................................ 50,521 6.4758 2 3 5 8 12 

378 ................................................................ 84,839 4.7121 2 3 4 6 8 

379 ................................................................ 128,807 3.5255 1 2 3 4 6 

380 ................................................................ 2,917 7.2129 2 4 5 9 14 

381 ................................................................ 4,895 5.3263 2 3 4 7 10 

382 ................................................................ 5,446 3.6430 1 2 3 5 6 

383 ................................................................ 1,303 5.8496 2 3 5 7 11 

384 ................................................................ 8,672 3.8546 1 2 3 5 7 

385 ................................................................ 2,107 9.0128 3 4 7 11 18 

386 ................................................................ 7,223 5.7597 2 3 5 7 11 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25075 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

387 ................................................................ 5,233 4.4323 2 2 4 6 8 

388 ................................................................ 18,272 7.4310 2 3 6 9 15 

389 ................................................................ 46,336 5.0762 2 3 4 6 9 

390 ................................................................ 48,061 3.5994 1 2 3 5 6 

391 ................................................................ 47,516 5.4690 2 2 4 7 11 

392 ................................................................ 306,603 3.5476 1 2 3 4 7 

393 ................................................................ 23,924 6.9569 2 3 5 9 14 

394 ................................................................ 45,966 4.9372 1 2 4 6 9 

395 ................................................................ 26,474 3.4027 1 2 3 4 6 

405 ................................................................ 3,903 17.3051 5 8 13 22 34 

406 ................................................................ 5,246 9.5141 2 5 8 12 18 

407 ................................................................ 2,310 5.6078 1 3 5 7 10 

408 ................................................................ 1,645 14.8182 5 8 12 19 27 

409 ................................................................ 1,713 9.9440 4 6 8 12 18 

410 ................................................................ 722 6.8172 3 4 6 8 11 

411 ................................................................ 978 13.0276 5 7 11 16 23 

412 ................................................................ 1,063 8.8579 4 5 8 11 15 

413 ................................................................ 882 6.0907 2 4 5 8 11 

414 ................................................................ 5,599 11.8391 5 7 10 15 21 

415 ................................................................ 6,852 7.7478 3 5 7 10 13 

416 ................................................................ 6,228 4.9045 2 3 4 6 8 

417 ................................................................ 16,677 8.4020 3 4 7 10 16 

418 ................................................................ 27,572 5.6679 2 3 5 7 10 

419 ................................................................ 38,296 3.1868 1 1 3 4 6 

420 ................................................................ 714 14.0126 3 6 11 18 27 

421 ................................................................ 1,091 7.8570 2 3 6 10 16 

422 ................................................................ 364 4.4615 1 2 4 6 8 

423 ................................................................ 1,501 15.3911 4 7 12 19 29 

424 ................................................................ 912 10.2664 3 5 8 13 20 

425 ................................................................ 157 5.8790 2 3 5 8 11 

432 ................................................................ 16,264 6.8549 2 3 5 8 14 

433 ................................................................ 9,022 4.8422 1 2 4 6 9 

434 ................................................................ 946 3.5888 1 2 3 5 7 

435 ................................................................ 11,915 7.6726 2 3 6 10 15 

436 ................................................................ 13,991 5.8723 2 3 5 8 11 

437 ................................................................ 4,359 4.3595 1 2 3 6 9 

438 ................................................................ 14,432 7.7379 2 3 6 10 16 

439 ................................................................ 24,824 5.4652 2 3 4 7 10 

440 ................................................................ 27,361 3.8783 1 2 3 5 7 

441 ................................................................ 13,922 6.9813 2 3 5 9 14 

442 ................................................................ 12,759 5.1323 2 3 4 6 10 

443 ................................................................ 6,703 3.8532 1 2 3 5 7 

444 ................................................................ 12,453 6.6271 2 3 5 8 13 

445 ................................................................ 16,759 4.8121 2 2 4 6 9 

446 ................................................................ 16,857 3.3299 1 2 3 4 6 

453 ................................................................ 846 15.8995 6 8 13 20 28 

454 ................................................................ 1,497 8.6306 3 5 7 11 16 

455 ................................................................ 1,877 4.8636 2 3 4 6 8 

456 ................................................................ 765 15.6693 5 7 12 19 30 

457 ................................................................ 1,764 8.2874 3 5 7 10 15 

458 ................................................................ 1,535 4.7466 2 3 4 6 7 

459 ................................................................ 3,183 9.6183 4 5 7 11 18 

460 ................................................................ 50,358 4.3516 2 3 4 5 7 

461 ................................................................ 1,062 8.3606 4 5 7 10 15 

462 ................................................................ 14,253 4.2891 3 3 4 5 7 

463 ................................................................ 5,285 16.7069 5 7 12 21 33 

464 ................................................................ 6,322 10.3945 3 5 8 13 20 

465 ................................................................ 2,942 6.3606 2 3 5 8 12 

466 ................................................................ 4,153 9.5538 4 5 7 11 18 

467 ................................................................ 10,821 6.0700 3 4 5 7 10 

468 ................................................................ 28,714 4.0543 2 3 4 5 6 

469 ................................................................ 29,744 8.4430 4 5 7 10 15 

470 ................................................................ 410,707 4.0256 3 3 4 4 6 

471 ................................................................ 2,229 10.0983 2 4 8 13 20 

472 ................................................................ 6,221 4.3728 1 1 3 6 10 

473 ................................................................ 22,573 2.0132 1 1 1 2 4 

474 ................................................................ 2,831 12.4822 4 6 10 16 24 

475 ................................................................ 3,533 8.6575 3 4 7 11 16 

476 ................................................................ 1,698 5.0683 1 2 4 7 10 

477 ................................................................ 2,257 12.5109 4 6 10 15 23 

mmaher on DSK3CLS3C1PROD with $$_JOB

25076 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

478 ................................................................ 7,144 6.9120 1 3 6 9 14 

479 ................................................................ 10,271 2.8762 1 1 1 4 7 

480 ................................................................ 25,882 9.4645 4 6 8 11 17 

481 ................................................................ 59,159 6.2065 3 4 5 7 10 

482 ................................................................ 64,819 4.9470 3 4 5 6 7 

483 ................................................................ 5,732 4.5700 2 2 3 6 9 

484 ................................................................ 17,981 2.5039 1 2 2 3 4 

485 ................................................................ 968 12.6715 5 7 10 15 23 

486 ................................................................ 1,536 8.3665 3 5 7 10 15 

487 ................................................................ 1,215 5.8025 3 4 5 7 10 

488 ................................................................ 1,552 5.6746 2 3 4 7 11 

489 ................................................................ 3,869 3.1171 1 2 3 4 6 

490 ................................................................ 19,809 4.8572 1 2 3 6 10 

491 ................................................................ 58,474 2.2865 1 1 2 3 4 

492 ................................................................ 4,704 8.7245 3 5 7 11 16 

493 ................................................................ 15,253 5.3926 2 3 4 7 9 

494 ................................................................ 30,588 3.4237 1 2 3 4 6 

495 ................................................................ 1,867 11.0664 3 5 9 14 21 

496 ................................................................ 5,049 6.0594 1 3 5 8 12 

497 ................................................................ 7,520 3.2645 1 1 2 4 7 

498 ................................................................ 1,177 8.4274 2 3 6 11 16 

499 ................................................................ 1,246 3.2584 1 1 3 4 6 

500 ................................................................ 1,349 11.1979 3 5 8 14 22 

501 ................................................................ 3,679 6.0294 2 3 5 8 12 

502 ................................................................ 6,829 2.9776 1 1 2 4 6 

503 ................................................................ 736 8.8628 3 4 7 11 17 

504 ................................................................ 2,155 6.5225 2 3 5 8 12 

505 ................................................................ 3,218 3.4058 1 2 3 4 7 

506 ................................................................ 909 3.2288 1 1 2 4 7 

507 ................................................................ 779 5.3286 1 2 4 7 11 

508 ................................................................ 2,723 2.0525 1 1 2 2 4 

509 ................................................................ 465 2.9441 1 1 2 3 7 

510 ................................................................ 957 6.6029 2 3 5 8 12 

511 ................................................................ 4,009 3.8735 1 2 3 5 7 

512 ................................................................ 11,982 2.1194 1 1 2 3 4 

513 ................................................................ 1,288 5.1250 1 2 4 7 10 

514 ................................................................ 1,341 2.6346 1 1 2 3 5 

515 ................................................................ 3,577 10.8784 3 5 9 14 20 

516 ................................................................ 10,964 6.0369 1 3 5 8 12 

517 ................................................................ 18,272 2.9365 1 1 2 4 7 

533 ................................................................ 829 6.9035 2 3 5 9 13 

534 ................................................................ 3,635 4.0083 1 2 3 5 7 

535 ................................................................ 6,844 6.3819 2 3 5 8 12 

536 ................................................................ 34,330 3.9729 1 3 3 5 7 

537 ................................................................ 654 4.7156 2 3 4 6 9 

538 ................................................................ 1,164 3.1357 1 2 3 4 5 

539 ................................................................ 3,382 10.1730 3 5 8 12 19 

540 ................................................................ 4,190 7.2535 3 4 6 9 13 

541 ................................................................ 1,858 5.6416 2 3 5 7 10 

542 ................................................................ 6,162 8.6883 3 4 7 11 17 

543 ................................................................ 18,418 5.9972 2 3 5 7 11 

544 ................................................................ 12,645 4.4837 2 3 4 6 8 

545 ................................................................ 4,019 9.0109 2 4 7 11 18 

546 ................................................................ 5,885 5.5694 2 3 4 7 10 

547 ................................................................ 4,888 3.9544 1 2 3 5 7 

548 ................................................................ 592 9.3125 3 4 7 11 17 

549 ................................................................ 1,078 6.3163 2 3 5 8 12 

550 ................................................................ 905 4.5271 1 3 4 6 8 

551 ................................................................ 9,504 7.2317 2 3 6 9 14 

552 ................................................................ 87,884 4.1777 1 2 3 5 8 

553 ................................................................ 2,793 6.0859 2 3 5 8 11 

554 ................................................................ 20,263 3.7237 1 2 3 5 7 

555 ................................................................ 1,995 4.9133 1 2 4 6 10 

556 ................................................................ 19,173 3.1840 1 2 3 4 6 

557 ................................................................ 3,184 6.9416 2 4 6 8 13 

558 ................................................................ 14,180 4.2641 2 3 4 5 7 

559 ................................................................ 1,635 7.2765 2 3 5 9 14 

560 ................................................................ 3,979 4.8030 1 2 4 6 9 

561 ................................................................ 7,618 2.7569 1 1 2 3 5 

562 ................................................................ 5,000 6.5032 2 3 5 8 12 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25077 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

563 ................................................................ 36,060 3.7152 1 2 3 4 6 

564 ................................................................ 1,607 7.1413 2 3 6 9 14 

565 ................................................................ 3,238 5.1115 2 3 4 7 9 

566 ................................................................ 2,780 3.7737 1 2 3 5 7 

573 ................................................................ 5,688 13.7773 4 6 10 16 28 

574 ................................................................ 12,103 9.4910 3 5 7 11 18 

575 ................................................................ 6,469 6.0077 2 3 5 7 11 

576 ................................................................ 558 12.1505 2 4 8 15 26 

577 ................................................................ 2,179 6.0069 1 2 4 8 13 

578 ................................................................ 3,299 3.4826 1 1 2 4 7 

579 ................................................................ 3,088 11.4058 3 5 9 14 22 

580 ................................................................ 6,767 7.2707 2 3 6 9 14 

581 ................................................................ 5,290 4.0115 1 2 3 5 8 

582 ................................................................ 8,978 2.7738 1 1 2 3 5 

583 ................................................................ 15,578 1.7536 1 1 1 2 3 

584 ................................................................ 1,431 4.5206 1 1 2 6 11 

585 ................................................................ 2,821 1.9018 1 1 1 2 4 

592 ................................................................ 3,984 8.8542 3 4 7 11 17 

593 ................................................................ 12,834 6.5156 2 4 5 8 12 

594 ................................................................ 2,955 4.9005 2 3 4 6 9 

595 ................................................................ 1,083 8.1782 2 4 6 10 16 

596 ................................................................ 5,756 4.8211 2 2 4 6 9 

597 ................................................................ 549 8.0729 2 3 6 10 16 

598 ................................................................ 1,483 5.6109 2 3 4 7 11 

599 ................................................................ 350 3.5914 1 1 3 5 8 

600 ................................................................ 572 5.4143 2 3 4 7 10 

601 ................................................................ 865 3.8335 1 2 3 5 7 

602 ................................................................ 21,315 7.0332 2 4 6 9 13 

603 ................................................................ 130,955 4.7383 2 3 4 6 8 

604 ................................................................ 2,627 5.4328 1 3 4 7 11 

605 ................................................................ 22,678 3.4824 1 2 3 4 6 

606 ................................................................ 1,363 5.8782 1 2 4 7 12 

607 ................................................................ 7,169 3.7576 1 2 3 5 7 

614 ................................................................ 1,377 7.3682 2 3 5 9 15 

615 ................................................................ 1,626 3.3911 1 2 3 4 6 

616 ................................................................ 1,133 15.5119 6 8 13 19 27 

617 ................................................................ 6,824 9.0098 3 5 8 12 16 

618 ................................................................ 343 6.4781 2 3 6 8 12 

619 ................................................................ 663 9.2926 3 4 6 10 21 

620 ................................................................ 1,878 4.2572 2 2 3 5 7 

621 ................................................................ 6,561 2.4476 1 1 2 3 4 

622 ................................................................ 1,234 13.1118 4 6 9 16 27 

623 ................................................................ 3,269 8.7641 3 5 7 10 16 

624 ................................................................ 488 5.9529 2 3 5 7 11 

625 ................................................................ 1,099 7.5332 2 3 5 9 17 

626 ................................................................ 2,523 3.3096 1 1 2 4 7 

627 ................................................................ 14,337 1.5601 1 1 1 2 2 

628 ................................................................ 3,267 11.7410 2 4 8 15 24 

629 ................................................................ 3,958 8.9277 3 5 7 11 16 

630 ................................................................ 684 5.4883 1 2 4 7 11 

637 ................................................................ 16,290 6.1765 2 3 5 7 12 

638 ................................................................ 40,817 4.4088 1 2 4 6 8 

639 ................................................................ 41,142 3.1006 1 2 3 4 6 

640 ................................................................ 55,697 5.6186 1 2 4 7 11 

641 ................................................................ 188,150 3.8620 1 2 3 5 7 

642 ................................................................ 1,544 5.2448 1 2 4 6 10 

643 ................................................................ 5,019 7.7675 2 4 6 10 15 

644 ................................................................ 11,848 5.4716 2 3 4 7 10 

645 ................................................................ 8,406 3.9222 1 2 3 5 7 

652 ................................................................ 10,439 7.9171 4 5 6 9 14 

653 ................................................................ 1,585 16.7584 7 9 13 20 31 

654 ................................................................ 3,231 10.1619 5 7 9 12 17 

655 ................................................................ 1,651 6.6887 3 4 7 8 10 

656 ................................................................ 3,721 10.7788 4 5 8 13 21 

657 ................................................................ 7,360 6.1595 3 4 5 7 10 

658 ................................................................ 8,484 3.8944 2 3 4 5 6 

659 ................................................................ 4,442 11.3197 3 5 8 14 23 

660 ................................................................ 7,446 6.6108 2 3 5 8 13 

661 ................................................................ 4,749 3.5475 1 2 3 4 7 

662 ................................................................ 988 10.4686 2 4 8 14 21 

mmaher on DSK3CLS3C1PROD with $$_JOB

25078 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

663 ................................................................ 2,131 5.2407 1 2 4 7 11 

664 ................................................................ 4,677 2.1760 1 1 1 2 4 

665 ................................................................ 690 12.1942 3 6 10 15 22 

666 ................................................................ 2,213 6.3448 1 2 4 9 14 

667 ................................................................ 3,951 2.8697 1 1 2 3 6 

668 ................................................................ 3,757 8.6191 2 4 7 11 17 

669 ................................................................ 12,494 4.3597 1 2 3 6 9 

670 ................................................................ 13,418 2.5885 1 1 2 3 6 

671 ................................................................ 884 5.7896 1 2 4 8 12 

672 ................................................................ 965 2.5990 1 1 2 3 5 

673 ................................................................ 12,578 10.1248 1 3 7 13 22 

674 ................................................................ 10,504 7.2773 1 2 5 10 16 

675 ................................................................ 11,707 2.5849 1 1 1 3 6 

682 ................................................................ 75,855 7.2988 2 3 6 9 15 

683 ................................................................ 112,156 5.8525 2 3 5 7 11 

684 ................................................................ 43,471 4.0578 1 2 3 5 7 

685 ................................................................ 2,498 3.5020 1 1 2 4 7 

686 ................................................................ 1,582 8.0493 2 4 6 10 15 

687 ................................................................ 3,322 5.3058 1 3 4 7 10 

688 ................................................................ 1,198 3.3222 1 1 3 4 6 

689 ................................................................ 55,402 6.3745 2 3 5 8 12 

690 ................................................................ 200,093 4.3011 2 2 4 5 8 

691 ................................................................ 898 4.1648 1 2 3 5 9 

692 ................................................................ 655 2.2580 1 1 2 3 4 

693 ................................................................ 2,235 5.2098 1 2 4 7 10 

694 ................................................................ 19,221 2.5735 1 1 2 3 5 

695 ................................................................ 975 5.7323 2 3 4 7 12 

696 ................................................................ 10,566 3.2277 1 2 3 4 6 

697 ................................................................ 575 3.2835 1 1 2 4 6 

698 ................................................................ 21,065 6.7737 2 3 5 8 13 

699 ................................................................ 22,826 5.0096 1 2 4 6 10 

700 ................................................................ 15,094 3.6045 1 2 3 5 7 

707 ................................................................ 4,875 4.8568 2 2 4 6 9 

708 ................................................................ 17,032 2.4324 1 1 2 3 4 

709 ................................................................ 755 6.6715 1 2 4 8 15 

710 ................................................................ 2,037 1.8949 1 1 1 2 3 

711 ................................................................ 922 7.9469 1 3 6 10 16 

712 ................................................................ 819 3.0024 1 1 2 4 7 

713 ................................................................ 11,760 4.1367 1 2 3 5 9 

714 ................................................................ 32,760 2.0154 1 1 2 2 3 

715 ................................................................ 638 6.1661 1 2 4 8 14 

716 ................................................................ 1,389 1.5227 1 1 1 1 2 

717 ................................................................ 635 7.6567 1 3 5 10 16 

718 ................................................................ 633 2.7994 1 1 2 4 5 

722 ................................................................ 871 7.4409 2 3 6 9 14 

723 ................................................................ 2,038 5.4328 2 3 4 7 10 

724 ................................................................ 666 3.3498 1 1 3 4 7 

725 ................................................................ 802 5.6160 2 3 4 7 11 

726 ................................................................ 3,941 3.5202 1 2 3 4 7 

727 ................................................................ 1,098 6.5556 2 3 5 8 12 

728 ................................................................ 6,177 4.0570 1 2 3 5 7 

729 ................................................................ 578 5.1488 1 2 4 7 10 

730 ................................................................ 552 3.2591 1 1 2 4 6 

734 ................................................................ 1,470 7.7129 3 4 5 9 15 

735 ................................................................ 1,329 3.5056 1 2 3 4 6 

736 ................................................................ 840 13.8619 5 8 12 18 25 

737 ................................................................ 3,429 7.4278 3 4 6 9 13 

738 ................................................................ 955 3.9874 2 3 4 5 6 

739 ................................................................ 975 10.2318 4 5 7 13 20 

740 ................................................................ 4,370 5.2190 2 3 4 6 9 

741 ................................................................ 6,562 3.1617 2 2 3 4 5 

742 ................................................................ 10,709 4.7158 2 2 3 5 9 

743 ................................................................ 35,368 2.3568 1 2 2 3 4 

744 ................................................................ 1,498 5.9012 1 2 4 7 12 

745 ................................................................ 2,194 2.6135 1 1 2 3 5 

746 ................................................................ 2,487 4.2059 1 2 3 5 8 

747 ................................................................ 11,231 1.9232 1 1 2 2 3 

748 ................................................................ 21,201 1.8026 1 1 1 2 3 

749 ................................................................ 1,038 9.9075 2 4 7 13 21 

750 ................................................................ 484 3.3306 1 2 3 4 6 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25079 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

754 ................................................................ 1,083 8.8144 2 4 7 11 19 

755 ................................................................ 3,152 5.6551 1 3 4 7 11 

756 ................................................................ 832 3.3221 1 1 3 4 7 

757 ................................................................ 1,323 8.9131 3 4 7 11 17 

758 ................................................................ 1,597 6.1327 2 3 5 8 11 

759 ................................................................ 1,186 4.6256 2 2 4 6 8 

760 ................................................................ 1,703 3.8227 1 2 3 5 7 

761 ................................................................ 1,918 2.4937 1 1 2 3 5 

765 ................................................................ 2,501 5.3215 2 3 4 5 8 

766 ................................................................ 2,637 3.2461 2 2 3 4 4 

767 ................................................................ 119 2.8824 1 2 2 3 5 

768 ................................................................ 10 5.8000 2 3 4 8 9 

769 ................................................................ 86 5.7326 1 2 3 7 12 

770 ................................................................ 181 2.7017 1 1 1 2 6 

774 ................................................................ 1,443 3.2467 2 2 3 3 4 

775 ................................................................ 5,236 2.3067 1 2 2 3 3 

776 ................................................................ 492 3.5691 1 2 2 4 7 

777 ................................................................ 178 2.0674 1 1 2 3 3 

778 ................................................................ 489 2.7607 1 1 2 3 5 

779 ................................................................ 107 2.6449 1 1 1 2 4 

780 ................................................................ 47 2.7021 1 1 1 1 2 

781 ................................................................ 3,004 3.8129 1 1 3 4 7 

782 ................................................................ 125 2.7920 1 1 1 2 5 

790 ................................................................ 1 65.0000 65 65 65 65 65 

793 ................................................................ 1 7.0000 7 7 7 7 7 

794 ................................................................ 7 1.2857 1 1 1 1 2 

799 ................................................................ 623 14.2472 4 7 11 19 28 

800 ................................................................ 700 8.3700 3 4 6 11 17 

801 ................................................................ 602 4.8688 2 2 4 6 9 

802 ................................................................ 692 12.9538 3 6 10 16 26 

803 ................................................................ 1,004 6.5787 1 3 5 8 13 

804 ................................................................ 996 3.3203 1 1 2 4 7 

808 ................................................................ 8,316 7.9752 2 4 6 10 15 

809 ................................................................ 15,532 5.0147 2 2 4 6 9 

810 ................................................................ 3,819 3.9296 1 2 3 5 7 

811 ................................................................ 18,353 5.5474 1 2 4 7 11 

812 ................................................................ 83,122 3.7292 1 2 3 5 7 

813 ................................................................ 15,074 5.1932 1 2 4 7 11 

814 ................................................................ 1,631 7.1594 2 3 5 9 15 

815 ................................................................ 3,340 4.9177 2 2 4 6 9 

816 ................................................................ 2,359 3.4349 1 2 3 4 7 

820 ................................................................ 1,481 18.3849 5 8 14 24 37 

821 ................................................................ 2,530 7.8375 1 3 6 10 16 

822 ................................................................ 2,142 3.7250 1 1 3 5 8 

823 ................................................................ 2,437 15.3943 5 8 13 20 28 

824 ................................................................ 3,039 8.8427 2 4 7 12 17 

825 ................................................................ 2,010 4.7866 1 2 3 7 10 

826 ................................................................ 562 17.3488 5 8 13 21 34 

827 ................................................................ 1,318 7.6115 2 4 6 9 15 

828 ................................................................ 872 3.7500 1 2 3 5 7 

829 ................................................................ 1,375 10.4611 2 4 7 14 23 

830 ................................................................ 531 3.6591 1 1 2 4 8 

834 ................................................................ 5,260 14.6249 2 4 9 23 35 

835 ................................................................ 1,469 8.2178 1 3 5 9 20 

836 ................................................................ 1,526 5.0125 1 2 3 6 10 

837 ................................................................ 1,624 22.6558 5 9 23 30 39 

838 ................................................................ 900 9.2122 3 4 5 7 25 

839 ................................................................ 1,385 6.0368 3 4 5 6 8 

840 ................................................................ 15,155 9.5956 2 4 7 12 20 

841 ................................................................ 11,017 6.6239 2 3 5 8 13 

842 ................................................................ 7,682 4.2890 1 2 3 6 8 

843 ................................................................ 1,477 8.7204 2 4 7 11 17 

844 ................................................................ 2,856 6.0007 2 3 5 8 12 

845 ................................................................ 1,008 4.3065 1 2 3 6 9 

846 ................................................................ 2,481 8.4869 2 3 5 10 19 

847 ................................................................ 23,676 3.2722 1 2 3 4 6 

848 ................................................................ 1,701 2.9259 1 1 2 4 5 

849 ................................................................ 1,500 5.9887 1 3 4 6 13 

853 ................................................................ 31,446 16.7084 5 8 13 21 31 

854 ................................................................ 6,882 11.1935 4 6 9 14 20 

mmaher on DSK3CLS3C1PROD with $$_JOB

25080 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

855 ................................................................ 467 7.5096 2 4 6 10 14 

856 ................................................................ 6,188 16.1577 5 7 12 20 32 

857 ................................................................ 10,066 8.8965 3 4 7 11 17 

858 ................................................................ 3,502 6.0888 2 3 5 7 11 

862 ................................................................ 7,426 8.2665 2 4 6 10 16 

863 ................................................................ 21,813 5.2222 2 3 4 7 9 

864 ................................................................ 19,829 4.0996 1 2 3 5 8 

865 ................................................................ 2,019 6.8366 2 3 5 8 15 

866 ................................................................ 9,410 3.5129 1 2 3 4 6 

867 ................................................................ 5,307 9.9354 3 4 7 13 20 

868 ................................................................ 2,371 6.0017 2 3 5 7 11 

869 ................................................................ 1,101 4.3697 2 2 4 5 8 

870 ................................................................ 13,711 15.2393 6 8 13 19 27 

871 ................................................................ 203,725 7.6898 2 4 6 10 15 

872 ................................................................ 92,141 5.7923 2 3 5 7 10 

876 ................................................................ 968 11.1746 1 4 8 14 24 

880 ................................................................ 10,497 3.2223 1 1 2 4 6 

881 ................................................................ 4,577 4.1534 1 2 3 5 8 

882 ................................................................ 1,656 4.4771 1 2 3 5 8 

883 ................................................................ 786 7.4288 1 2 4 8 16 

884 ................................................................ 21,621 5.3979 2 3 4 6 10 

885 ................................................................ 77,784 7.5960 2 3 6 9 15 

886 ................................................................ 376 5.8963 1 2 4 6 11 

887 ................................................................ 424 4.5825 1 2 3 5 8 

894 ................................................................ 4,480 2.9406 1 1 2 3 6 

895 ................................................................ 6,477 10.4868 3 5 8 14 21 

896 ................................................................ 5,372 6.6035 2 3 5 8 13 

897 ................................................................ 35,839 4.0848 1 2 3 5 7 

901 ................................................................ 917 14.4275 3 5 9 17 30 

902 ................................................................ 2,136 8.0108 2 3 6 10 16 

903 ................................................................ 1,740 4.8977 1 2 4 6 10 

904 ................................................................ 941 12.3528 2 4 7 14 22 

905 ................................................................ 798 4.8070 1 2 4 6 9 

906 ................................................................ 745 3.2725 1 1 2 4 7 

907 ................................................................ 8,101 11.6595 3 5 8 14 24 

908 ................................................................ 7,885 7.0411 2 3 5 9 14 

909 ................................................................ 5,974 3.6696 1 2 3 5 7 

913 ................................................................ 813 6.0873 2 3 5 8 12 

914 ................................................................ 6,959 3.3993 1 2 3 4 6 

915 ................................................................ 915 4.6120 1 2 3 6 10 

916 ................................................................ 5,370 2.1391 1 1 2 3 4 

917 ................................................................ 14,156 5.2280 1 2 4 6 11 

918 ................................................................ 34,873 2.7266 1 1 2 3 5 

919 ................................................................ 10,570 6.2364 1 3 4 8 13 

920 ................................................................ 12,143 4.4851 1 2 3 6 9 

921 ................................................................ 11,663 2.9882 1 1 2 4 6 

922 ................................................................ 1,005 6.0836 1 2 4 8 14 

923 ................................................................ 4,212 3.2946 1 1 2 4 6 

927 ................................................................ 182 28.9670 9 15 25 40 54 

928 ................................................................ 795 16.1975 4 8 14 20 31 

929 ................................................................ 459 7.7930 2 3 6 11 16 

933 ................................................................ 155 5.9097 1 1 2 6 14 

934 ................................................................ 694 6.8329 1 3 5 8 14 

935 ................................................................ 2,179 5.5571 1 2 4 7 12 

939 ................................................................ 423 10.9622 2 4 8 14 22 

940 ................................................................ 690 6.4580 1 3 5 8 14 

941 ................................................................ 1,077 3.1309 1 1 2 4 6 

945 ................................................................ 5,058 10.5042 4 6 9 13 19 

946 ................................................................ 3,199 7.8634 4 5 7 9 12 

947 ................................................................ 6,546 4.9904 1 2 4 6 10 

948 ................................................................ 34,333 3.4084 1 2 3 4 6 

949 ................................................................ 742 4.1631 1 1 2 5 8 

950 ................................................................ 476 3.4286 1 1 2 4 6 

951 ................................................................ 990 3.7434 1 1 2 3 6 

955 ................................................................ 446 12.2825 2 6 10 16 23 

956 ................................................................ 3,720 9.4664 4 5 7 11 18 

957 ................................................................ 1,157 16.7398 3 8 14 21 31 

958 ................................................................ 737 11.5875 3 6 10 14 21 

959 ................................................................ 816 7.7132 1 4 6 10 15 

963 ................................................................ 1,395 9.4803 1 4 8 13 19 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25081 

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR 

UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued 

DRG Number of 

discharges 

Arithmetic 

mean LOS 

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile 

964 ................................................................ 1,578 6.8054 2 4 6 9 12 

965 ................................................................ 2,016 4.6984 1 3 4 6 9 

969 ................................................................ 598 19.0033 5 8 14 24 38 

970 ................................................................ 231 11.7965 2 5 8 15 25 

974 ................................................................ 7,276 9.3487 2 4 7 12 20 

975 ................................................................ 3,463 8.0323 2 3 6 10 16 

976 ................................................................ 2,729 5.5790 2 3 4 7 11 

977 ................................................................ 4,874 5.2154 1 2 4 6 10 

981 ................................................................ 26,287 15.2524 5 8 12 19 28 

982 ................................................................ 18,597 10.0533 3 5 8 13 19 

983 ................................................................ 6,767 5.5626 1 2 5 7 11 

984 ................................................................ 669 14.6114 5 8 13 18 27 

985 ................................................................ 1,048 9.8559 2 5 9 13 18 

986 ................................................................ 890 5.2213 1 2 4 8 11 

987 ................................................................ 8,037 13.1528 4 6 11 17 25 

988 ................................................................ 11,880 7.9806 2 4 7 10 15 

989 ................................................................ 6,538 4.2389 1 1 3 6 9 

11,663,472 

TABLE 8A.—PROPOSED STATEWIDE

AVERAGE OPERATING COST-TOCHARGE RATIOS—MARCH 2007 

State Urban Rural 

Alabama .............................. 0.26 0.34 

Alaska .................................. 0.42 0.714 

Arizona ................................ 0.28 0.43 

Arkansas ............................. 0.332 0.353 

California ............................. 0.23 0.33 

Colorado .............................. 0.302 0.446 

Connecticut ......................... 0.417 0.502 

Delaware ............................. 0.496 0.462 

District of Columbia ............. 0.351 ................

Florida ................................. 0.246 0.288 

Georgia ................................ 0.341 0.392 

Hawaii .................................. 0.37 0.444 

Idaho ................................... 0.47 0.565 

Illinois .................................. 0.319 0.403 

Indiana ................................. 0.411 0.447 

Iowa ..................................... 0.374 0.455 

Kansas ................................ 0.296 0.441 

Kentucky .............................. 0.379 0.375 

Louisiana ............................. 0.307 0.355 

Maine ................................... 0.495 0.466 

Maryland .............................. 0.732 0.799 

Massachusetts .................... 0.48 ................

Michigan .............................. 0.371 0.467 

Minnesota ............................ 0.385 0.526 

Mississippi ........................... 0.317 0.369 

Missouri ............................... 0.329 0.372 

Montana .............................. 0.431 0.49 

Nebraska ............................. 0.363 0.457 

Nevada ................................ 0.224 0.483 

New Hampshire ................... 0.456 0.443 

New Jersey ......................... 0.183 ................

New Mexico ......................... 0.379 0.386 

New York ............................. 0.358 0.523 

North Carolina ..................... 0.434 0.414 

North Dakota ....................... 0.443 0.467 

Ohio ..................................... 0.361 0.534 

Oklahoma ............................ 0.308 0.394 

Oregon ................................ 0.467 0.42 

Pennsylvania ....................... 0.275 0.436 

Puerto Rico ......................... 0.452 ................

Rhode Island ....................... 0.394 ................

South Carolina .................... 0.284 0.317 

South Dakota ...................... 0.352 0.442 

Tennessee ........................... 0.316 0.379 

Texas ................................... 0.271 0.348 

Utah ..................................... 0.418 0.571 

Vermont ............................... 0.54 0.637 

Virginia ................................ 0.363 0.37 

Washington ......................... 0.401 0.447 

TABLE 8A.—PROPOSED STATEWIDE

AVERAGE OPERATING COST-TOCHARGE RATIOS—MARCH 2007— 

Continued 

State Urban Rural 

West Virginia ....................... 0.484 0.474 

Wisconsin ............................ 0.425 0.476 

Wyoming ............................. 0.431 0.53 

TABLE 8B.—PROPOSED STATEWIDE

AVERAGE CAPITAL COST-TOCHARGE RATIOS—MARCH 2007 

State Ratio 

Alabama .................................................. 0.025 

Alaska ...................................................... 0.039 

Arizona .................................................... 0.024 

Arkansas ................................................. 0.025 

California ................................................. 0.016 

Colorado .................................................. 0.029 

Connecticut ............................................. 0.028 

Delaware ................................................. 0.036 

District of Columbia ................................. 0.025 

Florida ..................................................... 0.023 

Georgia .................................................... 0.029 

Hawaii ...................................................... 0.032 

Idaho ....................................................... 0.04 

Illinois ...................................................... 0.026 

Indiana ..................................................... 0.037 

Iowa ......................................................... 0.028 

Kansas .................................................... 0.03 

Kentucky .................................................. 0.029 

Louisiana ................................................. 0.03 

Maine ....................................................... 0.033 

Maryland .................................................. 0.055 

Massachusetts ........................................ 0.032 

Michigan .................................................. 0.03 

Minnesota ................................................ 0.028 

Mississippi ............................................... 0.028 

Missouri ................................................... 0.027 

Montana .................................................. 0.036 

Nebraska ................................................. 0.038 

Nevada .................................................... 0.023 

New Hampshire ....................................... 0.034 

New Jersey ............................................. 0.013 

New Mexico ............................................. 0.032 

New York ................................................. 0.029 

North Carolina ......................................... 0.036 

North Dakota ........................................... 0.04 

TABLE 8B.—PROPOSED STATEWIDE

AVERAGE CAPITAL COST-TOCHARGE RATIOS—MARCH 2007— 

Continued 

State Ratio 

Ohio ......................................................... 0.029 

Oklahoma ................................................ 0.029 

Oregon .................................................... 0.032 

Pennsylvania ........................................... 0.023 

Puerto Rico ............................................. 0.035 

Rhode Island ........................................... 0.021 

South Carolina ........................................ 0.025 

South Dakota .......................................... 0.033 

Tennessee ............................................... 0.031 

Texas ....................................................... 0.027 

Utah ......................................................... 0.037 

Vermont ................................................... 0.042 

Virginia .................................................... 0.037 

Washington ............................................. 0.031 

West Virginia ........................................... 0.033 

Wisconsin ................................................ 0.039 

Wyoming ................................................. 0.044 

TABLE 8C.—PROPOSED STATEWIDE

AVERAGE TOTAL COST-TO-CHARGE

RATIOS FOR LTCHS—MARCH 2007 

State Urban Rural 

Alabama .............................. 0.283 0.372 

Alaska .................................. 0.453 0.776 

Arizona ................................ 0.305 0.465 

Arkansas ............................. 0.355 0.383 

California ............................. 0.244 0.351 

Colorado .............................. 0.329 0.491 

Connecticut ......................... 0.445 0.543 

Delaware ............................. 0.532 0.504 

mmaher on DSK3CLS3C1PROD with $$_JOB

25082 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 8C.—PROPOSED STATEWIDE

AVERAGE TOTAL COST-TO-CHARGE

RATIOS FOR LTCHS—MARCH

2007—Continued 

State Urban Rural 

District of Columbia * .......... 0.376 ................

Florida ................................. 0.269 0.32 

Georgia ................................ 0.369 0.427 

Hawaii .................................. 0.4 0.482 

Idaho ................................... 0.509 0.609 

Illinois .................................. 0.344 0.436 

Indiana ................................. 0.448 0.493 

Iowa ..................................... 0.398 0.496 

Kansas ................................ 0.323 0.482 

Kentucky .............................. 0.408 0.405 

Louisiana ............................. 0.337 0.385 

Maine ................................... 0.53 0.495 

Maryland ** .......................... 0.445 0.351 

Massachusetts * .................. 0.512 ................

Michigan .............................. 0.4 0.503 

Minnesota ............................ 0.412 0.564 

Mississippi ........................... 0.344 0.398 

Missouri ............................... 0.354 0.406 

Montana .............................. 0.463 0.533 

TABLE 8C.—PROPOSED STATEWIDE

AVERAGE TOTAL COST-TO-CHARGE

RATIOS FOR LTCHS—MARCH

2007—Continued 

State Urban Rural 

Nebraska ............................. 0.398 0.504 

Nevada ................................ 0.246 0.549 

New Hampshire ................... 0.491 0.475 

New Jersey * ....................... 0.196 ................

New Mexico ......................... 0.412 0.417 

New York ............................. 0.387 0.56 

North Carolina ..................... 0.47 0.449 

North Dakota ....................... 0.48 0.515 

Ohio ..................................... 0.388 0.575 

Oklahoma ............................ 0.336 0.425 

Oregon ................................ 0.5 0.451 

Pennsylvania ....................... 0.295 0.469 

Puerto Rico * ....................... 0.487 ................

Rhode Island * .................... 0.415 ................

South Carolina .................... 0.309 0.344 

South Dakota ...................... 0.381 0.481 

Tennessee ........................... 0.346 0.413 

Texas ................................... 0.297 0.379 

Utah ..................................... 0.454 0.627 

TABLE 8C.—PROPOSED STATEWIDE

AVERAGE TOTAL COST-TO-CHARGE

RATIOS FOR LTCHS—MARCH

2007—Continued 

State Urban Rural 

Vermont ............................... 0.584 0.676 

Virginia ................................ 0.4 0.408 

Washington ......................... 0.432 0.48 

West Virginia ....................... 0.517 0.507 

Wisconsin ............................ 0.464 0.516 

Wyoming ............................. 0.466 0.583 

* All counties in the State or Territory are 

classified as urban, with the exception of Massachusetts, which has areas designated as 

rural. However, no short-term acute care IPPS 

hospitals or LTCHs are located in those areas 

as of March 2007. 

**National average IPPS total cost-to-charge 

ratios, as discussed in section VI.E. of this proposed rule. 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

010005 .............................................................................................................................................................. 01 26620 

010009 .............................................................................................................................................................. 19460 26620 

010010 .............................................................................................................................................................. 01 13820 

010012 .............................................................................................................................................................. 01 40660 

010022 .............................................................................................................................................................. 01 12060 LUGAR 

010025 .............................................................................................................................................................. 01 17980 

010029 .............................................................................................................................................................. 12220 17980 

010035 .............................................................................................................................................................. 01 13820 

010044 .............................................................................................................................................................. 01 13820 

010045 .............................................................................................................................................................. 01 13820 

010054 .............................................................................................................................................................. 19460 26620 

010059 .............................................................................................................................................................. 19460 26620 

010065 .............................................................................................................................................................. 01 13820 

010072 .............................................................................................................................................................. 01 11500 LUGAR 

010083 .............................................................................................................................................................. 01 33660 

010085 .............................................................................................................................................................. 19460 26620 

010090 .............................................................................................................................................................. 33660 37700 

010100 .............................................................................................................................................................. 01 37860 

010101 .............................................................................................................................................................. 01 13820 LUGAR 

010118 .............................................................................................................................................................. 01 46220 

010126 .............................................................................................................................................................. 01 33860 

010143 .............................................................................................................................................................. 01 13820 

010150 .............................................................................................................................................................. 01 33860 

010158 .............................................................................................................................................................. 01 19460 

010164 .............................................................................................................................................................. 01 11500 LUGAR 

020008 .............................................................................................................................................................. 02 11260 

030007 .............................................................................................................................................................. 39140 22380 LUGAR 

030033 .............................................................................................................................................................. 03 22380 

030055 .............................................................................................................................................................. 29420 39140 

030101 .............................................................................................................................................................. 29420 29820 

040014 .............................................................................................................................................................. 04 30780 

040017 .............................................................................................................................................................. 04 22220 

040019 .............................................................................................................................................................. 04 32820 

040020 .............................................................................................................................................................. 27860 32820 

040027 .............................................................................................................................................................. 04 44180 

040039 .............................................................................................................................................................. 04 26 

040041 .............................................................................................................................................................. 04 30780 

040069 .............................................................................................................................................................. 04 32820 

040071 .............................................................................................................................................................. 38220 30780 

040076 .............................................................................................................................................................. 04 30780 LUGAR 

040078 .............................................................................................................................................................. 26300 30780 

040080 .............................................................................................................................................................. 04 27860 

040085 .............................................................................................................................................................. 04 32820 

040088 .............................................................................................................................................................. 04 33740 

040091 .............................................................................................................................................................. 04 45500 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25083 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

040100 .............................................................................................................................................................. 04 30780 

040119 .............................................................................................................................................................. 04 30780 

050006 .............................................................................................................................................................. 05 39820 

050009 .............................................................................................................................................................. 34900 46700 

050013 .............................................................................................................................................................. 34900 46700 

050014 .............................................................................................................................................................. 05 40900 

050022 .............................................................................................................................................................. 40140 42044 

050042 .............................................................................................................................................................. 05 39820 

050046 .............................................................................................................................................................. 37100 31084 

050054 .............................................................................................................................................................. 40140 42044 

050065 .............................................................................................................................................................. 42044 31084 

050069 .............................................................................................................................................................. 42044 31084 

050071 .............................................................................................................................................................. 41940 36084 

050073 .............................................................................................................................................................. 46700 36084 

050076 .............................................................................................................................................................. 41884 36084 

050082 .............................................................................................................................................................. 37100 31084 

050089 .............................................................................................................................................................. 40140 31084 

050090 .............................................................................................................................................................. 42220 41884 

050099 .............................................................................................................................................................. 40140 31084 

050101 .............................................................................................................................................................. 46700 36084 

050102 .............................................................................................................................................................. 40140 42044 

050118 .............................................................................................................................................................. 44700 33700 

050129 .............................................................................................................................................................. 40140 31084 

050133 .............................................................................................................................................................. 49700 40900 

050136 .............................................................................................................................................................. 42220 41884 

050140 .............................................................................................................................................................. 40140 31084 

050150 .............................................................................................................................................................. 05 0900 

050159 .............................................................................................................................................................. 37100 31084 

050168 .............................................................................................................................................................. 42044 31084 

050173 .............................................................................................................................................................. 42044 31084 

050174 .............................................................................................................................................................. 42220 41884 

050193 .............................................................................................................................................................. 42044 31084 

050194 .............................................................................................................................................................. 42100 41940 

050197 .............................................................................................................................................................. 41884 36084 

050224 .............................................................................................................................................................. 42044 31084 

050226 .............................................................................................................................................................. 42044 31084 

050230 .............................................................................................................................................................. 42044 31084 

050236 .............................................................................................................................................................. 37100 31084 

050242 .............................................................................................................................................................. 42100 41940 

050243 .............................................................................................................................................................. 40140 42044 

050245 .............................................................................................................................................................. 40140 31084 

050272 .............................................................................................................................................................. 40140 31084 

050279 .............................................................................................................................................................. 40140 31084 

050291 .............................................................................................................................................................. 42220 41884 

050292 .............................................................................................................................................................. 40140 42044 

050298 .............................................................................................................................................................. 40140 31084 

050300 .............................................................................................................................................................. 40140 31084 

050301 .............................................................................................................................................................. 05 42220 

050327 .............................................................................................................................................................. 40140 31084 

050329 .............................................................................................................................................................. 40140 42044 

050348 .............................................................................................................................................................. 42044 31084 

050367 .............................................................................................................................................................. 46700 36084 

050385 .............................................................................................................................................................. 42220 41884 

050390 .............................................................................................................................................................. 40140 42044 

050394 .............................................................................................................................................................. 37100 31084 

050423 .............................................................................................................................................................. 40140 42044 

050426 .............................................................................................................................................................. 42044 31084 

050476 .............................................................................................................................................................. 05 42220 

050494 .............................................................................................................................................................. 05 40900 

050510 .............................................................................................................................................................. 41884 36084 

050517 .............................................................................................................................................................. 40140 31084 

050526 .............................................................................................................................................................. 42044 31084 

050534 .............................................................................................................................................................. 40140 42044 

050535 .............................................................................................................................................................. 42044 31084 

050541 .............................................................................................................................................................. 41884 36084 

050543 .............................................................................................................................................................. 42044 31084 

050547 .............................................................................................................................................................. 42220 41884 

050548 .............................................................................................................................................................. 42044 31084 

050549 .............................................................................................................................................................. 37100 31084 

050550 .............................................................................................................................................................. 42044 31084 

050551 .............................................................................................................................................................. 42044 31084 

mmaher on DSK3CLS3C1PROD with $$_JOB

25084 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

050567 .............................................................................................................................................................. 42044 31084 

050570 .............................................................................................................................................................. 42044 31084 

050573 .............................................................................................................................................................. 40140 42044 

050580 .............................................................................................................................................................. 42044 31084 

050584 .............................................................................................................................................................. 40140 31084 

050585 .............................................................................................................................................................. 42044 31084 

050586 .............................................................................................................................................................. 40140 31084 

050589 .............................................................................................................................................................. 42044 31084 

050592 .............................................................................................................................................................. 42044 31084 

050594 .............................................................................................................................................................. 42044 31084 

050603 .............................................................................................................................................................. 42044 31084 

050609 .............................................................................................................................................................. 42044 31084 

050616 .............................................................................................................................................................. 37100 31084 

050667 .............................................................................................................................................................. 34900 46700 

050678 .............................................................................................................................................................. 42044 31084 

050680 .............................................................................................................................................................. 46700 36084 

050684 .............................................................................................................................................................. 40140 42044 

050686 .............................................................................................................................................................. 40140 42044 

050690 .............................................................................................................................................................. 42220 41884 

050693 .............................................................................................................................................................. 42044 31084 

050694 .............................................................................................................................................................. 40140 42044 

050701 .............................................................................................................................................................. 40140 42044 

050709 .............................................................................................................................................................. 40140 31084 

050714 .............................................................................................................................................................. 42100 41940 

050718 .............................................................................................................................................................. 40140 42044 

050720 .............................................................................................................................................................. 42044 31084 

050749 .............................................................................................................................................................. 37100 31084 

060001 .............................................................................................................................................................. 24540 19740 

060003 .............................................................................................................................................................. 14500 19740 

060023 .............................................................................................................................................................. 24300 19740 

060027 .............................................................................................................................................................. 14500 19740 

060049 .............................................................................................................................................................. 06 22660 

060075 .............................................................................................................................................................. 06 24300 

060096 .............................................................................................................................................................. 06 19740 

060103 .............................................................................................................................................................. 14500 19740 

060116 .............................................................................................................................................................. 14500 19740 

070001 .............................................................................................................................................................. 35300 35004 

070003 .............................................................................................................................................................. 07 25540 LUGAR 

070005 .............................................................................................................................................................. 35300 35004 

070006 .............................................................................................................................................................. 14860 35644 

070010 .............................................................................................................................................................. 14860 35644 

070015 .............................................................................................................................................................. 25540 35644 

070016 .............................................................................................................................................................. 35300 35004 

070017 .............................................................................................................................................................. 35300 35004 

070018 .............................................................................................................................................................. 14860 35644 

070019 .............................................................................................................................................................. 35300 35004 

070022 .............................................................................................................................................................. 35300 35004 

070028 .............................................................................................................................................................. 14860 35644 

070031 .............................................................................................................................................................. 35300 35004 

070033 .............................................................................................................................................................. 14860 35644 

070034 .............................................................................................................................................................. 14860 35644 

070036 .............................................................................................................................................................. 25540 35300 

070038 .............................................................................................................................................................. 35300 35004 

070039 .............................................................................................................................................................. 35300 35004 

080001 .............................................................................................................................................................. 48864 37964 

080003 .............................................................................................................................................................. 48864 37964 

080004 .............................................................................................................................................................. 20100 48864 

080006 .............................................................................................................................................................. 08 20100 

080007 .............................................................................................................................................................. 08 36140 

090011 .............................................................................................................................................................. 47894 13644 

100002 .............................................................................................................................................................. 48424 22744 

100014 .............................................................................................................................................................. 19660 36740 

100017 .............................................................................................................................................................. 19660 36740 

100022 .............................................................................................................................................................. 33124 22744 

100023 .............................................................................................................................................................. 10 36740 

100024 .............................................................................................................................................................. 10 33124 

100045 .............................................................................................................................................................. 19660 36740 

100047 .............................................................................................................................................................. 39460 42260 

100049 .............................................................................................................................................................. 10 29460 

100068 .............................................................................................................................................................. 19660 36740 

100072 .............................................................................................................................................................. 19660 36740 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25085 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

100077 .............................................................................................................................................................. 39460 42260 

100080 .............................................................................................................................................................. 48424 22744 

100081 .............................................................................................................................................................. 10 23020 LUGAR 

100105 .............................................................................................................................................................. 42680 38940 

100109 .............................................................................................................................................................. 10 36740 

100118 .............................................................................................................................................................. 37380 27260 

100130 .............................................................................................................................................................. 48424 22744 

100139 .............................................................................................................................................................. 10 23540 LUGAR 

100150 .............................................................................................................................................................. 10 33124 

100156 .............................................................................................................................................................. 10 23540 

100157 .............................................................................................................................................................. 29460 45300 

100168 .............................................................................................................................................................. 48424 22744 

100176 .............................................................................................................................................................. 48424 22744 

100217 .............................................................................................................................................................. 42680 38940 

100232 .............................................................................................................................................................. 10 23540 

100234 .............................................................................................................................................................. 48424 22744 

100236 .............................................................................................................................................................. 39460 42260 

100239 .............................................................................................................................................................. 45300 42260 

100249 .............................................................................................................................................................. 10 45300 

100252 .............................................................................................................................................................. 10 42680 

100253 .............................................................................................................................................................. 48424 22744 

100258 .............................................................................................................................................................. 48424 22744 

100268 .............................................................................................................................................................. 48424 22744 

100269 .............................................................................................................................................................. 48424 22744 

100275 .............................................................................................................................................................. 48424 22744 

100287 .............................................................................................................................................................. 48424 22744 

100288 .............................................................................................................................................................. 48424 22744 

100292 .............................................................................................................................................................. 10 23020 LUGAR 

110002 .............................................................................................................................................................. 11 12060 

110016 .............................................................................................................................................................. 11 17980 

110023 .............................................................................................................................................................. 11 12060 

110029 .............................................................................................................................................................. 23580 12060 

110038 .............................................................................................................................................................. 11 45220 

110040 .............................................................................................................................................................. 11 12060 LUGAR 

110041 .............................................................................................................................................................. 11 12060 

110052 .............................................................................................................................................................. 11 16860 LUGAR 

110054 .............................................................................................................................................................. 40660 12060 

110069 .............................................................................................................................................................. 47580 31420 

110075 .............................................................................................................................................................. 11 42340 

110088 .............................................................................................................................................................. 11 12060 LUGAR 

110095 .............................................................................................................................................................. 11 10500 

110117 .............................................................................................................................................................. 11 12060 LUGAR 

110121 .............................................................................................................................................................. 11 45220 

110122 .............................................................................................................................................................. 46660 45220 

110125 .............................................................................................................................................................. 11 31420 

110128 .............................................................................................................................................................. 11 42340 

110146 .............................................................................................................................................................. 11 27260 

110150 .............................................................................................................................................................. 11 12060 

110153 .............................................................................................................................................................. 47580 31420 

110168 .............................................................................................................................................................. 40660 12060 

110187 .............................................................................................................................................................. 11 12060 LUGAR 

110189 .............................................................................................................................................................. 11 12060 

120028 .............................................................................................................................................................. 12 26180 

130002 .............................................................................................................................................................. 13 29 

130003 .............................................................................................................................................................. 30300 28420 

130018 .............................................................................................................................................................. 26820 38540 

130049 .............................................................................................................................................................. 17660 44060 

130067 .............................................................................................................................................................. 13 26820 LUGAR 

140010 .............................................................................................................................................................. 16974 16974 

140012 .............................................................................................................................................................. 14 16974 

140015 .............................................................................................................................................................. 14 41180 

140032 .............................................................................................................................................................. 14 41180 

140033 .............................................................................................................................................................. 29404 16974 

140034 .............................................................................................................................................................. 14 41180 

140040 .............................................................................................................................................................. 14 37900 

140043 .............................................................................................................................................................. 14 19340 

140046 .............................................................................................................................................................. 14 41180 

140058 .............................................................................................................................................................. 14 41180 

140064 .............................................................................................................................................................. 14 37900 

140084 .............................................................................................................................................................. 29404 16974 

140100 .............................................................................................................................................................. 29404 16974 

mmaher on DSK3CLS3C1PROD with $$_JOB

25086 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

140110 .............................................................................................................................................................. 14 16974 

140130 .............................................................................................................................................................. 29404 16974 

140143 .............................................................................................................................................................. 14 16974 

140155 .............................................................................................................................................................. 28100 16974 

140160 .............................................................................................................................................................. 14 40420 

140161 .............................................................................................................................................................. 14 16974 

140164 .............................................................................................................................................................. 14 41180 

140186 .............................................................................................................................................................. 28100 16974 

140202 .............................................................................................................................................................. 29404 16974 

140233 .............................................................................................................................................................. 40420 16974 

140236 .............................................................................................................................................................. 14 28100 LUGAR 

140291 .............................................................................................................................................................. 29404 16974 

150002 .............................................................................................................................................................. 23844 16974 

150004 .............................................................................................................................................................. 23844 16974 

150006 .............................................................................................................................................................. 33140 43780 

150008 .............................................................................................................................................................. 23844 16974 

150011 .............................................................................................................................................................. 15 26900 

150018 .............................................................................................................................................................. 21140 43780 

150026 .............................................................................................................................................................. 21140 43780 

150030 .............................................................................................................................................................. 15 26900 LUGAR 

150034 .............................................................................................................................................................. 23844 16974 

150042 .............................................................................................................................................................. 15 14020 

150045 .............................................................................................................................................................. 15 23060 

150048 .............................................................................................................................................................. 15 17140 

150051 .............................................................................................................................................................. 14020 26900 

150065 .............................................................................................................................................................. 15 26900 

150069 .............................................................................................................................................................. 15 17140 

150076 .............................................................................................................................................................. 15 43780 

150088 .............................................................................................................................................................. 11300 26900 

150090 .............................................................................................................................................................. 23844 16974 

150091 .............................................................................................................................................................. 15 23060 

150102 .............................................................................................................................................................. 15 23844 LUGAR 

150112 .............................................................................................................................................................. 18020 26900 

150113 .............................................................................................................................................................. 11300 26900 

150115 .............................................................................................................................................................. 15 21780 

150122 .............................................................................................................................................................. 15 26900 

150125 .............................................................................................................................................................. 23844 16974 

150126 .............................................................................................................................................................. 23844 16974 

150133 .............................................................................................................................................................. 15 23060 

150146 .............................................................................................................................................................. 15 23060 

150147 .............................................................................................................................................................. 23844 16974 

160001 .............................................................................................................................................................. 16 11180 

160016 .............................................................................................................................................................. 16 11180 

160057 .............................................................................................................................................................. 16 26980 

160064 .............................................................................................................................................................. 16 47940 

160080 .............................................................................................................................................................. 16 19340 

160089 .............................................................................................................................................................. 16 26980 

160147 .............................................................................................................................................................. 16 11180 

170006 .............................................................................................................................................................. 17 27900 

170012 .............................................................................................................................................................. 17 48620 

170013 .............................................................................................................................................................. 17 48620 

170020 .............................................................................................................................................................. 17 48620 

170023 .............................................................................................................................................................. 17 48620 

170033 .............................................................................................................................................................. 17 48620 

170058 .............................................................................................................................................................. 17 28140 

170068 .............................................................................................................................................................. 17 11100 

170120 .............................................................................................................................................................. 17 27900 

170142 .............................................................................................................................................................. 17 45820 

170175 .............................................................................................................................................................. 17 48620 

170190 .............................................................................................................................................................. 17 45820 

170193 .............................................................................................................................................................. 17 48620 

180002 .............................................................................................................................................................. 18 49 

180005 .............................................................................................................................................................. 18 26580 

180011 .............................................................................................................................................................. 18 30460 

180012 .............................................................................................................................................................. 21060 31140 

180013 .............................................................................................................................................................. 14540 34980 

180017 .............................................................................................................................................................. 18 21060 

180019 .............................................................................................................................................................. 18 17140 

180024 .............................................................................................................................................................. 18 31140 

180027 .............................................................................................................................................................. 18 17300 

180029 .............................................................................................................................................................. 18 30460 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25087 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

180044 .............................................................................................................................................................. 18 26580 

180048 .............................................................................................................................................................. 18 31140 

180049 .............................................................................................................................................................. 18 30460 

180050 .............................................................................................................................................................. 18 28700 

180066 .............................................................................................................................................................. 18 34980 

180069 .............................................................................................................................................................. 18 26580 

180075 .............................................................................................................................................................. 18 14540 LUGAR 

180078 .............................................................................................................................................................. 18 26580 

180080 .............................................................................................................................................................. 18 28940 

180093 .............................................................................................................................................................. 18 21780 

180102 .............................................................................................................................................................. 18 17300 

180104 .............................................................................................................................................................. 18 17300 

180116 .............................................................................................................................................................. 18 17300 

180124 .............................................................................................................................................................. 14540 34980 

180127 .............................................................................................................................................................. 18 31140 

180132 .............................................................................................................................................................. 18 30460 

190003 .............................................................................................................................................................. 19 29180 

190015 .............................................................................................................................................................. 19 35380 

190086 .............................................................................................................................................................. 19 33740 

190088 .............................................................................................................................................................. 19 43340 

190099 .............................................................................................................................................................. 19 12940 

190106 .............................................................................................................................................................. 19 10780 

190144 .............................................................................................................................................................. 19 43340 

190155 .............................................................................................................................................................. 19 12940 LUGAR 

190164 .............................................................................................................................................................. 19 45 

190167 .............................................................................................................................................................. 19 29180 

190184 .............................................................................................................................................................. 19 33740 

190191 .............................................................................................................................................................. 19 29180 

190208 .............................................................................................................................................................. 19 04 

190218 .............................................................................................................................................................. 19 43340 

190223 .............................................................................................................................................................. 19 12940 LUGAR 

200020 .............................................................................................................................................................. 38860 40484 

200024 .............................................................................................................................................................. 30340 38860 

200034 .............................................................................................................................................................. 30340 38860 

200039 .............................................................................................................................................................. 20 38860 

200050 .............................................................................................................................................................. 20 12620 

200063 .............................................................................................................................................................. 20 38860 

220001 .............................................................................................................................................................. 49340 14484 

220002 .............................................................................................................................................................. 15764 14484 

220008 .............................................................................................................................................................. 39300 14484 

220010 .............................................................................................................................................................. 37764 14484 

220011 .............................................................................................................................................................. 15764 14484 

220019 .............................................................................................................................................................. 49340 14484 

220020 .............................................................................................................................................................. 39300 14484 

220025 .............................................................................................................................................................. 49340 14484 

220028 .............................................................................................................................................................. 49340 14484 

220029 .............................................................................................................................................................. 37764 14484 

220033 .............................................................................................................................................................. 37764 14484 

220035 .............................................................................................................................................................. 37764 14484 

220049 .............................................................................................................................................................. 15764 14484 

220058 .............................................................................................................................................................. 49340 14484 

220062 .............................................................................................................................................................. 49340 14484 

220063 .............................................................................................................................................................. 15764 14484 

220070 .............................................................................................................................................................. 15764 14484 

220073 .............................................................................................................................................................. 39300 14484 

220077 .............................................................................................................................................................. 44140 25540 

220080 .............................................................................................................................................................. 37764 14484 

220082 .............................................................................................................................................................. 15764 14484 

220084 .............................................................................................................................................................. 15764 14484 

220090 .............................................................................................................................................................. 49340 14484 

220095 .............................................................................................................................................................. 49340 14484 

220098 .............................................................................................................................................................. 15764 14484 

220101 .............................................................................................................................................................. 15764 14484 

220105 .............................................................................................................................................................. 15764 14484 

220133 .............................................................................................................................................................. 15764 14484 

220163 .............................................................................................................................................................. 49340 14484 

220171 .............................................................................................................................................................. 15764 14484 

220174 .............................................................................................................................................................. 37764 14484 

230002 .............................................................................................................................................................. 19804 11460 

230003 .............................................................................................................................................................. 26100 34740 

230013 .............................................................................................................................................................. 47644 22420 

mmaher on DSK3CLS3C1PROD with $$_JOB

25088 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

230019 .............................................................................................................................................................. 47644 22420 

230020 .............................................................................................................................................................. 19804 11460 

230021 .............................................................................................................................................................. 35660 28020 

230022 .............................................................................................................................................................. 23 29620 

230024 .............................................................................................................................................................. 19804 11460 

230029 .............................................................................................................................................................. 47644 22420 

230030 .............................................................................................................................................................. 23 40980 

230035 .............................................................................................................................................................. 23 24340 LUGAR 

230036 .............................................................................................................................................................. 23 13020 

230037 .............................................................................................................................................................. 23 11460 

230038 .............................................................................................................................................................. 24340 34740 

230047 .............................................................................................................................................................. 47644 19804 

230053 .............................................................................................................................................................. 19804 11460 

230054 .............................................................................................................................................................. 23 24580 

230059 .............................................................................................................................................................. 24340 34740 

230065 .............................................................................................................................................................. 19804 11460 

230069 .............................................................................................................................................................. 47644 11460 

230071 .............................................................................................................................................................. 47644 22420 

230072 .............................................................................................................................................................. 26100 34740 

230077 .............................................................................................................................................................. 40980 22420 

230080 .............................................................................................................................................................. 23 13020 

230089 .............................................................................................................................................................. 19804 11460 

230092 .............................................................................................................................................................. 27100 11460 

230096 .............................................................................................................................................................. 23 28020 

230097 .............................................................................................................................................................. 23 24340 

230099 .............................................................................................................................................................. 33780 11460 

230104 .............................................................................................................................................................. 19804 11460 

230105 .............................................................................................................................................................. 23 13020 

230106 .............................................................................................................................................................. 24340 34740 

230119 .............................................................................................................................................................. 19804 11460 

230121 .............................................................................................................................................................. 23 29620 LUGAR 

230130 .............................................................................................................................................................. 47644 22420 

230134 .............................................................................................................................................................. 23 26100 LUGAR 

230135 .............................................................................................................................................................. 19804 11460 

230142 .............................................................................................................................................................. 19804 11460 

230146 .............................................................................................................................................................. 19804 11460 

230151 .............................................................................................................................................................. 47644 22420 

230165 .............................................................................................................................................................. 19804 11460 

230174 .............................................................................................................................................................. 26100 34740 

230176 .............................................................................................................................................................. 19804 11460 

230195 .............................................................................................................................................................. 47644 19804 

230204 .............................................................................................................................................................. 47644 19804 

230207 .............................................................................................................................................................. 47644 22420 

230208 .............................................................................................................................................................. 23 24340 LUGAR 

230217 .............................................................................................................................................................. 12980 29620 

230222 .............................................................................................................................................................. 23 13020 

230223 .............................................................................................................................................................. 47644 22420 

230227 .............................................................................................................................................................. 47644 19804 

230236 .............................................................................................................................................................. 24340 34740 

230244 .............................................................................................................................................................. 19804 11460 

230254 .............................................................................................................................................................. 47644 22420 

230257 .............................................................................................................................................................. 47644 19804 

230264 .............................................................................................................................................................. 47644 19804 

230269 .............................................................................................................................................................. 47644 22420 

230270 .............................................................................................................................................................. 19804 11460 

230273 .............................................................................................................................................................. 19804 11460 

230277 .............................................................................................................................................................. 47644 22420 

230279 .............................................................................................................................................................. 47644 11460 

230293 .............................................................................................................................................................. 19804 11460 

230295 .............................................................................................................................................................. 23 26100 LUGAR 

240030 .............................................................................................................................................................. 24 41060 

240036 .............................................................................................................................................................. 41060 33460 

240064 .............................................................................................................................................................. 24 20260 

240069 .............................................................................................................................................................. 24 40340 

240071 .............................................................................................................................................................. 24 40340 

240075 .............................................................................................................................................................. 24 41060 

240088 .............................................................................................................................................................. 24 41060 

240093 .............................................................................................................................................................. 24 33460 

240105 .............................................................................................................................................................. 24 40340 LUGAR 

240150 .............................................................................................................................................................. 24 40340 LUGAR 

240187 .............................................................................................................................................................. 24 33460 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25089 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

250002 .............................................................................................................................................................. 25 22520 

250004 .............................................................................................................................................................. 25 32820 

250006 .............................................................................................................................................................. 25 32820 

250009 .............................................................................................................................................................. 25 27180 

250023 .............................................................................................................................................................. 25 25060 LUGAR 

250031 .............................................................................................................................................................. 25 27140 

250034 .............................................................................................................................................................. 25 32820 

250040 .............................................................................................................................................................. 37700 25060 

250042 .............................................................................................................................................................. 25 32820 

250044 .............................................................................................................................................................. 25 22520 

250069 .............................................................................................................................................................. 25 46220 

250078 .............................................................................................................................................................. 25620 25060 

250079 .............................................................................................................................................................. 25 27140 

250081 .............................................................................................................................................................. 25 46220 

250082 .............................................................................................................................................................. 25 38220 

250094 .............................................................................................................................................................. 25620 25060 

250097 .............................................................................................................................................................. 25 12940 

250099 .............................................................................................................................................................. 25 27140 

250100 .............................................................................................................................................................. 25 46220 

250104 .............................................................................................................................................................. 25 46220 

250117 .............................................................................................................................................................. 25 25060 LUGAR 

260009 .............................................................................................................................................................. 26 28140 

260015 .............................................................................................................................................................. 26 27860 

260017 .............................................................................................................................................................. 26 27620 

260022 .............................................................................................................................................................. 26 16 

260025 .............................................................................................................................................................. 26 41180 

260049 .............................................................................................................................................................. 26 44180 LUGAR 

260050 .............................................................................................................................................................. 26 41140 

260064 .............................................................................................................................................................. 26 17860 

260074 .............................................................................................................................................................. 26 17860 

260094 .............................................................................................................................................................. 26 44180 

260110 .............................................................................................................................................................. 26 41180 

260113 .............................................................................................................................................................. 26 14 

260119 .............................................................................................................................................................. 26 27860 

260175 .............................................................................................................................................................. 26 28140 

260183 .............................................................................................................................................................. 26 41180 

260186 .............................................................................................................................................................. 26 27620 

270003 .............................................................................................................................................................. 27 24500 

270017 .............................................................................................................................................................. 27 33540 

280009 .............................................................................................................................................................. 28 30700 

280023 .............................................................................................................................................................. 28 30700 

280032 .............................................................................................................................................................. 28 30700 

280061 .............................................................................................................................................................. 28 53 

280065 .............................................................................................................................................................. 28 24540 

280125 .............................................................................................................................................................. 28 43580 

290002 .............................................................................................................................................................. 29 16180 LUGAR 

290006 .............................................................................................................................................................. 29 39900 

290008 .............................................................................................................................................................. 29 41620 

290019 .............................................................................................................................................................. 16180 39900 

300011 .............................................................................................................................................................. 31700 15764 

300012 .............................................................................................................................................................. 31700 15764 

300014 .............................................................................................................................................................. 40484 31700 

300018 .............................................................................................................................................................. 40484 31700 

300019 .............................................................................................................................................................. 30 15764 

300020 .............................................................................................................................................................. 31700 15764 

300034 .............................................................................................................................................................. 31700 15764 

310002 .............................................................................................................................................................. 35084 35644 

310009 .............................................................................................................................................................. 35084 35644 

310013 .............................................................................................................................................................. 35084 35644 

310014 .............................................................................................................................................................. 15804 37964 

310015 .............................................................................................................................................................. 35084 35644 

310017 .............................................................................................................................................................. 35084 35644 

310018 .............................................................................................................................................................. 35084 35644 

310021 .............................................................................................................................................................. 45940 35084 

310031 .............................................................................................................................................................. 15804 20764 

310032 .............................................................................................................................................................. 47220 48864 

310038 .............................................................................................................................................................. 20764 35644 

310039 .............................................................................................................................................................. 20764 35644 

310048 .............................................................................................................................................................. 20764 35084 

310050 .............................................................................................................................................................. 35084 35644 

310054 .............................................................................................................................................................. 35084 35644 

mmaher on DSK3CLS3C1PROD with $$_JOB

25090 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

310070 .............................................................................................................................................................. 20764 35644 

310076 .............................................................................................................................................................. 35084 35644 

310081 .............................................................................................................................................................. 15804 37964 

310083 .............................................................................................................................................................. 35084 35644 

310093 .............................................................................................................................................................. 35084 35644 

310096 .............................................................................................................................................................. 35084 35644 

310108 .............................................................................................................................................................. 20764 35644 

310119 .............................................................................................................................................................. 35084 35644 

320003 .............................................................................................................................................................. 32 42140 

320005 .............................................................................................................................................................. 22140 10740 

320006 .............................................................................................................................................................. 32 10740 

320013 .............................................................................................................................................................. 32 42140 

320014 .............................................................................................................................................................. 32 29740 

320033 .............................................................................................................................................................. 32 42140 LUGAR 

320063 .............................................................................................................................................................. 32 36220 

320065 .............................................................................................................................................................. 32 36220 

330004 .............................................................................................................................................................. 28740 39100 

330008 .............................................................................................................................................................. 33 15380 LUGAR 

330023 .............................................................................................................................................................. 39100 14860 

330027 .............................................................................................................................................................. 35004 35644 

330038 .............................................................................................................................................................. 33 40380 LUGAR 

330049 .............................................................................................................................................................. 39100 14860 

330067 .............................................................................................................................................................. 39100 14860 

330073 .............................................................................................................................................................. 33 40380 LUGAR 

330079 .............................................................................................................................................................. 33 47 

330085 .............................................................................................................................................................. 33 45060 

330094 .............................................................................................................................................................. 33 28740 

330103 .............................................................................................................................................................. 33 39 

330106 .............................................................................................................................................................. 35004 35644 

330126 .............................................................................................................................................................. 39100 35644 

330136 .............................................................................................................................................................. 33 45060 

330157 .............................................................................................................................................................. 33 45060 

330167 .............................................................................................................................................................. 35004 35644 

330181 .............................................................................................................................................................. 35004 35644 

330182 .............................................................................................................................................................. 35004 35644 

330191 .............................................................................................................................................................. 24020 10580 

330198 .............................................................................................................................................................. 35004 35644 

330224 .............................................................................................................................................................. 28740 39100 

330225 .............................................................................................................................................................. 35004 35644 

330229 .............................................................................................................................................................. 33 21500 

330235 .............................................................................................................................................................. 33 45060 LUGAR 

330239 .............................................................................................................................................................. 33 21500 

330250 .............................................................................................................................................................. 33 15540 

330259 .............................................................................................................................................................. 35004 35644 

330277 .............................................................................................................................................................. 33 27060 

330331 .............................................................................................................................................................. 35004 35644 

330332 .............................................................................................................................................................. 35004 35644 

330372 .............................................................................................................................................................. 35004 35644 

330386 .............................................................................................................................................................. 33 35084 

340004 .............................................................................................................................................................. 24660 49180 

340008 .............................................................................................................................................................. 34 16740 

340010 .............................................................................................................................................................. 24140 39580 

340013 .............................................................................................................................................................. 34 16740 

340015 .............................................................................................................................................................. 34 16740 

340021 .............................................................................................................................................................. 34 16740 

340023 .............................................................................................................................................................. 11700 24860 

340027 .............................................................................................................................................................. 34 24780 

340039 .............................................................................................................................................................. 34 16740 

340050 .............................................................................................................................................................. 34 22180 

340051 .............................................................................................................................................................. 34 25860 

340068 .............................................................................................................................................................. 34 48900 

340069 .............................................................................................................................................................. 39580 20500 

340070 .............................................................................................................................................................. 15500 24660 

340071 .............................................................................................................................................................. 34 39580 LUGAR 

340073 .............................................................................................................................................................. 39580 20500 

340091 .............................................................................................................................................................. 24660 49180 

340109 .............................................................................................................................................................. 34 47260 

340114 .............................................................................................................................................................. 39580 20500 

340115 .............................................................................................................................................................. 34 20500 

340124 .............................................................................................................................................................. 34 39580 LUGAR 

340126 .............................................................................................................................................................. 34 39580 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25091 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

340127 .............................................................................................................................................................. 34 20500 LUGAR 

340129 .............................................................................................................................................................. 34 16740 

340131 .............................................................................................................................................................. 34 24780 

340136 .............................................................................................................................................................. 34 20500 LUGAR 

340138 .............................................................................................................................................................. 39580 20500 

340144 .............................................................................................................................................................. 34 16740 

340145 .............................................................................................................................................................. 34 16740 LUGAR 

340147 .............................................................................................................................................................. 40580 39580 

340173 .............................................................................................................................................................. 39580 20500 

350003 .............................................................................................................................................................. 35 13900 

350006 .............................................................................................................................................................. 35 13900 

350009 .............................................................................................................................................................. 35 22020 

360008 .............................................................................................................................................................. 36 26580 

360010 .............................................................................................................................................................. 36 15940 

360011 .............................................................................................................................................................. 36 18140 

360013 .............................................................................................................................................................. 36 30620 

360014 .............................................................................................................................................................. 36 18140 

360019 .............................................................................................................................................................. 10420 17460 

360020 .............................................................................................................................................................. 10420 17460 

360025 .............................................................................................................................................................. 41780 45780 

360027 .............................................................................................................................................................. 10420 17460 

360036 .............................................................................................................................................................. 36 17460 

360039 .............................................................................................................................................................. 36 18140 

360054 .............................................................................................................................................................. 36 26580 

360065 .............................................................................................................................................................. 36 45780 

360078 .............................................................................................................................................................. 10420 17460 

360079 .............................................................................................................................................................. 19380 17140 

360084 .............................................................................................................................................................. 15940 10420 

360086 .............................................................................................................................................................. 44220 19380 

360095 .............................................................................................................................................................. 36 45780 

360096 .............................................................................................................................................................. 36 49660 LUGAR 

360107 .............................................................................................................................................................. 36 45780 

360121 .............................................................................................................................................................. 36 45780 

360150 .............................................................................................................................................................. 10420 17460 

360159 .............................................................................................................................................................. 36 18140 

360175 .............................................................................................................................................................. 36 18140 

360185 .............................................................................................................................................................. 36 49660 LUGAR 

360187 .............................................................................................................................................................. 44220 19380 

360197 .............................................................................................................................................................. 36 18140 

360211 .............................................................................................................................................................. 48260 38300 

360238 .............................................................................................................................................................. 36 49660 LUGAR 

360241 .............................................................................................................................................................. 10420 17460 

360245 .............................................................................................................................................................. 36 17460 LUGAR 

360253 .............................................................................................................................................................. 19380 17140 

370004 .............................................................................................................................................................. 37 27900 

370006 .............................................................................................................................................................. 37 46140 

370014 .............................................................................................................................................................. 37 43300 

370015 .............................................................................................................................................................. 37 46140 

370016 .............................................................................................................................................................. 37 36420 

370018 .............................................................................................................................................................. 37 46140 

370022 .............................................................................................................................................................. 37 30020 

370025 .............................................................................................................................................................. 37 46140 

370026 .............................................................................................................................................................. 37 36420 

370047 .............................................................................................................................................................. 37 36420 

370049 .............................................................................................................................................................. 37 36420 

370113 .............................................................................................................................................................. 37 22220 

370149 .............................................................................................................................................................. 37 36420 

380001 .............................................................................................................................................................. 38 38900 

380022 .............................................................................................................................................................. 38 18700 LUGAR 

380027 .............................................................................................................................................................. 38 21660 

380050 .............................................................................................................................................................. 38 32780 

380090 .............................................................................................................................................................. 38 21660 

390006 .............................................................................................................................................................. 39 25420 

390013 .............................................................................................................................................................. 39 25420 

390016 .............................................................................................................................................................. 39 36 

390030 .............................................................................................................................................................. 39 10900 

390031 .............................................................................................................................................................. 39 39740 LUGAR 

390044 .............................................................................................................................................................. 39740 37964 

390046 .............................................................................................................................................................. 49620 29540 

390048 .............................................................................................................................................................. 39 25420 

390065 .............................................................................................................................................................. 39 12580 

mmaher on DSK3CLS3C1PROD with $$_JOB

25092 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

390066 .............................................................................................................................................................. 30140 25420 

390071 .............................................................................................................................................................. 39 48700 LUGAR 

390079 .............................................................................................................................................................. 39 13780 

390081 .............................................................................................................................................................. 37964 48864 

390086 .............................................................................................................................................................. 39 27780 

390091 .............................................................................................................................................................. 39 49660 

390093 .............................................................................................................................................................. 39 38300 

390096 .............................................................................................................................................................. 39740 37964 

390110 .............................................................................................................................................................. 27780 38300 

390113 .............................................................................................................................................................. 39 49660 

390133 .............................................................................................................................................................. 10900 37964 

390138 .............................................................................................................................................................. 39 25420 

390150 .............................................................................................................................................................. 39 38300 LUGAR 

390151 .............................................................................................................................................................. 39 13644 

390156 .............................................................................................................................................................. 37964 48864 

390162 .............................................................................................................................................................. 10900 35084 

390180 .............................................................................................................................................................. 37964 48864 

390222 .............................................................................................................................................................. 37964 48864 

390246 .............................................................................................................................................................. 39 48700 

390313 .............................................................................................................................................................. 39 39740 LUGAR 

400048 .............................................................................................................................................................. 25020 41980 

410001 .............................................................................................................................................................. 39300 14484 

410004 .............................................................................................................................................................. 39300 14484 

410005 .............................................................................................................................................................. 39300 14484 

410007 .............................................................................................................................................................. 39300 14484 

410010 .............................................................................................................................................................. 39300 14484 

410011 .............................................................................................................................................................. 39300 14484 

410012 .............................................................................................................................................................. 39300 14484 

410013 .............................................................................................................................................................. 39300 35980 

420007 .............................................................................................................................................................. 43900 24860 

420009 .............................................................................................................................................................. 42 24860 LUGAR 

420020 .............................................................................................................................................................. 42 16770 

420027 .............................................................................................................................................................. 11340 24860 

420028 .............................................................................................................................................................. 42 44940 LUGAR 

420030 .............................................................................................................................................................. 42 16700 

420036 .............................................................................................................................................................. 42 16740 

420039 .............................................................................................................................................................. 42 43900 LUGAR 

420062 .............................................................................................................................................................. 42 16740 

420067 .............................................................................................................................................................. 42 42340 

420068 .............................................................................................................................................................. 42 16700 

420069 .............................................................................................................................................................. 42 44940 LUGAR 

420071 .............................................................................................................................................................. 42 24860 

420080 .............................................................................................................................................................. 42 42340 

420083 .............................................................................................................................................................. 43900 24860 

420085 .............................................................................................................................................................. 34820 48900 

420098 .............................................................................................................................................................. 42 34820 

430012 .............................................................................................................................................................. 43 43620 

430013 .............................................................................................................................................................. 43 43620 

430014 .............................................................................................................................................................. 43 22020 

440002 .............................................................................................................................................................. 27180 32820 

440008 .............................................................................................................................................................. 44 27180 

440020 .............................................................................................................................................................. 44 26620 

440024 .............................................................................................................................................................. 17420 16860 

440025 .............................................................................................................................................................. 44 34 

440035 .............................................................................................................................................................. 17300 34980 

440056 .............................................................................................................................................................. 34100 28940 

440060 .............................................................................................................................................................. 44 27180 

440067 .............................................................................................................................................................. 34100 28700 

440068 .............................................................................................................................................................. 44 16860 

440072 .............................................................................................................................................................. 44 32820 

440073 .............................................................................................................................................................. 44 34980 

440148 .............................................................................................................................................................. 44 34980 

440151 .............................................................................................................................................................. 44 34980 

440175 .............................................................................................................................................................. 44 34980 

440185 .............................................................................................................................................................. 17420 16860 

440192 .............................................................................................................................................................. 44 34980 

450007 .............................................................................................................................................................. 45 41700 

450032 .............................................................................................................................................................. 45 43340 

450039 .............................................................................................................................................................. 23104 19124 

450059 .............................................................................................................................................................. 41700 12420 

450064 .............................................................................................................................................................. 23104 19124 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25093 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

450080 .............................................................................................................................................................. 45 30980 

450087 .............................................................................................................................................................. 23104 19124 

450099 .............................................................................................................................................................. 45 11100 

450121 .............................................................................................................................................................. 23104 19124 

450135 .............................................................................................................................................................. 23104 19124 

450137 .............................................................................................................................................................. 23104 19124 

450148 .............................................................................................................................................................. 23104 19124 

450178 .............................................................................................................................................................. 45 36220 

450187 .............................................................................................................................................................. 45 26420 

450196 .............................................................................................................................................................. 45 19124 

450211 .............................................................................................................................................................. 45 30980 

450214 .............................................................................................................................................................. 45 26420 

450224 .............................................................................................................................................................. 45 46340 

450283 .............................................................................................................................................................. 45 19124 LUGAR 

450286 .............................................................................................................................................................. 45 17780 LUGAR 

450324 .............................................................................................................................................................. 43300 19124 

450347 .............................................................................................................................................................. 45 26420 

450351 .............................................................................................................................................................. 45 23104 

450389 .............................................................................................................................................................. 45 19124 LUGAR 

450393 .............................................................................................................................................................. 43300 19124 

450395 .............................................................................................................................................................. 45 26420 

450419 .............................................................................................................................................................. 23104 19124 

450438 .............................................................................................................................................................. 45 26420 

450447 .............................................................................................................................................................. 45 19124 

450465 .............................................................................................................................................................. 45 26420 

450469 .............................................................................................................................................................. 43300 19124 

450484 .............................................................................................................................................................. 45 30980 

450508 .............................................................................................................................................................. 45 30980 

450563 .............................................................................................................................................................. 23104 19124 

450596 .............................................................................................................................................................. 45 23104 

450639 .............................................................................................................................................................. 23104 19124 

450656 .............................................................................................................................................................. 45 30980 

450672 .............................................................................................................................................................. 23104 19124 

450675 .............................................................................................................................................................. 23104 19124 

450677 .............................................................................................................................................................. 23104 19124 

450747 .............................................................................................................................................................. 45 46340 

450770 .............................................................................................................................................................. 45 12420 LUGAR 

450779 .............................................................................................................................................................. 23104 19124 

450813 .............................................................................................................................................................. 45 41700 

450830 .............................................................................................................................................................. 45 36220 

450839 .............................................................................................................................................................. 45 43340 

450858 .............................................................................................................................................................. 23104 19124 

450872 .............................................................................................................................................................. 23104 19124 

450880 .............................................................................................................................................................. 23104 19124 

460004 .............................................................................................................................................................. 36260 41620 

460005 .............................................................................................................................................................. 36260 41620 

460007 .............................................................................................................................................................. 46 41100 

460011 .............................................................................................................................................................. 46 39340 

460021 .............................................................................................................................................................. 41100 29820 

460026 .............................................................................................................................................................. 46 39340 

460039 .............................................................................................................................................................. 46 30860 

460041 .............................................................................................................................................................. 36260 41620 

460042 .............................................................................................................................................................. 36260 41620 

470001 .............................................................................................................................................................. 47 30 

470012 .............................................................................................................................................................. 47 38340 

490004 .............................................................................................................................................................. 25500 16820 

490005 .............................................................................................................................................................. 49020 47894 

490013 .............................................................................................................................................................. 49 31340 

490018 .............................................................................................................................................................. 49 16820 

490019 .............................................................................................................................................................. 49 47894 

490042 .............................................................................................................................................................. 13980 40220 

490048 .............................................................................................................................................................. 40220 31340 

490079 .............................................................................................................................................................. 49 49180 

490092 .............................................................................................................................................................. 49 40060 

490097 .............................................................................................................................................................. 49 40060 

490105 .............................................................................................................................................................. 49 28700 

490106 .............................................................................................................................................................. 49 16820 

490109 .............................................................................................................................................................. 47260 40060 

500002 .............................................................................................................................................................. 50 28420 

500003 .............................................................................................................................................................. 34580 42644 

500007 .............................................................................................................................................................. 34580 42644 

mmaher on DSK3CLS3C1PROD with $$_JOB

25094 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued 

Provider No. Geographic 

CBSA 

Reclassified 

CBSA LUGAR 

500016 .............................................................................................................................................................. 48300 42644 

500021 .............................................................................................................................................................. 45104 42644 

500024 .............................................................................................................................................................. 36500 45104 

500031 .............................................................................................................................................................. 50 36500 

500039 .............................................................................................................................................................. 14740 42644 

500041 .............................................................................................................................................................. 31020 38900 

500072 .............................................................................................................................................................. 50 14740 

500079 .............................................................................................................................................................. 45104 42644 

500108 .............................................................................................................................................................. 45104 42644 

500129 .............................................................................................................................................................. 45104 42644 

500139 .............................................................................................................................................................. 36500 45104 

500143 .............................................................................................................................................................. 36500 45104 

510001 .............................................................................................................................................................. 34060 38300 

510002 .............................................................................................................................................................. 51 40220 

510006 .............................................................................................................................................................. 51 34060 

510018 .............................................................................................................................................................. 51 16620 LUGAR 

510024 .............................................................................................................................................................. 34060 38300 

510030 .............................................................................................................................................................. 51 34060 

510046 .............................................................................................................................................................. 51 13980 

510047 .............................................................................................................................................................. 51 38300 

510062 .............................................................................................................................................................. 51 16620 

510070 .............................................................................................................................................................. 51 16620 

510071 .............................................................................................................................................................. 51 13980 

510077 .............................................................................................................................................................. 51 26580 

520002 .............................................................................................................................................................. 52 48140 

520021 .............................................................................................................................................................. 29404 16974 

520028 .............................................................................................................................................................. 52 31540 LUGAR 

520037 .............................................................................................................................................................. 52 48140 

520059 .............................................................................................................................................................. 39540 29404 

520071 .............................................................................................................................................................. 52 33340 LUGAR 

520076 .............................................................................................................................................................. 52 31540 

520095 .............................................................................................................................................................. 52 31540 

520102 .............................................................................................................................................................. 52 33340 LUGAR 

520107 .............................................................................................................................................................. 52 22540 

520113 .............................................................................................................................................................. 52 24580 

520116 .............................................................................................................................................................. 52 33340 LUGAR 

520189 .............................................................................................................................................................. 29404 16974 

530015 .............................................................................................................................................................. 53 26820 

TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION

1886(d)(8)(E) OF THE ACT—FY 

2008 

Provider No. Geographic 

CBSA 

Redesignated rural 

area 

050192 ................ 23420 05 

TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION

1886(d)(8)(E) OF THE ACT—FY 

2008—Continued 

Provider No. Geographic 

CBSA 

Redesignated rural 

area 

050528 ................ 32900 05 

TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION

1886(d)(8)(E) OF THE ACT—FY 

2008—Continued 

Provider No. Geographic 

CBSA 

Redesignated rural 

area 

050618 ................ 40140 05 

070004 ................ 25540 07 

100048 ................ 37860 10 

100134 ................ 27260 10 

140167 ................ 14 14 

170137 ................ 29940 17 

220051 ................ 38340 22 

230078 ................ 35660 23 

250126 ................ 32820 25 

260006 ................ 41140 26 

260047 ................ 27620 26 

260195 ................ 44180 26 

330044 ................ 46540 33 

330245 ................ 46540 33 

330268 ................ 10580 33 

360125 ................ 36 36 

370054 ................ 36420 37 

380040 ................ 13460 38 

390181 ................ 39 39 

390183 ................ 39 39 

390201 ................ 39 39 

440135 ................ 34980 44 

440144 ................ 44 44 

450052 ................ 45 45 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25095 

TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION

1886(d)(8)(E) OF THE ACT—FY 

2008—Continued 

Provider No. Geographic 

CBSA 

Redesignated rural 

area 

450078 ................ 10180 45 

450243 ................ 10180 45 

450348 ................ 45 45 

500148 ................ 48300 50 

520060 ................ 52 52 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1

Proposed MS–DRG Number of 

cases Threshold 

1 .................................. 629 $368,015 

2 .................................. 328 $193,497 

3 .................................. 23,999 $290,254 

4 .................................. 21,742 $177,964 

5 .................................. 842 $174,380 

6 .................................. 495 $99,214 

7 .................................. 413 $141,623 

8 .................................. 560 $101,160 

9 .................................. 1,358 $104,436 

10 ................................ 177 $78,629 

11 ................................ 1,289 $77,495 

12 ................................ 1,923 $55,136 

13 ................................ 1,484 $39,385 

20 ................................ 901 $151,503 

21 ................................ 558 $117,026 

22 ................................ 251 $80,993 

23 ................................ 3,112 $88,345 

24 ................................ 2,576 $65,146 

25 ................................ 8,417 $85,623 

26 ................................ 11,626 $56,519 

27 ................................ 14,454 $43,781 

28 ................................ 1,609 $79,474 

29 ................................ 2,862 $48,075 

30 ................................ 3,751 $32,131 

31 ................................ 1,057 $64,226 

32 ................................ 2,987 $37,367 

33 ................................ 4,263 $30,935 

34 ................................ 813 $61,467 

35 ................................ 2,506 $44,314 

36 ................................ 7,710 $38,140 

37 ................................ 4,777 $54,615 

38 ................................ 14,602 $34,542 

39 ................................ 55,357 $25,687 

40 ................................ 4,549 $62,715 

41 ................................ 7,720 $41,782 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

42 ................................ 5,430 $36,036 

52 ................................ 1,156 $31,042 

53 ................................ 593 $23,808 

54 ................................ 4,664 $32,133 

55 ................................ 16,896 $25,987 

56 ................................ 7,716 $30,536 

57 ................................ 48,432 $19,657 

58 ................................ 789 $29,810 

59 ................................ 2,639 $23,219 

60 ................................ 4,201 $17,679 

61 ................................ 1,340 $56,598 

62 ................................ 2,288 $44,319 

63 ................................ 1,185 $38,047 

64 ................................ 55,552 $36,315 

65 ................................ 112,189 $28,253 

66 ................................ 94,547 $21,586 

67 ................................ 1,383 $32,331 

68 ................................ 12,393 $23,593 

69 ................................ 103,747 $18,936 

70 ................................ 7,092 $35,876 

71 ................................ 10,001 $27,570 

72 ................................ 6,056 $20,628 

73 ................................ 8,655 $28,280 

74 ................................ 32,523 $21,427 

75 ................................ 1,197 $35,846 

76 ................................ 874 $24,623 

77 ................................ 1,101 $34,912 

78 ................................ 1,307 $25,663 

79 ................................ 957 $20,523 

80 ................................ 2,077 $25,444 

81 ................................ 8,190 $17,502 

82 ................................ 1,646 $36,204 

83 ................................ 1,940 $30,062 

84 ................................ 2,591 $23,356 

85 ................................ 5,328 $37,792 

86 ................................ 10,382 $27,625 

87 ................................ 12,152 $20,144 

88 ................................ 717 $31,775 

89 ................................ 2,641 $24,257 

90 ................................ 3,319 $17,874 

91 ................................ 6,676 $31,194 

92 ................................ 14,890 $22,313 

93 ................................ 15,484 $17,172 

94 ................................ 1,521 $60,743 

95 ................................ 1,088 $45,389 

96 ................................ 755 $38,576 

97 ................................ 1,252 $54,573 

98 ................................ 1,048 $37,845 

99 ................................ 642 $31,587 

100 .............................. 15,837 $30,385 

101 .............................. 56,905 $19,341 

102 .............................. 1,352 $25,466 

103 .............................. 15,023 $17,133 

113 .............................. 568 $33,509 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

114 .............................. 601 $21,640 

115 .............................. 1,098 $26,668 

116 .............................. 665 $24,976 

117 .............................. 1,400 $16,827 

121 .............................. 587 $23,703 

122 .............................. 674 $13,518 

123 .............................. 2,843 $19,108 

124 .............................. 679 $25,406 

125 .............................. 4,705 $16,568 

129 .............................. 1,374 $39,926 

130 .............................. 1,072 $30,097 

131 .............................. 655 $38,488 

132 .............................. 728 $28,470 

133 .............................. 1,352 $32,869 

134 .............................. 2,661 $20,306 

135 .............................. 781 $37,347 

136 .............................. 1,113 $24,451 

137 .............................. 1,108 $29,974 

138 .............................. 1,370 $20,587 

139 .............................. 2,145 $22,300 

146 .............................. 687 $37,368 

147 .............................. 1,422 $26,407 

148 .............................. 935 $18,944 

149 .............................. 39,248 $15,883 

150 .............................. 939 $26,227 

151 .............................. 6,801 $13,607 

152 .............................. 2,352 $23,720 

153 .............................. 16,028 $15,145 

154 .............................. 1,843 $29,263 

155 .............................. 4,207 $22,020 

156 .............................. 5,140 $16,103 

157 .............................. 1,145 $29,722 

158 .............................. 3,039 $21,662 

159 .............................. 2,418 $15,345 

163 .............................. 13,431 $84,838 

164 .............................. 18,047 $50,487 

165 .............................. 14,553 $39,842 

166 .............................. 20,290 $62,666 

167 .............................. 20,772 $42,250 

168 .............................. 5,758 $31,795 

175 .............................. 11,954 $35,088 

176 .............................. 40,173 $26,922 

177 .............................. 57,179 $38,623 

178 .............................. 71,192 $31,821 

179 .............................. 27,454 $25,264 

180 .............................. 22,474 $34,645 

181 .............................. 32,156 $27,982 

182 .............................. 6,163 $23,372 

183 .............................. 1,654 $31,015 

184 .............................. 4,141 $22,561 

185 .............................. 2,593 $15,740 

186 .............................. 8,533 $33,538 

mmaher on DSK3CLS3C1PROD with $$_JOB

25096 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

187 .............................. 9,968 $26,845 

188 .............................. 5,148 $20,974 

189 .............................. 104,531 $30,042 

190 .............................. 57,041 $29,138 

191 .............................. 121,659 $24,641 

192 .............................. 196,903 $18,419 

193 .............................. 88,053 $31,201 

194 .............................. 266,599 $25,213 

195 .............................. 147,744 $18,274 

196 .............................. 5,143 $32,537 

197 .............................. 6,894 $26,836 

198 .............................. 4,943 $21,129 

199 .............................. 3,257 $34,933 

200 .............................. 8,185 $24,946 

201 .............................. 3,523 $17,676 

202 .............................. 31,587 $20,635 

203 .............................. 41,587 $15,003 

204 .............................. 26,039 $17,394 

205 .............................. 5,775 $27,595 

206 .............................. 22,415 $18,854 

207 .............................. 46,165 $89,753 

208 .............................. 79,432 $43,969 

215 .............................. 150 $161,680 

216 .............................. 8,411 $176,029 

217 .............................. 7,609 $124,842 

218 .............................. 3,256 $104,178 

219 .............................. 10,062 $140,684 

220 .............................. 13,481 $99,812 

221 .............................. 8,383 $85,690 

222 .............................. 2,865 $159,922 

223 .............................. 5,770 $123,934 

224 .............................. 1,919 $147,237 

225 .............................. 5,871 $115,628 

226 .............................. 7,048 $120,197 

227 .............................. 50,536 $93,738 

228 .............................. 3,084 $135,095 

229 .............................. 4,128 $94,076 

230 .............................. 1,989 $77,297 

231 .............................. 1,478 $147,555 

232 .............................. 1,795 $114,348 

233 .............................. 16,911 $128,139 

234 .............................. 39,167 $91,908 

235 .............................. 9,628 $103,136 

236 .............................. 32,871 $71,913 

237 .............................. 21,789 $90,628 

238 .............................. 44,929 $56,647 

239 .............................. 13,814 $69,191 

240 .............................. 13,349 $45,896 

241 .............................. 3,350 $33,094 

242 .............................. 17,179 $68,158 

243 .............................. 37,856 $52,815 

244 .............................. 68,201 $44,155 

245 .............................. 6,241 $57,244 

246 .............................. 32,661 $68,691 

247 .............................. 279,972 $49,206 

248 .............................. 5,013 $61,557 

249 .............................. 29,657 $43,877 

250 .............................. 5,739 $56,715 

251 .............................. 39,905 $40,116 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

252 .............................. 44,602 $51,463 

253 .............................. 46,864 $45,888 

254 .............................. 59,029 $36,249 

255 .............................. 2,609 $42,857 

256 .............................. 3,833 $32,015 

257 .............................. 774 $23,818 

258 .............................. 598 $53,008 

259 .............................. 7,328 $36,819 

260 .............................. 867 $50,387 

261 .............................. 2,804 $29,564 

262 .............................. 3,378 $23,301 

263 .............................. 788 $30,589 

264 .............................. 30,137 $42,489 

280 .............................. 60,735 $38,714 

281 .............................. 57,734 $29,876 

282 .............................. 60,951 $23,031 

283 .............................. 15,852 $32,521 

284 .............................. 4,911 $24,328 

285 .............................. 3,254 $17,351 

286 .............................. 23,282 $42,720 

287 .............................. 172,488 $29,775 

288 .............................. 3,245 $53,565 

289 .............................. 1,423 $38,265 

290 .............................. 484 $29,384 

291 .............................. 183,774 $30,658 

292 .............................. 217,052 $24,625 

293 .............................. 226,688 $17,810 

294 .............................. 1,704 $21,989 

295 .............................. 1,658 $13,805 

296 .............................. 1,730 $28,035 

297 .............................. 943 $20,306 

298 .............................. 554 $12,889 

299 .............................. 17,443 $29,542 

300 .............................. 46,820 $21,997 

301 .............................. 39,910 $15,712 

302 .............................. 7,873 $24,885 

303 .............................. 81,458 $15,192 

304 .............................. 2,084 $25,286 

305 .............................. 35,646 $15,139 

306 .............................. 1,379 $29,019 

307 .............................. 6,447 $18,857 

308 .............................. 33,528 $28,534 

309 .............................. 79,751 $20,827 

310 .............................. 160,738 $14,816 

311 .............................. 24,867 $13,364 

312 .............................. 169,247 $18,273 

313 .............................. 220,769 $14,894 

314 .............................. 60,053 $32,586 

315 .............................. 30,730 $24,616 

316 .............................. 20,101 $16,823 

326 .............................. 11,567 $94,842 

327 .............................. 10,901 $52,780 

328 .............................. 9,333 $33,659 

329 .............................. 48,135 $85,323 

330 .............................. 66,303 $49,556 

331 .............................. 31,391 $36,640 

332 .............................. 1,890 $78,691 

333 .............................. 6,196 $48,432 

334 .............................. 4,023 $35,774 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

335 .............................. 7,161 $72,588 

336 .............................. 12,516 $45,452 

337 .............................. 8,835 $34,087 

338 .............................. 1,499 $61,541 

339 .............................. 3,192 $41,786 

340 .............................. 3,607 $31,931 

341 .............................. 874 $45,417 

342 .............................. 2,536 $33,389 

343 .............................. 6,875 $24,258 

344 .............................. 898 $54,574 

345 .............................. 2,915 $35,196 

346 .............................. 2,909 $27,779 

347 .............................. 1,568 $38,823 

348 .............................. 3,985 $29,136 

349 .............................. 5,787 $19,265 

350 .............................. 1,669 $43,250 

351 .............................. 3,997 $29,564 

352 .............................. 8,419 $19,894 

353 .............................. 3,182 $46,944 

354 .............................. 9,118 $32,066 

355 .............................. 17,451 $23,281 

356 .............................. 8,366 $62,960 

357 .............................. 8,046 $42,318 

358 .............................. 2,714 $32,613 

368 .............................. 3,052 $33,308 

369 .............................. 4,005 $26,885 

370 .............................. 3,914 $20,084 

371 .............................. 16,843 $34,017 

372 .............................. 22,903 $27,955 

373 .............................. 14,897 $20,598 

374 .............................. 9,414 $36,691 

375 .............................. 19,730 $27,763 

376 .............................. 4,816 $22,720 

377 .............................. 50,503 $32,599 

378 .............................. 84,806 $25,682 

379 .............................. 128,748 $19,140 

380 .............................. 2,917 $34,352 

381 .............................. 4,894 $28,117 

382 .............................. 5,445 $20,581 

383 .............................. 1,303 $29,683 

384 .............................. 8,664 $21,556 

385 .............................. 2,107 $35,137 

386 .............................. 7,221 $26,066 

387 .............................. 5,230 $20,543 

388 .............................. 18,267 $31,162 

389 .............................. 46,328 $23,425 

390 .............................. 48,052 $16,336 

391 .............................. 47,511 $25,915 

392 .............................. 306,515 $17,829 

393 .............................. 23,917 $30,478 

394 .............................. 45,952 $24,292 

395 .............................. 26,460 $17,594 

405 .............................. 3,903 $90,226 

406 .............................. 5,241 $52,384 

407 .............................. 2,310 $38,743 

408 .............................. 1,644 $71,983 

409 .............................. 1,713 $49,309 

410 .............................. 722 $37,665 

411 .............................. 978 $69,625 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25097 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

412 .............................. 1,063 $50,630 

413 .............................. 881 $39,302 

414 .............................. 5,596 $63,496 

415 .............................. 6,847 $42,806 

416 .............................. 6,222 $31,773 

417 .............................. 16,671 $49,010 

418 .............................. 27,563 $38,299 

419 .............................. 38,264 $29,285 

420 .............................. 714 $65,599 

421 .............................. 1,091 $38,623 

422 .............................. 364 $30,085 

423 .............................. 1,500 $68,219 

424 .............................. 912 $46,919 

425 .............................. 157 $38,094 

432 .............................. 16,259 $32,310 

433 .............................. 9,022 $23,457 

434 .............................. 945 $17,210 

435 .............................. 11,908 $34,335 

436 .............................. 13,987 $27,538 

437 .............................. 4,357 $24,539 

438 .............................. 14,426 $33,536 

439 .............................. 24,816 $26,419 

440 .............................. 27,346 $18,913 

441 .............................. 13,912 $30,900 

442 .............................. 12,756 $24,488 

443 .............................. 6,698 $18,374 

444 .............................. 12,447 $32,912 

445 .............................. 16,757 $26,999 

446 .............................. 16,849 $20,274 

453 .............................. 846 $174,685 

454 .............................. 1,496 $117,216 

455 .............................. 1,875 $90,966 

456 .............................. 764 $142,125 

457 .............................. 1,763 $100,035 

458 .............................. 1,534 $82,734 

459 .............................. 3,180 $98,971 

460 .............................. 50,317 $64,868 

461 .............................. 1,062 $82,101 

462 .............................. 14,234 $61,454 

463 .............................. 5,283 $68,787 

464 .............................. 6,322 $44,864 

465 .............................. 2,942 $32,894 

466 .............................. 4,152 $74,863 

467 .............................. 10,818 $55,556 

468 .............................. 28,701 $46,551 

469 .............................. 29,730 $60,216 

470 .............................. 410,173 $43,290 

471 .............................. 2,227 $76,468 

472 .............................. 6,218 $50,893 

473 .............................. 22,546 $41,804 

474 .............................. 2,829 $54,927 

475 .............................. 3,530 $37,782 

476 .............................. 1,698 $26,665 

477 .............................. 2,257 $60,431 

478 .............................. 7,144 $43,558 

479 .............................. 10,267 $34,775 

480 .............................. 25,866 $53,540 

481 .............................. 59,136 $40,012 

482 .............................. 64,739 $34,370 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

483 .............................. 5,729 $46,686 

484 .............................. 17,949 $39,280 

485 .............................. 967 $59,138 

486 .............................. 1,535 $43,053 

487 .............................. 1,214 $34,867 

488 .............................. 1,551 $34,851 

489 .............................. 3,866 $26,609 

490 .............................. 19,803 $35,660 

491 .............................. 58,396 $24,028 

492 .............................. 4,700 $51,225 

493 .............................. 15,248 $38,100 

494 .............................. 30,563 $29,460 

495 .............................. 1,867 $54,818 

496 .............................. 5,049 $36,082 

497 .............................. 7,519 $28,326 

498 .............................. 1,177 $38,828 

499 .............................. 1,245 $22,858 

500 .............................. 1,349 $50,966 

501 .............................. 3,679 $32,218 

502 .............................. 6,825 $23,032 

503 .............................. 736 $40,314 

504 .............................. 2,155 $32,350 

505 .............................. 3,214 $24,352 

506 .............................. 909 $25,086 

507 .............................. 779 $34,570 

508 .............................. 2,722 $26,249 

509 .............................. 465 $25,608 

510 .............................. 957 $40,566 

511 .............................. 4,008 $31,428 

512 .............................. 11,961 $23,087 

513 .............................. 1,287 $31,071 

514 .............................. 1,339 $20,718 

515 .............................. 3,577 $54,297 

516 .............................. 10,963 $39,039 

517 .............................. 18,263 $31,703 

533 .............................. 828 $28,832 

534 .............................. 3,634 $15,819 

535 .............................. 6,844 $28,150 

536 .............................. 34,321 $15,408 

537 .............................. 654 $20,405 

538 .............................. 1,164 $12,954 

539 .............................. 3,379 $36,833 

540 .............................. 4,187 $28,818 

541 .............................. 1,858 $22,002 

542 .............................. 6,158 $34,845 

543 .............................. 18,413 $26,086 

544 .............................. 12,644 $18,008 

545 .............................. 4,016 $36,462 

546 .............................. 5,881 $25,135 

547 .............................. 4,880 $18,469 

548 .............................. 591 $34,989 

549 .............................. 1,077 $26,366 

550 .............................. 904 $18,381 

551 .............................. 9,502 $31,033 

552 .............................. 87,859 $18,492 

553 .............................. 2,790 $25,374 

554 .............................. 20,253 $14,944 

555 .............................. 1,995 $23,282 

556 .............................. 19,168 $14,428 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

557 .............................. 3,184 $30,733 

558 .............................. 14,178 $19,372 

559 .............................. 1,635 $30,332 

560 .............................. 3,979 $20,901 

561 .............................. 7,617 $13,636 

562 .............................. 4,996 $28,213 

563 .............................. 36,056 $15,451 

564 .............................. 1,606 $28,809 

565 .............................. 3,237 $21,478 

566 .............................. 2,779 $15,695 

573 .............................. 5,687 $50,477 

574 .............................. 12,100 $35,412 

575 .............................. 6,468 $26,698 

576 .............................. 558 $47,915 

577 .............................. 2,179 $32,787 

578 .............................. 3,299 $23,686 

579 .............................. 3,088 $48,029 

580 .............................. 6,766 $33,258 

581 .............................. 5,288 $23,944 

582 .............................. 8,972 $24,930 

583 .............................. 15,549 $19,001 

584 .............................. 1,431 $29,247 

585 .............................. 2,818 $20,786 

592 .............................. 3,982 $32,110 

593 .............................. 12,832 $24,303 

594 .............................. 2,955 $16,562 

595 .............................. 1,082 $31,299 

596 .............................. 5,755 $19,571 

597 .............................. 548 $31,103 

598 .............................. 1,483 $24,558 

599 .............................. 350 $15,943 

600 .............................. 572 $22,870 

601 .............................. 865 $15,125 

602 .............................. 21,307 $28,307 

603 .............................. 130,923 $18,145 

604 .............................. 2,627 $26,277 

605 .............................. 22,672 $16,152 

606 .............................. 1,363 $24,074 

607 .............................. 7,169 $14,791 

614 .............................. 1,376 $47,229 

615 .............................. 1,626 $34,519 

616 .............................. 1,132 $65,696 

617 .............................. 6,822 $39,614 

618 .............................. 343 $29,975 

619 .............................. 663 $64,216 

620 .............................. 1,877 $43,862 

621 .............................. 6,556 $37,409 

622 .............................. 1,234 $49,435 

623 .............................. 3,268 $35,278 

624 .............................. 487 $26,158 

625 .............................. 1,098 $42,919 

626 .............................. 2,522 $28,885 

627 .............................. 14,305 $19,134 

628 .............................. 3,267 $55,480 

629 .............................. 3,958 $43,435 

630 .............................. 684 $33,106 

637 .............................. 16,283 $28,425 

638 .............................. 40,811 $20,070 

639 .............................. 41,135 $14,010 

mmaher on DSK3CLS3C1PROD with $$_JOB

25098 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

640 .............................. 55,690 $25,143 

641 .............................. 188,104 $16,575 

642 .............................. 1,542 $24,193 

643 .............................. 5,014 $32,744 

644 .............................. 11,845 $25,227 

645 .............................. 8,402 $18,520 

652 .............................. 10,437 $62,402 

653 .............................. 1,585 $91,794 

654 .............................. 3,231 $57,305 

655 .............................. 1,650 $42,998 

656 .............................. 3,721 $59,955 

657 .............................. 7,359 $40,718 

658 .............................. 8,479 $33,723 

659 .............................. 4,442 $54,626 

660 .............................. 7,444 $38,339 

661 .............................. 4,745 $31,241 

662 .............................. 988 $44,122 

663 .............................. 2,131 $30,611 

664 .............................. 4,676 $23,754 

665 .............................. 690 $49,701 

666 .............................. 2,213 $31,959 

667 .............................. 3,948 $19,910 

668 .............................. 3,757 $41,676 

669 .............................. 12,491 $29,038 

670 .............................. 13,411 $19,410 

671 .............................. 884 $30,142 

672 .............................. 965 $19,128 

673 .............................. 12,577 $46,104 

674 .............................. 10,503 $42,636 

675 .............................. 11,704 $32,785 

682 .............................. 75,827 $31,972 

683 .............................. 112,129 $26,767 

684 .............................. 43,451 $19,020 

685 .............................. 2,493 $20,233 

686 .............................. 1,581 $32,841 

687 .............................. 3,322 $25,246 

688 .............................. 1,198 $18,441 

689 .............................. 55,398 $27,175 

690 .............................. 200,059 $18,352 

691 .............................. 898 $33,393 

692 .............................. 654 $25,534 

693 .............................. 2,235 $29,001 

694 .............................. 19,213 $17,667 

695 .............................. 974 $25,020 

696 .............................. 10,565 $14,808 

697 .............................. 575 $17,475 

698 .............................. 21,061 $29,461 

699 .............................. 22,820 $24,300 

700 .............................. 15,089 $17,723 

707 .............................. 4,874 $37,314 

708 .............................. 17,015 $29,414 

709 .............................. 755 $36,305 

710 .............................. 2,037 $29,222 

711 .............................. 921 $36,269 

712 .............................. 819 $20,449 

713 .............................. 11,755 $26,239 

714 .............................. 32,745 $15,644 

715 .............................. 638 $36,067 

716 .............................. 1,382 $28,098 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

717 .............................. 634 $33,174 

718 .............................. 633 $19,455 

722 .............................. 871 $30,591 

723 .............................. 2,037 $24,888 

724 .............................. 666 $15,999 

725 .............................. 802 $24,549 

726 .............................. 3,940 $16,420 

727 .............................. 1,098 $27,652 

728 .............................. 6,176 $16,848 

729 .............................. 578 $23,477 

730 .............................. 552 $14,387 

734 .............................. 1,470 $42,020 

735 .............................. 1,328 $26,263 

736 .............................. 840 $73,881 

737 .............................. 3,429 $41,554 

738 .............................. 954 $29,484 

739 .............................. 975 $51,269 

740 .............................. 4,366 $33,218 

741 .............................. 6,554 $24,119 

742 .............................. 10,705 $31,515 

743 .............................. 35,310 $21,122 

744 .............................. 1,498 $30,509 

745 .............................. 2,189 $20,066 

746 .............................. 2,486 $29,036 

747 .............................. 11,218 $20,664 

748 .............................. 21,171 $19,841 

749 .............................. 1,037 $45,581 

750 .............................. 484 $24,671 

754 .............................. 1,083 $33,538 

755 .............................. 3,152 $25,336 

756 .............................. 831 $16,790 

757 .............................. 1,322 $32,841 

758 .............................. 1,597 $25,832 

759 .............................. 1,186 $19,161 

760 .............................. 1,703 $19,848 

761 .............................. 1,918 $13,557 

765 .............................. 2,497 $22,146 

766 .............................. 2,634 $14,889 

767 .............................. 119 $15,750 

768 .............................. 10 $29,739 

769 .............................. 86 $31,941 

770 .............................. 181 $18,191 

774 .............................. 1,442 $12,637 

775 .............................. 5,224 $9,066 

776 .............................. 491 $15,413 

777 .............................. 177 $19,480 

778 .............................. 489 $8,798 

779 .............................. 107 $14,082 

780 .............................. 47 $5,638 

781 .............................. 3,004 $13,343 

782 .............................. 125 $8,369 

794 .............................. 7 $2,880 

799 .............................. 623 $80,879 

800 .............................. 699 $48,145 

801 .............................. 602 $37,100 

802 .............................. 691 $55,325 

803 .............................. 1,003 $35,487 

804 .............................. 996 $25,527 

808 .............................. 8,315 $35,924 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

809 .............................. 15,527 $25,920 

810 .............................. 3,818 $21,504 

811 .............................. 18,344 $25,759 

812 .............................. 83,082 $18,156 

813 .............................. 15,031 $26,262 

814 .............................. 1,631 $31,374 

815 .............................. 3,337 $24,871 

816 .............................. 2,355 $18,234 

820 .............................. 1,481 $89,134 

821 .............................. 2,529 $42,943 

822 .............................. 2,139 $30,127 

823 .............................. 2,436 $68,790 

824 .............................. 3,039 $42,669 

825 .............................. 2,009 $31,129 

826 .............................. 562 $82,779 

827 .............................. 1,318 $42,427 

828 .............................. 872 $30,710 

829 .............................. 1,374 $47,009 

830 .............................. 531 $26,963 

834 .............................. 5,257 $54,533 

835 .............................. 1,469 $32,379 

836 .............................. 1,526 $24,423 

837 .............................. 1,623 $91,611 

838 .............................. 900 $44,011 

839 .............................. 1,385 $28,304 

840 .............................. 15,152 $40,430 

841 .............................. 11,012 $30,388 

842 .............................. 7,678 $23,796 

843 .............................. 1,477 $34,387 

844 .............................. 2,854 $26,126 

845 .............................. 1,008 $21,865 

846 .............................. 2,480 $39,831 

847 .............................. 23,667 $26,464 

848 .............................. 1,699 $20,748 

849 .............................. 1,498 $28,295 

853 .............................. 31,444 $83,950 

854 .............................. 6,881 $53,045 

855 .............................. 467 $37,927 

856 .............................. 6,187 $74,156 

857 .............................. 10,059 $39,007 

858 .............................. 3,500 $30,128 

862 .............................. 7,425 $34,703 

863 .............................. 21,807 $21,882 

864 .............................. 19,826 $20,564 

865 .............................. 2,019 $29,189 

866 .............................. 9,406 $16,786 

867 .............................. 5,306 $40,813 

868 .............................. 2,369 $25,734 

869 .............................. 1,100 $20,520 

870 .............................. 13,710 $99,453 

871 .............................. 203,702 $35,587 

872 .............................. 92,118 $26,548 

876 .............................. 968 $43,100 

880 .............................. 10,494 $15,328 

881 .............................. 4,576 $11,727 

882 .............................. 1,656 $12,481 

883 .............................. 786 $17,701 

884 .............................. 21,619 $19,048 

885 .............................. 77,763 $16,598 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25099 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

886 .............................. 376 $14,393 

887 .............................. 423 $18,850 

894 .............................. 4,480 $8,389 

895 .............................. 6,474 $16,201 

896 .............................. 5,369 $26,659 

897 .............................. 35,835 $13,689 

901 .............................. 917 $51,824 

902 .............................. 2,135 $33,272 

903 .............................. 1,739 $24,889 

904 .............................. 941 $42,415 

905 .............................. 798 $26,522 

906 .............................. 745 $24,393 

907 .............................. 8,098 $57,686 

908 .............................. 7,884 $37,304 

909 .............................. 5,971 $27,385 

913 .............................. 813 $27,433 

914 .............................. 6,958 $16,346 

915 .............................. 915 $25,250 

916 .............................. 5,369 $10,725 

917 .............................. 14,155 $30,038 

918 .............................. 34,847 $14,539 

919 .............................. 10,569 $29,326 

920 .............................. 12,135 $22,791 

921 .............................. 11,659 $15,316 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

922 .............................. 1,005 $28,199 

923 .............................. 4,211 $16,053 

927 .............................. 182 $206,517 

928 .............................. 794 $66,194 

929 .............................. 459 $35,403 

933 .............................. 155 $33,800 

934 .............................. 694 $25,296 

935 .............................. 2,179 $22,619 

939 .............................. 423 $45,897 

940 .............................. 690 $34,557 

941 .............................. 1,077 $27,512 

945 .............................. 5,053 $21,694 

946 .............................. 3,199 $17,198 

947 .............................. 6,544 $24,507 

948 .............................. 34,325 $15,485 

949 .............................. 742 $18,955 

950 .............................. 476 $12,079 

951 .............................. 990 $14,489 

955 .............................. 446 $89,598 

956 .............................. 3,718 $58,558 

957 .............................. 1,157 $112,575 

958 .............................. 737 $76,928 

959 .............................. 816 $58,670 

963 .............................. 1,395 $49,648 

TABLE 10.—GEOMETRIC MEAN PLUS

THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING

STANDARDIZED PAYMENT AMOUNT

(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND

CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY PROPOSED MEDICARE SEVERITY

DIAGNOSISRELATED GROUP (MS– 

DRG) APRIL 2007 1—Continued 

Proposed MS–DRG Number of 

cases Threshold 

964 .............................. 1,578 $34,426 

965 .............................. 2,016 $29,169 

969 .............................. 598 $83,524 

970 .............................. 231 $52,404 

974 .............................. 7,276 $37,920 

975 .............................. 3,463 $32,068 

976 .............................. 2,728 $25,665 

977 .............................. 4,871 $24,657 

981 .............................. 26,280 $82,945 

982 .............................. 18,594 $56,659 

983 .............................. 6,766 $40,536 

984 .............................. 669 $59,799 

985 .............................. 1,048 $41,065 

986 .............................. 890 $29,062 

987 .............................. 8,036 $58,165 

988 .............................. 11,880 $38,036 

989 .............................. 6,537 $27,418 

999 .............................. 18 $16,006 

1 Cases taken from the FY 2006 MedPAR 

file; proposed MSDRGs are from GROUPER 

Version 25.0. 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

1 .................. Heart transplant or implant of heart assist system w MCC 7 .......................... 1 0 0.0000 0.0 0.0 

2 .................. Heart transplant or implant of heart assist system w/o MCC 7 ....................... 1 0 0.0000 0.0 0.0 

3 .................. ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R .. 3 270 4.2008 64.5 53.8 

4 .................. Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R ............... 4 1,069 2.9804 46.7 38.9 

5 .................. Liver transplant w MCC or intestinal transplant 7 ............................................ 5 0 0.0000 0.0 0.0 

6 .................. Liver transplant w/o MCC 7 .............................................................................. 5 0 0.0000 0.0 0.0 

7 .................. Lung transplant 7 .............................................................................................. 7 0 0.0000 0.0 0.0 

8 .................. Simultaneous pancreas/kidney transplant 7 .................................................... 8 0 0.0000 0.0 0.0 

9 .................. Bone marrow transplant 8 ................................................................................ 9 0 1.0950 30.3 25.3 

10 ................ Pancreas transplant 7 ...................................................................................... 10 0 0.0000 0.0 0.0 

11 ................ Tracheostomy for face, mouth & neck diagnoses w MCC 9 ........................... 11 0 1.6489 36.5 30.4 

12 ................ Tracheostomy for face, mouth & neck diagnoses w CC 5 .............................. 11 1 1.6489 36.5 30.4 

13 ................ Tracheostomy for face, mouth & neck diagnoses w/o CC/MCC 9 .................. 11 0 1.6489 36.5 30.4 

20 ................ Intracranial vascular procedures w PDX hemorrhage w MCC 8 ..................... 20 0 1.6489 36.5 30.4 

21 ................ Intracranial vascular procedures w PDX hemorrhage w CC 8 ........................ 20 0 0.4800 19.9 16.6 

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25100 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

22 ................ Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC 8 ............ 20 0 0.4800 19.9 16.6 

23 ................ Craniotomy w major device implant or acute complex CNS PDX w MCC 8 .. 23 0 1.6489 36.5 30.4 

24 ................ Craniotomy w major device implant or acute complex CNS PDX w/o MCC 8 23 0 0.4800 19.9 16.6 

25 ................ Craniotomy & endovascular intracranial procedures w MCC 9 ....................... 25 0 1.6489 36.5 30.4 

26 ................ Craniotomy & endovascular intracranial procedures w CC 5 .......................... 25 2 1.6489 36.5 30.4 

27 ................ Craniotomy & endovascular intracranial procedures w/o CC/MCC 9 .............. 25 0 1.6489 36.5 30.4 

28 ................ Spinal procedures w MCC 4 ............................................................................ 28 6 1.0950 30.3 25.3 

29 ................ Spinal procedures w CC 4 ............................................................................... 28 4 1.0950 30.3 25.3 

30 ................ Spinal procedures w/o CC/MCC 1 ................................................................... 28 2 0.4800 19.9 16.6 

31 ................ Ventricular shunt procedures w MCC 5 ........................................................... 31 2 1.6489 36.5 30.4 

32 ................ Ventricular shunt procedures w CC 1 .............................................................. 31 1 0.4800 19.9 16.6 

33 ................ Ventricular shunt procedures w/o CC/MCC 1 .................................................. 31 1 0.4800 19.9 16.6 

34 ................ Carotid artery stent procedure w MCC 8 ......................................................... 34 0 1.6489 36.5 30.4 

35 ................ Carotid artery stent procedure w CC 8 ............................................................ 34 0 1.0950 30.3 25.3 

36 ................ Carotid artery stent procedure w/o CC/MCC 8 ................................................ 34 0 1.0950 30.3 25.3 

37 ................ Extracranial procedures w MCC 5 ................................................................... 37 12 1.6489 36.5 30.4 

38 ................ Extracranial procedures w CC 4 ...................................................................... 37 7 1.0950 30.3 25.3 

39 ................ Extracranial procedures w/o CC/MCC 4 .......................................................... 37 1 1.0950 30.3 25.3 

40 ................ Periph & cranial nerve & other nerv syst proc w MCC ................................... 40 156 1.3371 36.3 30.3

41 ................ Periph & cranial nerve & other nerv syst proc w CC ...................................... 40 99 0.9653 34.3 28.6 

42 ................ Periph & cranial nerve & other nerv syst proc w/o CC/MCC 3 ....................... 40 10 0.8072 24.6 20.5 

52 ................ Spinal disorders & injuries w CC/MCC ............................................................ 52 78 1.0786 32.8 27.3 

53 ................ Spinal disorders & injuries w/o CC/MCC 3 ...................................................... 52 19 0.8072 24.6 20.5 

54 ................ Nervous system neoplasms w MCC ................................................................ 54 50 0.7245 23.6 19.7 

55 ................ Nervous system neoplasms w/o MCC ............................................................. 54 67 0.6543 22.0 18.3 

56 ................ Degenerative nervous system disorders w MCC ............................................ 56 1,320 0.7993 26.4 22.0 

57 ................ Degenerative nervous system disorders w/o MCC ......................................... 56 2,623 0.5844 24.4 20.3 

58 ................ Multiple sclerosis & cerebellar ataxia w MCC 6 .............................................. 58 23 0.5405 22.2 18.5 

59 ................ Multiple sclerosis & cerebellar ataxia w CC .................................................... 58 44 0.5405 22.2 18.5 

60 ................ Multiple sclerosis & cerebellar ataxia w/o CC/MCC 6 ..................................... 58 22 0.5405 22.2 18.5 

61 ................ Acute ischemic stroke w use of thrombolytic agent w MCC 8 ........................ 61 0 0.8131 24.0 20.0 

62 ................ Acute ischemic stroke w use of thrombolytic agent w CC 8 ........................... 61 0 0.4800 19.9 16.6 

63 ................ Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC 8 ............... 61 0 0.4800 19.9 16.6 

64 ................ Intracranial hemorrhage or cerebral infarction w MCC ................................... 64 126 0.8199 25.1 20.9 

65 ................ Intracranial hemorrhage or cerebral infarction w CC ...................................... 64 116 0.6159 23.5 19.6 

66 ................ Intracranial hemorrhage or cerebral infarction w/o CC/MCC 1 ....................... 64 24 0.4800 19.9 16.6 

67 ................ Nonspecific cva & precerebral occlusion w/o infarct w MCC 1 ....................... 67 5 0.4800 19.9 16.6 

68 ................ Nonspecific cva & precerebral occlusion w/o infarct w/o MCC 1 .................... 67 8 0.4800 19.9 16.6 

69 ................ Transient ischemia 1 ........................................................................................ 69 17 0.4800 19.9 16.6 

70 ................ Nonspecific cerebrovascular disorders w MCC ............................................... 70 103 0.8131 24.0 20.0 

71 ................ Nonspecific cerebrovascular disorders w CC .................................................. 70 86 0.5751 22.7 18.9 

72 ................ Nonspecific cerebrovascular disorders w/o CC/MCC 1 ................................... 70 9 0.4800 19.9 16.6 

73 ................ Cranial & peripheral nerve disorders w MCC .................................................. 73 83 0.8630 24.9 20.8 

74 ................ Cranial & peripheral nerve disorders w/o MCC ............................................... 73 173 0.5645 23.3 19.4 

75 ................ Viral meningitis w CC/MCC 2 ........................................................................... 75 20 0.6513 22.7 18.9 

76 ................ Viral meningitis w/o CC/MCC 1 ........................................................................ 75 1 0.4800 19.9 16.6 

77 ................ Hypertensive encephalopathy w MCC 2 .......................................................... 77 4 0.6513 22.7 18.9 

78 ................ Hypertensive encephalopathy w CC 2, 6 .......................................................... 77 9 0.6513 22.7 18.9 

79 ................ Hypertensive encephalopathy w/o CC/MCC 1 ................................................. 77 1 0.4800 19.9 16.6 

80 ................ Nontraumatic stupor & coma w MCC .............................................................. 80 40 0.6767 24.6 20.5 

81 ................ Nontraumatic stupor & coma w/o MCC ........................................................... 80 71 0.5395 23.1 19.3 

82 ................ Traumatic stupor & coma, coma ≤1 hr w MCC ............................................... 82 27 0.8821 29.5 24.6 

83 ................ Traumatic stupor & coma, coma ≤1 hr w CC2 ................................................ 82 12 0.6513 22.7 18.9 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25101 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

84 ................ Traumatic stupor & coma, coma ≤1 hr w/o CC/MCC 2 ................................... 82 4 0.6513 22.7 18.9 

85 ................ Traumatic stupor & coma, coma <1 hr w MCC ............................................... 85 102 0.9666 28.3 23.6 

86 ................ Traumatic stupor & coma, coma <1 hr w CC .................................................. 85 86 0.6711 25.2 21.0 

87 ................ Traumatic stupor & coma, coma <1 hr w/o CC/MCC ...................................... 85 30 0.5363 20.1 16.8 

88 ................ Concussion w MCC 4, 6 .................................................................................... 88 1 1.0950 30.3 25.3 

89 ................ Concussion w CC 4 .......................................................................................... 88 2 1.0950 30.3 25.3 

90 ................ Concussion w/o CC/MCC 9 ............................................................................. 88 0 1.0950 30.3 25.3 

91 ................ Other disorders of nervous system w MCC .................................................... 91 243 0.8500 25.7 21.4 

92 ................ Other disorders of nervous system w CC ....................................................... 91 189 0.5981 21.9 18.3 

93 ................ Other disorders of nervous system w/o CC/MCC ........................................... 91 54 0.4835 20.0 16.7

94 ................ Bacterial & tuberculous infections of nervous system w MCC ........................ 94 211 1.0574 28.0 23.3 

95 ................ Bacterial & tuberculous infections of nervous system w CC ........................... 94 105 0.8454 26.8 22.3 

96 ................ Bacterial & tuberculous infections of nervous system w/o CC/MCC .............. 94 26 0.8454 26.8 22.3 

97 ................ Non-bacterial infect of nervous sys exc viral meningitis w MCC .................... 97 57 0.9189 26.2 21.8 

98 ................ Non-bacterial infect of nervous sys exc viral meningitis w CC ....................... 97 33 0.8242 22.7 18.9 

99 ................ Non-bacterial infect of nervoussys exc viral meningitis w/o CC/MCC 2 .......... 97 10 0.6513 22.7 18.9 

100 .............. Seizures w MCC .............................................................................................. 100 40 0.8295 26.5 22.1 

101 .............. Seizures w/o MCC ........................................................................................... 100 37 0.5564 21.4 17.8 

102 .............. Headaches w MCC 3, 6 .................................................................................... 102 6 0.8072 24.6 20.5 

103 .............. Headaches w/o MCC 3 .................................................................................... 102 11 0.8072 24.6 20.5 

113 .............. Orbital procedures w CC/MCC 2 ..................................................................... 113 1 0.6513 22.7 18.9 

114 .............. Orbital procedures w/o CC/MCC 9 .................................................................. 113 0 0.6513 22.7 18.9 

115 .............. Extraocular procedures exceptorbit 8 .............................................................. 115 0 0.6513 22.7 18.9 

116 .............. Intraocular procedures w CC/MCC 8 ............................................................... 116 0 0.6513 22.7 18.9 

117 .............. Intraocular procedures w/o CC/MCC 8 ............................................................ 116 0 0.6513 22.7 18.9 

121 .............. Acute major eye infections w CC/MCC 2 ........................................................ 121 8 0.6513 22.7 18.9 

122 .............. Acute major eye infections w/o CC/MCC 1 ..................................................... 121 2 0.4800 19.9 16.6 

123 .............. Neurological eye disorders 1 ............................................................................ 123 3 0.4800 19.9 16.6 

124 .............. Other disorders of the eye w MCC 4 ............................................................... 124 2 1.0950 30.3 25.3 

125 .............. Other disorders of the eye w/o MCC 2 ............................................................ 124 10 0.6513 22.7 18.9 

129 .............. Major head & neck procedures w CC/MCC or major device 8 ....................... 129 0 1.0950 30.3 25.3 

130 .............. Major head & neck procedures w/o CC/MCC 8 .............................................. 129 0 0.6513 22.7 18.9 

131 .............. Cranial/facial procedures w CC/MCC 5 ........................................................... 131 2 1.6489 36.5 30.4 

132 .............. Cranial/facial procedures w/o CC/MCC 9 ........................................................ 131 0 1.6489 36.5 30.4 

133 .............. Other ear, nose, mouth & throat O.R. procedures w CC/MCC 3, 6 ................. 133 3 0.8072 24.6 20.5 

134 .............. Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC 3, 6 .............. 133 1 0.8072 24.6 20.5 

135 .............. Sinus & mastoid procedures w CC/MCC 8 ...................................................... 135 0 0.8072 24.6 20.5 

136 .............. Sinus & mastoid procedures w/o CC/MCC 8 ................................................... 135 0 0.8072 24.6 20.5 

137 .............. Mouth procedures w CC/MCC 5 ...................................................................... 137 1 1.6489 36.5 30.4 

138 .............. Mouth procedures w/o CC/MCC 9 ................................................................... 137 0 1.6489 36.5 30.4 

139 .............. Salivary gland procedures 5 ............................................................................. 139 1 1.6489 36.5 30.4 

146 .............. Ear, nose, mouth & throat malignancy w MCC ............................................... 146 44 1.2620 26.4 22.0 

147 .............. Ear, nose, mouth & throat malignancy w CC .................................................. 146 37 0.9530 24.9 20.8 

148 .............. Ear, nose, mouth & throat malignancy w/o CC/MCC 2 ................................... 146 4 0.6513 22.7 18.9 

149 .............. Dysequilibrium 1 ............................................................................................... 149 9 0.4800 19.9 16.6 

150 .............. Epistaxis w MCC 8 ........................................................................................... 150 0 0.6513 22.7 18.9 

151 .............. Epistaxis w/o MCC 8 ........................................................................................ 150 0 0.4800 19.9 16.6 

152 .............. Otitis media & URI w MCC 2 ........................................................................... 152 10 0.6513 22.7 18.9 

153 .............. Otitis media & URI w/o MCC 1 ........................................................................ 152 23 0.4800 19.9 16.6 

154 .............. Nasal trauma & deformity w MCC ................................................................... 154 55 0.7560 21.2 17.7 

155 .............. Nasal trauma & deformity w CC ...................................................................... 154 44 0.7320 20.4 17.0 

156 .............. Nasal trauma & deformity w/o CC/MCC 2 ....................................................... 154 11 0.6513 22.7 18.9 

157 .............. Dental & Oral Diseases w MCC 3, 6 ................................................................ 157 9 0.8072 24.6 20.5 

158 .............. Dental & Oral Diseases w CC 3, 6 ................................................................... 157 18 0.8072 24.6 20.5 

159 .............. Dental & Oral Diseases w/o CC/MCC 3, 6 ....................................................... 157 2 0.8072 24.6 20.5 

163 .............. Major chest procedures w MCC ...................................................................... 163 27 2.2983 39.7 33.1 

164 .............. Major chest procedures w CC 5 ...................................................................... 163 10 1.6489 36.5 30.4 

mmaher on DSK3CLS3C1PROD with $$_JOB

25102 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

165 .............. Major chest procedures w/o CC/MCC 9 .......................................................... 163 0 1.6489 36.5 30.4 

166 .............. Other resp system O.R. procedures w MCC ................................................... 166 1,568 2.4517 42.4 35.3 

167 .............. Other resp system O.R. procedures w CC ...................................................... 166 233 1.8802 37.6 31.3 

168 .............. Other resp system O.R. procedures w/o CC/MCC 4 ....................................... 166 10 1.0950 30.3 25.3 

175 .............. Pulmonary embolism w MCC .......................................................................... 175 103 0.7766 22.9 19.1 

176 .............. Pulmonary embolism w/o MCC ....................................................................... 175 139 0.5350 20.2 16.8 

177 .............. Respiratory infections & inflammations w MCC .............................................. 177 2,943 0.8638 23.6 19.7 

178 .............. Respiratory infections & inflammations w CC ................................................. 177 2,247 0.7254 22.2 18.5 

179 .............. Respiratory infections & inflammations w/o CC/MCC ..................................... 177 390 0.5896 19.2 16.0

180 .............. Respiratory neoplasms w MCC ....................................................................... 180 162 0.8433 20.1 16.8 

181 .............. Respiratory neoplasms w CC .......................................................................... 180 110 0.6481 19.3 16.1 

182 .............. Respiratory neoplasms w/o CC/MCC 1 ........................................................... 180 19 0.4800 19.9 16.6 

183 .............. Major chest trauma w MCC 1 .......................................................................... 183 1 0.4800 19.9 16.6 

184 .............. Major chest trauma w CC 1, 6 .......................................................................... 183 1 0.4800 19.9 16.6 

185 .............. Major chest trauma w/o CC/MCC 9 ................................................................. 183 0 0.4800 19.9 16.6 

186 .............. Pleural effusion w MCC ................................................................................... 186 136 0.8571 23.6 19.7 

187 .............. Pleural effusion w CC ...................................................................................... 186 64 0.6165 21.1 17.6 

188 .............. Pleural effusion w/o CC/MCC 6 ....................................................................... 186 14 0.6165 21.1 17.6 

189 .............. Pulmonary edema & respiratory failure ........................................................... 189 5,686 0.9560 23.9 19.9 

190 .............. Chronic obstructive pulmonary disease w MCC .............................................. 190 1,657 0.7195 20.9 17.4 

191 .............. Chronic obstructive pulmonary disease w CC ................................................. 190 1,542 0.6024 19.6 16.3 

192 .............. Chronic obstructive pulmonary disease w/o CC/MCC .................................... 190 894 0.5192 17.2 14.3 

193 .............. Simple pneumonia & pleurisy w MCC ............................................................. 193 1,689 0.7400 21.6 18.0 

194 .............. Simple pneumonia & pleurisy w CC ................................................................ 193 2,090 0.6108 19.8 16.5 

195 .............. Simple pneumonia & pleurisy w/o CC/MCC .................................................... 193 475 0.5321 18.1 15.1 

196 .............. Interstitial lung disease w MCC ....................................................................... 196 114 0.6613 20.0 16.7 

197 .............. Interstitial lung disease w CC .......................................................................... 196 94 0.5863 19.6 16.3 

198 .............. Interstitial lung disease w/o CC/MCC .............................................................. 196 45 0.5717 19.7 16.4 

199 .............. Pneumothorax w MCC ..................................................................................... 199 25 0.7596 22.4 18.7 

200 .............. Pneumothorax w CC2 ...................................................................................... 199 16 0.6513 22.7 18.9 

201 .............. Pneumothorax w/o CC/MCC 1 ......................................................................... 199 11 0.4800 19.9 16.6 

202 .............. Bronchitis & asthma w CC/MCC ...................................................................... 202 92 0.6915 21.4 17.8 

203 .............. Bronchitis & asthma w/o CC/MCC ................................................................... 202 38 0.4994 16.6 13.8 

204 .............. Respiratory signs & symptoms ........................................................................ 204 313 0.8025 22.0 18.3 

205 .............. Other respiratory system diagnoses w MCC ................................................... 205 260 0.8221 22.5 18.8 

206 .............. Other respiratory system diagnoses w/o MCC ................................................ 205 169 0.7446 21.7 18.1 

207 .............. Respiratory system diagnosis w ventilator support 96+ hours ........................ 207 12,390 1.9944 34.2 28.5

208 .............. Respiratory system diagnosis w ventilator support 96 hours .......................... 208 1,879 1.5234 27.8 23.2

215 .............. Other heart assist system implant 8 ................................................................ 215 0 0.8072 24.6 20.5 

216 .............. Cardiac valve & oth maj cardiothoracic proc w card cath w MCC 8 ............... 216 0 1.6489 36.5 30.4 

217 .............. Cardiac valve & oth maj cardiothoracic proc w card cath w CC 8 .................. 216 0 0.8072 24.6 20.5 

218 .............. Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC 8 ...... 216 0 0.8072 24.6 20.5 

219 .............. Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC 8 ............ 219 0 1.6489 36.5 30.4 

220 .............. Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC 8 ............... 219 0 0.8072 24.6 20.5 

221 .............. Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC 8 ... 219 0 0.8072 24.6 20.5 

222 .............. Cardiac defib implant w cardiaccath w AMI/HF/shock w MCC 8 .................... 222 0 1.6489 36.5 30.4 

223 .............. Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC 8 ................ 222 0 1.6489 36.5 30.4 

224 .............. Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC 8 ................ 224 0 1.6489 36.5 30.4 

225 .............. Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC 8 ............. 224 0 1.6489 36.5 30.4 

226 .............. Cardiac defibrillator implant w/o cardiac cath w MCC 5 .................................. 226 11 1.6489 36.5 30.4 

227 .............. Cardiac defibrillator implant w/o cardiac cath w/o MCC 5 ............................... 226 4 1.6489 36.5 30.4 

228 .............. Other cardiothoracic procedures w MCC 8 ...................................................... 228 0 1.6489 36.5 30.4 

229 .............. Other cardiothoracic procedures w CC 8 ......................................................... 228 0 1.0950 30.3 25.3 

230 .............. Other cardiothoracic procedures w/o CC/MCC 8 ............................................ 228 0 1.0950 30.3 25.3 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25103 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

231 .............. Coronary bypass w PTCA w MCC 8 ............................................................... 231 0 1.6489 36.5 30.4 

232 .............. Coronary bypass w PTCA w/o MCC 8 ............................................................ 231 0 0.8072 24.6 20.5 

233 .............. Coronary bypass w cardiac cath w MCC 8 ..................................................... 233 0 1.6489 36.5 30.4 

234 .............. Coronary bypass w cardiac cath w/o MCC 8 .................................................. 233 0 0.8072 24.6 20.5 

235 .............. Coronary bypass w/o cardiac cath w MCC 8 .................................................. 235 0 1.6489 36.5 30.4 

236 .............. Coronary bypass w/o cardiac cath w/o MCC 8 ............................................... 235 0 0.8072 24.6 20.5 

237 .............. Major cardiovascular procedures w MCC 5 ..................................................... 237 3 1.6489 36.5 30.4 

238 .............. Major cardiovascular procedures w/o MCC 3 .................................................. 237 3 0.8072 24.6 20.5 

239 .............. Amputation for circ sys disorders exc upper limb & toe w MCC .................... 239 171 1.3954 37.4 31.2 

240 .............. Amputation for circ sys disorders exc upper limb & toe w CC ....................... 239 92 1.2100 36.1 30.1 

241 .............. Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC 4 ......... 239 6 1.0950 30.3 25.3 

242 .............. Permanent cardiac pacemaker implant w MCC 5, 6 ........................................ 242 14 1.6489 36.5 30.4 

243 .............. Permanent cardiac pacemaker implant w CC 5 .............................................. 242 9 1.6489 36.5 30.4 

244 .............. Permanent cardiac pacemaker implant w/o CC/MCC 4 .................................. 242 3 1.0950 30.3 25.3 

245 .............. AICD lead & generator procedures 2 ............................................................... 245 2 0.6513 22.7 18.9 

246 .............. Percutaneous cardiovascular proc w drug-eluting stent w MCC 3 .................. 246 1 0.8072 24.6 20.5 

247 .............. Percutaneous cardiovascular proc w drug-eluting stent w/o MCC 9 ............... 246 0 0.8072 24.6 20.5 

248 .............. Percutaneous cardiovasc proc w non-drug-eluting stent w MCC 5 ................ 248 1 1.6489 36.5 30.4 

249 .............. Percutaneous cardiovasc proc w non-drug-eluting stent w/o MCC 9 ............. 248 0 1.6489 36.5 30.4 

250 .............. Perc cardiovasc proc w/o coronary artery stent or AMI w MCC 3 .................. 250 1 0.8072 24.6 20.5 

251 .............. Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC 9 ............... 250 0 0.8072 24.6 20.5 

252 .............. Other vascular procedures w MCC ................................................................. 252 107 1.5938 34.9 29.1 

253 .............. Other vascular procedures w CC .................................................................... 252 54 1.0987 30.8 25.7 

254 .............. Other vascular procedures w/o CC/MCC 4 ..................................................... 252 6 1.0950 30.3 25.3 

255 .............. Upper limb & toe amputation for circ system disorders w MCC ..................... 255 45 1.2596 33.7 28.1 

256 .............. Upper limb & toe amputation for circ system disorders w CC ........................ 255 37 0.8278 29.4 24.5 

257 .............. Upper limb & toe amputation for circ system disorders w/o CC/MCC 6 ......... 255 1 0.8278 29.4 24.5 

258 .............. Cardiac pacemaker device replacement w MCC 5 ......................................... 258 1 1.6489 36.5 30.4 

259 .............. Cardiac pacemaker device replacement w/o MCC 9 ...................................... 258 0 1.6489 36.5 30.4 

260 .............. Cardiac pacemaker revision except device replacement w MCC 5 ................ 260 1 1.6489 36.5 30.4 

261 .............. Cardiac pacemaker revision except device replacement w CC 1 ................... 260 1 0.4800 19.9 16.6 

262 .............. Cardiac pacemaker revision except device replacement w/o CC/MCC 1 ....... 260 1 0.4800 19.9 16.6 

263 .............. Vein ligation & stripping 3 ................................................................................ 263 1 0.8072 24.6 20.5 

264 .............. Other circulatory system O.R. procedures ...................................................... 264 596 1.0516 31.6 26.3 

280 .............. Circulatory disorders w AMI, discharged alive w MCC ................................... 280 107 0.7177 21.4 17.8

281 .............. Circulatory disorders w AMI, discharged alive w CC ...................................... 280 60 0.6709 23.3 19.4 

282 .............. Circulatory disorders w AMI, discharged alive w/o CC/MCC 2 ....................... 280 9 0.6513 22.7 18.9 

283 .............. Circulatory disorders w AMI, expired w MCC .................................................. 283 26 0.6486 17.0 14.2 

284 .............. Circulatory disorders w AMI, expired w CC 6 .................................................. 283 5 0.6486 17.0 14.2 

285 .............. Circulatory disorders w AMI, expired w/o CC/MCC 6 ...................................... 283 1 0.6486 17.0 14.2 

286 .............. Circulatory disorders except AMI, w card cath w MCC 4 ................................ 286 15 1.0950 30.3 25.3 

287 .............. Circulatory disorders except AMI, w card cath w/o MCC 3 ............................. 286 7 0.8072 24.6 20.5 

288 .............. Acute & subacute endocarditis w MCC ........................................................... 288 450 0.9199 26.4 22.0 

289 .............. Acute & subacute endocarditis w CC .............................................................. 288 216 0.8385 26.7 22.3 

290 .............. Acute & subacute endocarditis w/o CC/MCC .................................................. 288 61 0.6409 25.1 20.9 

291 .............. Heart failure & shock w MCC .......................................................................... 291 1,603 0.7271 21.4 17.8 

292 .............. Heart failure & shock w CC ............................................................................. 291 1,115 0.5887 20.5 17.1 

293 .............. Heart failure & shock w/o CC/MCC ................................................................. 291 461 0.5015 18.6 15.5 

294 .............. Deep vein thrombophlebitis w CC/MCC 3 ....................................................... 294 7 0.8072 24.6 20.5 

295 .............. Deep vein thrombophlebitis w/o CC/MCC 9 .................................................... 294 0 0.8072 24.6 20.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

25104 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

296 .............. Cardiac arrest, unexplained w MCC 8 ............................................................. 296 0 0.6513 22.7 18.9 

297 .............. Cardiac arrest, unexplained w CC 8 ................................................................ 296 0 0.6513 22.7 18.9 

298 .............. Cardiac arrest, unexplained w/o CC/MCC 8 .................................................... 296 0 0.6513 22.7 18.9 

299 .............. Peripheral vascular disorders w MCC ............................................................. 299 551 0.7657 24.7 20.6 

300 .............. Peripheral vascular disorders w CC ................................................................ 299 790 0.5711 22.2 18.5 

301 .............. Peripheral vascular disorders w/o CC/MCC .................................................... 299 103 0.4906 19.4 16.2 

302 .............. Atherosclerosis w MCC .................................................................................... 302 68 0.6324 22.3 18.6 

303 .............. Atherosclerosis w/o MCC ................................................................................. 302 94 0.5383 20.3 16.9 

304 .............. Hypertension w MCC 2 .................................................................................... 304 12 0.6513 22.7 18.9 

305 .............. Hypertension w/o MCC .................................................................................... 304 42 0.5464 22.2 18.5 

306 .............. Cardiac congenital & valvular disorders w MCC ............................................. 306 54 0.9077 24.2 20.2 

307 .............. Cardiac congenital & valvular disorders w/o MCC .......................................... 306 39 0.7090 23.1 19.3 

308 .............. Cardiac arrhythmia & conduction disorders w MCC ....................................... 308 87 0.8126 24.7 20.6 

309 .............. Cardiac arrhythmia & conduction disorders w CC .......................................... 308 79 0.5311 20.6 17.2 

310 .............. Cardiac arrhythmia & conduction disorders w/o CC/MCC .............................. 308 39 0.4341 16.5 13.8 

311 .............. Angina pectoris 2 .............................................................................................. 311 4 0.6513 22.7 18.9 

312 .............. Syncope & collapse ......................................................................................... 312 44 0.5159 19.7 16.4 

313 .............. Chest pain 1 ..................................................................................................... 313 5 0.4800 19.9 16.6 

314 .............. Other circulatory system diagnoses w MCC ................................................... 314 1,393 0.8267 23.0 19.2 

315 .............. Other circulatory system diagnoses w CC ...................................................... 314 426 0.6380 21.6 18.0 

316 .............. Other circulatory system diagnoses w/o CC/MCC .......................................... 314 122 0.5126 19.4 16.2 

326 .............. Stomach, esophageal & duodenal proc w MCC ............................................. 326 33 2.0279 36.0 30.0 

327 .............. Stomach, esophageal & duodenal proc w CC 5 .............................................. 326 9 1.6489 36.5 30.4 

328 .............. Stomach, esophageal & duodenal proc w/o CC/MCC 1 ................................. 326 1 0.4800 19.9 16.6 

329 .............. Major small & large bowel procedures w MCC 5 ............................................ 329 24 1.6489 36.5 30.4 

330 .............. Major small & large bowel procedures w CC 5 ............................................... 329 20 1.6489 36.5 30.4 

331 .............. Major small & large bowel procedures w/o CC/MCC 1 ................................... 329 1 0.4800 19.9 16.6 

332 .............. Rectal resection w MCC 8 ............................................................................... 332 0 1.6489 36.5 30.4 

333 .............. Rectal resection w CC 8 .................................................................................. 332 0 1.0950 30.3 25.3 

334 .............. Rectal resection w/o CC/MCC 8 ...................................................................... 332 0 0.8072 24.6 20.5 

335 .............. Peritoneal adhesiolysis w MCC 5 .................................................................... 335 4 1.6489 36.5 30.4 

336 .............. Peritoneal adhesiolysis w CC2 ........................................................................ 335 2 0.6513 22.7 18.9 

337 .............. Peritoneal adhesiolysis w/o CC/MCC 9 ........................................................... 335 0 0.6513 22.7 18.9 

338 .............. Appendectomy w complicated principal diag w MCC 8 ................................... 338 0 0.8072 24.6 20.5 

339 .............. Appendectomy w complicated principal diag w CC 8 ...................................... 338 0 0.6513 22.7 18.9 

340 .............. Appendectomy w complicated principal diag w/o CC/MCC 8 ......................... 338 0 0.4800 19.9 16.6 

341 .............. Appendectomy w/o complicated principal diag w MCC 8 ................................ 341 0 0.8072 24.6 20.5 

342 .............. Appendectomy w/o complicated principal diag w CC 8 ................................... 341 0 0.6513 22.7 18.9 

343 .............. Appendectomy w/o complicated principal diag w/o CC/MCC 8 ...................... 341 0 0.4800 19.9 16.6 

344 .............. Minor small & large bowel procedures w MCC 8 ............................................ 344 0 0.8072 24.6 20.5 

345 .............. Minor small & large bowel procedures w CC 8 ............................................... 344 0 0.6513 22.7 18.9 

346 .............. Minor small & large bowel procedures w/o CC/MCC 8 ................................... 344 0 0.4800 19.9 16.6 

347 .............. Anal & stomal procedures w MCC 3 ................................................................ 347 5 0.8072 24.6 20.5 

348 .............. Anal & stomal procedures w CC 3 ................................................................... 347 3 0.8072 24.6 20.5 

349 .............. Anal & stomal procedures w/o CC/MCC 1 ...................................................... 347 1 0.4800 19.9 16.6 

350 .............. Inguinal & femoral hernia procedures w MCC 5 .............................................. 350 1 1.6489 36.5 30.4 

351 .............. Inguinal & femoral hernia procedures w CC 4 ................................................. 350 1 1.0950 30.3 25.3 

352 .............. Inguinal & femoral hernia procedures w/o CC/MCC 3 .................................... 350 1 0.8072 24.6 20.5 

353 .............. Hernia procedures except inguinal & femoral w MCC 9 ................................. 353 0 0.8072 24.6 20.5 

354 .............. Hernia procedures except inguinal & femoral w CC 3 .................................... 353 1 0.8072 24.6 20.5 

355 .............. Hernia procedures except inguinal & femoral w/o CC/MCC 9 ........................ 353 0 0.8072 24.6 20.5 

356 .............. Other digestive system O.R. procedures w MCC ........................................... 356 107 1.4828 36.0 30.0 

357 .............. Other digestive system O.R. procedures w CC .............................................. 356 45 1.1816 30.8 25.7 

358 .............. Other digestive system O.R. procedures w/o CC/MCC 3 ............................... 356 3 0.8072 24.6 20.5 

368 .............. Major esophageal disorders w MCC 4 ............................................................. 368 22 1.0950 30.3 25.3 

369 .............. Major esophageal disorders w CC 4 ................................................................ 368 8 1.0950 30.3 25.3 

370 .............. Major esophageal disorders w/o CC/MCC 4, 6 ................................................ 368 1 1.0950 30.3 25.3 

371 .............. Major gastrointestinal disorders & peritoneal infections w MCC ..................... 371 667 0.9214 24.0 20.0 

372 .............. Major gastrointestinal disorders & peritoneal infections w CC ........................ 371 422 0.6969 22.2 18.5 

373 .............. Major gastrointestinal disorders & peritoneal infections w/o CC/MCC ............ 371 55 0.5312 19.8 16.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25105 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

374 .............. Digestive malignancy w MCC .......................................................................... 374 122 0.8609 22.9 19.1 

375 .............. Digestive malignancy w CC ............................................................................. 374 83 0.7077 19.7 16.4 

376 .............. Digestive malignancy w/o CC/MCC 1 .............................................................. 374 9 0.4800 19.9 16.6 

377 .............. G.I. hemorrhage w MCC .................................................................................. 377 94 0.7327 22.5 18.8 

378 .............. G.I. hemorrhage w CC ..................................................................................... 377 54 0.6107 21.7 18.1 

379 .............. G.I. hemorrhage w/o CC/MCC ......................................................................... 377 26 0.4401 19.0 15.8 

380 .............. Complicated peptic ulcer w MCC 3 .................................................................. 380 14 0.8072 24.6 20.5 

381 .............. Complicated peptic ulcer w CC 3 ..................................................................... 380 17 0.8072 24.6 20.5 

382 .............. Complicated peptic ulcer w/o CC/MCC 2 ........................................................ 380 6 0.6513 22.7 18.9 

383 .............. Uncomplicated peptic ulcer w MCC 3 .............................................................. 383 6 0.8072 24.6 20.5 

384 .............. Uncomplicated peptic ulcer w/o MCC 2 ........................................................... 383 6 0.6513 22.7 18.9 

385 .............. Inflammatory bowel disease w MCC ............................................................... 385 32 0.9337 24.6 20.5 

386 .............. Inflammatory bowel disease w CC .................................................................. 385 26 0.6932 22.9 19.1 

387 .............. Inflammatory bowel disease w/o CC/MCC 6 ................................................... 385 5 0.6932 22.9 19.1 

388 .............. G.I. obstruction w MCC .................................................................................... 388 189 0.9293 22.7 18.9 

389 .............. G.I. obstruction w CC ....................................................................................... 388 89 0.7306 22.2 18.5 

390 .............. G.I. obstruction w/o CC/MCC 2 ........................................................................ 388 14 0.6513 22.7 18.9 

391 .............. Esophagitis, gastroent & misc digest disorders w MCC ................................. 391 246 0.9179 24.3 20.3 

392 .............. Esophagitis, gastroent & misc digest disorders w/o MCC .............................. 391 270 0.6195 20.4 17.0 

393 .............. Other digestive system diagnoses w MCC ...................................................... 393 680 1.0363 25.6 21.3 

394 .............. Other digestive system diagnoses w CC ......................................................... 393 385 0.7624 22.1 18.4 

395 .............. Other digestive system diagnoses w/o CC/MCC ............................................ 393 33 0.5956 19.8 16.5

405 .............. Pancreas, liver & shunt procedures w MCC 5 ................................................. 405 9 1.6489 36.5 30.4 

406 .............. Pancreas, liver & shunt procedures w CC 5 .................................................... 405 2 1.6489 36.5 30.4 

407 .............. Pancreas, liver & shunt procedures w/o CC/MCC 4 ....................................... 405 1 1.0950 30.3 25.3 

408 .............. Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC 5, 6 ............... 408 1 1.6489 36.5 30.4 

409 .............. Biliary tract proc except only cholecyst w or w/o c.d.e. w CC 5 ...................... 408 1 1.6489 36.5 30.4 

410 .............. Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC 9 ......... 408 0 1.6489 36.5 30.4 

411 .............. Cholecystectomy w c.d.e. w MCC 9 ................................................................ 411 0 1.0950 30.3 25.3 

412 .............. Cholecystectomy w c.d.e. w CC 4 ................................................................... 411 1 1.0950 30.3 25.3 

413 .............. Cholecystectomy w c.d.e. w/o CC/MCC 9 ....................................................... 411 0 1.0950 30.3 25.3 

414 .............. Cholecystectomy except by laparoscope w/o c.d.e. w MCC 4 ........................ 414 2 1.0950 30.3 25.3 

415 .............. Cholecystectomy except by laparoscope w/o c.d.e. w CC 4 ........................... 414 3 1.0950 30.3 25.3 

416 .............. Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC 9 .............. 414 0 1.0950 30.3 25.3 

417 .............. Laparoscopic cholecystectomy w/o c.d.e. w MCC 5 ....................................... 417 7 1.6489 36.5 30.4 

418 .............. Laparoscopic cholecystectomy w/o c.d.e. w CC 4 .......................................... 417 5 1.0950 30.3 25.3 

419 .............. Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC 9 .............................. 417 0 1.0950 30.3 25.3 

420 .............. Hepatobiliary diagnostic procedures w MCC 3 ................................................ 420 2 0.8072 24.6 20.5 

421 .............. Hepatobiliary diagnostic procedures w CC 3 ................................................... 420 1 0.8072 24.6 20.5 

422 .............. Hepatobiliary diagnostic procedures w/o CC/MCC 9 ....................................... 420 0 0.8072 24.6 20.5 

423 .............. Other hepatobiliary or pancreas O.R. procedures w MCC 4 ........................... 423 23 1.0950 30.3 25.3 

424 .............. Other hepatobiliary or pancreas O.R. procedures w CC 3 .............................. 423 4 0.8072 24.6 20.5 

425 .............. Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC 3 ................. 423 1 0.8072 24.6 20.5 

432 .............. Cirrhosis & alcoholic hepatitis w MCC ............................................................. 432 98 0.6000 18.7 15.6 

433 .............. Cirrhosis & alcoholic hepatitis w CC 6 ............................................................. 432 21 0.6000 18.7 15.6 

434 .............. Cirrhosis & alcoholic hepatitis w/o CC/MCC 6 ................................................. 432 1 0.6000 18.7 15.6 

435 .............. Malignancy of hepatobiliary system or pancreas w MCC ............................... 435 48 0.7447 20.2 16.8 

436 .............. Malignancy of hepatobiliary system or pancreas w CC .................................. 435 35 0.7039 20.5 17.1 

437 .............. Malignancy of hepatobiliary system or pancreas w/o CC/MCC 2 ................... 435 4 0.6513 22.7 18.9 

438 .............. Disorders of pancreas except malignancy w MCC ......................................... 438 251 1.0728 24.3 20.3

439 .............. Disorders of pancreas except malignancy w CC ............................................ 438 167 0.7538 21.9 18.3 

440 .............. Disorders of pancreas except malignancy w/o CC/MCC ................................ 438 29 0.5185 19.0 15.8 

441 .............. Disorders of liver except malig, cirr, alc hepa w MCC .................................... 441 117 0.7825 21.8 18.2 

442 .............. Disorders of liver except malig, cirr, alc hepa w CC ....................................... 441 66 0.6893 22.1 18.4 

443 .............. Disorders of liver except malig, cirr, alc hepa w/o CC/MCC 2 ........................ 441 13 0.6513 22.7 18.9 

444 .............. Disorders of the biliary tract w MCC ................................................................ 444 71 0.8602 24.0 20.0 

mmaher on DSK3CLS3C1PROD with $$_JOB

25106 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

445 .............. Disorders of the biliary tract w CC ................................................................... 444 39 0.6390 22.2 18.5 

446 .............. Disorders of the biliary tract w/o CC/MCC 1 .................................................... 444 9 0.4800 19.9 16.6 

453 .............. Combined anterior/posterior spinal fusion w MCC 9 ....................................... 453 0 1.6489 36.5 30.4 

454 .............. Combined anterior/posterior spinal fusion w CC 5 .......................................... 453 1 1.6489 36.5 30.4 

455 .............. Combined anterior/posterior spinal fusion w/o CC/MCC 9 .............................. 453 0 1.6489 36.5 30.4 

456 .............. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w MCC 5 .............. 456 1 1.6489 36.5 30.4 

457 .............. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w CC 8 ................. 456 0 1.6489 36.5 30.4 

458 .............. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w/o CC/MCC 9 ..... 456 0 1.6489 36.5 30.4 

459 .............. Spinal fusion except cervical w MCC 5 ........................................................... 459 2 1.6489 36.5 30.4 

460 .............. Spinal fusion except cervical w/o MCC 5 ........................................................ 459 3 1.6489 36.5 30.4 

461 .............. Bilateral or multiple major joint procs of lower extremity w MCC 8 ................. 461 0 1.6489 36.5 30.4 

462 .............. Bilateral or multiple major joint procs of lower extremity w/o MCC 8 .............. 461 0 1.0950 30.3 25.3 

463 .............. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC .............. 463 506 1.4061 38.7 32.3 

464 .............. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC ................. 463 310 1.0963 36.5 30.4 

465 .............. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC ..... 463 60 0.8588 28.5 23.8 

466 .............. Revision of hip or knee replacement w MCC 5 ............................................... 466 3 1.6489 36.5 30.4 

467 .............. Revision of hip or knee replacement w CC 5 .................................................. 466 4 1.6489 36.5 30.4 

468 .............. Revision of hip or knee replacement w/o CC/MCC 9 ...................................... 466 0 1.6489 36.5 30.4 

469 .............. Major joint replacement or reattachment of lower extremity w MCC 5 ........... 469 2 1.6489 36.5 30.4 

470 .............. Major joint replacement or reattachment of lower extremity w/o MCC 5 ........ 469 2 1.6489 36.5 30.4 

471 .............. Cervical spinal fusion w MCC 5 ....................................................................... 471 5 1.6489 36.5 30.4 

472 .............. Cervical spinal fusion w CC 4 .......................................................................... 471 2 1.0950 30.3 25.3 

473 .............. Cervical spinal fusion w/o CC/MCC 9 .............................................................. 471 0 1.0950 30.3 25.3 

474 .............. Amputation for musculoskeletal sys & conn tissue dis w MCC ...................... 474 91 1.3850 36.6 30.5 

475 .............. Amputation for musculoskeletal sys & conn tissue dis w CC ......................... 474 52 0.9993 32.7 27.3 

476 .............. Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC 6 .......... 474 10 0.9993 32.7 27.3 

477 .............. Biopsies of musculoskeletal system & connective tissue w MCC 5 ................ 477 13 1.6489 36.5 30.4 

478 .............. Biopsies of musculoskeletal system & connective tissue w CC 4 ................... 477 14 1.0950 30.3 25.3 

479 .............. Biopsies of musculoskeletal system & connective tissue w/o CC/MCC 4 ....... 477 5 1.0950 30.3 25.3 

480 .............. Hip & femur procedures except major joint w MCC 5 ..................................... 480 10 1.6489 36.5 30.4 

481 .............. Hip & femur procedures except major joint w CC 5 ........................................ 480 19 1.6489 36.5 30.4 

482 .............. Hip & femur procedures except major joint w/o CC/MCC 4 ............................ 480 1 1.0950 30.3 25.3 

483 .............. Major joint & limb reattachment proc of upper extremity w CC/MCC 8 .......... 483 0 1.6489 36.5 30.4 

484 .............. Major joint & limb reattachment proc of upper extremity w/o CC/MCC 8 ....... 483 0 1.0950 30.3 25.3 

485 .............. Knee procedures w pdx of infection w MCC 5 ................................................ 485 10 1.6489 36.5 30.4 

486 .............. Knee procedures w pdx of infection w CC 4 ................................................... 485 9 1.0950 30.3 25.3 

487 .............. Knee procedures w pdx of infection w/o CC/MCC 4 ....................................... 485 1 1.0950 30.3 25.3 

488 .............. Knee procedures w/o pdx of infection w CC/MCC 5 ....................................... 488 2 1.6489 36.5 30.4 

489 .............. Knee procedures w/o pdx of infection w/o CC/MCC 9 .................................... 488 0 1.6489 36.5 30.4 

490 .............. Back & neck procedures except spinal fusion w CC/MCC or disc devices 4 490 7 1.0950 30.3 25.3 

491 .............. Back & neck procedures except spinal fusion w/o CC/MCC 9 ....................... 490 0 1.0950 30.3 25.3 

492 .............. Lower extrem & humer proc except hip, foot, femur w MCC 5 ....................... 492 5 1.6489 36.5 30.4 

493 .............. Lower extrem & humer proc except hip, foot, femur w CC 4 .......................... 492 18 1.0950 30.3 25.3 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25107 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

494 .............. Lower extrem & humer proc except hip, foot, femur w/o CC/MCC 3 .............. 492 2 0.8072 24.6 20.5 

495 .............. Local excision & removal int fix devices exc hip & femur w MCC .................. 495 32 1.4142 38.1 31.8 

496 .............. Local excision & removal int fix devices exc hip & femur w CC ..................... 495 26 1.1010 38.3 31.9 

497 .............. Local excision & removal int fix devices exc hip & femur w/o CC/MCC 4 ...... 495 3 1.0950 30.3 25.3 

498 .............. Local excision & removal int fix devices of hip & femur w CC/MCC 5 ............ 498 8 1.6489 36.5 30.4 

499 .............. Local excision & removal int fix devices of hip & femur w/o CC/MCC 2 ......... 498 2 0.6513 22.7 18.9 

500 .............. Soft tissue procedures w MCC ........................................................................ 500 46 1.3054 35.2 29.3 

501 .............. Soft tissue procedures w CC ........................................................................... 500 27 1.2940 30.9 25.8 

502 .............. Soft tissue procedures w/o CC/MCC 3 ............................................................ 500 4 0.8072 24.6 20.5 

503 .............. Foot procedures w MCC 4 ............................................................................... 503 18 1.0950 30.3 25.3 

504 .............. Foot procedures w CC 3 .................................................................................. 503 13 0.8072 24.6 20.5 

505 .............. Foot procedures w/o CC/MCC 1 ...................................................................... 503 1 0.4800 19.9 16.6 

506 .............. Major thumb or joint procedures 8 ................................................................... 506 0 0.6513 22.7 18.9 

507 .............. Major shoulder or elbow joint procedures w CC/MCC 3 ................................. 507 3 0.8072 24.6 20.5 

508 .............. Major shoulder or elbow joint procedures w/o CC/MCC 9 .............................. 507 0 0.8072 24.6 20.5 

509 .............. Arthroscopy 8 ................................................................................................... 509 0 0.4800 19.9 16.6 

510 .............. Shoulder,elbow or forearm proc, exc major joint proc w MCC 9 ..................... 510 0 1.0950 30.3 25.3 

511 .............. Shoulder,elbow or forearm proc, exc major joint proc w CC 4 ........................ 510 4 1.0950 30.3 25.3 

512 .............. Shoulder,elbow or forearm proc, exc major joint proc w/o CC/MCC 1 ........... 510 1 0.4800 19.9 16.6 

513 .............. Hand or wrist proc, except major thumb or joint proc w CC/MCC 5 ............... 513 4 1.6489 36.5 30.4 

514 .............. Hand or wrist proc, except major thumb or joint proc w/o CC/MCC 2 ............ 513 4 0.6513 22.7 18.9 

515 .............. Other musculoskelet sys & conn tiss O.R. proc w MCC ................................. 515 48 1.3557 34.7 28.9 

516 .............. Other musculoskelet sys & conn tiss O.R. proc w CC 4 ................................. 515 21 1.0950 30.3 25.3 

517 .............. Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC 3 ..................... 515 6 0.8072 24.6 20.5 

533 .............. Fractures of femur w MCC 3 ............................................................................ 533 3 0.8072 24.6 20.5 

534 .............. Fractures of femur w/o MCC 2 ......................................................................... 533 7 0.6513 22.7 18.9 

535 .............. Fractures of hip & pelvis w MCC 2 .................................................................. 535 18 0.6513 22.7 18.9 

536 .............. Fractures of hip & pelvis w/o MCC .................................................................. 535 34 0.5447 23.7 19.8 

537 .............. Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC 8 ................ 537 0 0.4800 19.9 16.6 

538 .............. Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC 8 ............. 537 0 0.4800 19.9 16.6 

539 .............. Osteomyelitis w MCC ....................................................................................... 539 932 0.9369 29.7 24.8 

540 .............. Osteomyelitis w CC .......................................................................................... 539 745 0.7697 28.9 24.1 

541 .............. Osteomyelitis w/o CC/MCC ............................................................................. 539 273 0.6853 26.4 22.0 

542 .............. Pathological fractures & musculoskelet & conn tiss malig w MCC ................. 542 56 0.7914 21.7 18.1 

543 .............. Pathological fractures & musculoskelet & conn tiss malig w CC .................... 542 61 0.5904 21.3 17.8 

544 .............. Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC 1 ..... 542 18 0.4800 19.9 16.6 

545 .............. Connective tissue disorders w MCC ................................................................ 545 58 0.9349 24.0 20.0 

546 .............. Connective tissue disorders w CC ................................................................... 545 39 0.5510 20.7 17.3 

547 .............. Connective tissue disorders w/o CC/MCC 1 .................................................... 545 13 0.4800 19.9 16.6 

548 .............. Septic arthritis w MCC ..................................................................................... 548 166 0.9257 28.1 23.4 

549 .............. Septic arthritis w CC ........................................................................................ 548 187 0.6862 26.4 22.0 

550 .............. Septic arthritis w/o CC/MCC ............................................................................ 548 72 0.5780 23.6 19.7 

551 .............. Medical back problems w MCC ....................................................................... 551 109 0.8081 26.6 22.2 

552 .............. Medical back problems w/o MCC .................................................................... 551 248 0.5575 22.8 19.0 

553 .............. Bone diseases & arthropathies w MCC 2 ........................................................ 553 24 0.6513 22.7 18.9 

554 .............. Bone diseases & arthropathies w/o MCC ........................................................ 553 66 0.4534 20.5 17.1 

555 .............. Signs & symptoms of musculoskeletal system & conn tissue w MCC 2 ......... 555 13 0.6513 22.7 18.9 

mmaher on DSK3CLS3C1PROD with $$_JOB

25108 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

556 .............. Signs & symptoms of musculoskeletal system & conn tissue w/o MCC 2 ...... 555 15 0.6513 22.7 18.9 

557 .............. Tendonitis, myositis & bursitis w MCC ............................................................ 557 86 0.8676 25.9 21.6 

558 .............. Tendonitis, myositis & bursitis w/o MCC ......................................................... 557 113 0.6167 21.4 17.8 

559 .............. Aftercare, musculoskeletal system & connective tissue w MCC ..................... 559 1,366 0.7654 26.2 21.8 

560 .............. Aftercare, musculoskeletal system & connective tissue w CC ........................ 559 1,995 0.6174 24.7 20.6 

561 .............. Aftercare, musculoskeletal system & connective tissue w/o CC/MCC ........... 559 1,074 0.5146 21.6 18.0 

562 .............. Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC 4 ..................... 562 6 1.0950 30.3 25.3 

563 .............. Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC 1 .................. 562 23 0.4800 19.9 16.6 

564 .............. Other musculoskeletal sys & connective tissue diagnoses w MCC ................ 564 240 0.8462 24.9 20.8 

565 .............. Other musculoskeletal sys & connective tissue diagnoses w CC ................... 564 225 0.6991 25.1 20.9 

566 .............. Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC ...... 564 75 0.6073 21.6 18.0 

573 .............. Skin graft &/or debrid for skn ulcer or cellulitis w MCC .................................. 573 1,862 1.3619 38.0 31.7 

574 .............. Skin graft &/or debrid for skn ulcer or cellulitis w CC ..................................... 573 1,898 1.0731 37.1 30.9 

575 .............. Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC ......................... 573 215 0.8813 31.6 26.3

576 .............. Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC 4 ........................ 576 22 1.0950 30.3 25.3 

577 .............. Skin graft &/or debrid exc for skin ulcer or cellulitis w CC 4 ........................... 576 24 1.0950 30.3 25.3 

578 .............. Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC 2 ............... 576 5 0.6513 22.7 18.9 

579 .............. Other skin, subcut tiss & breast proc w MCC ................................................. 579 489 1.3275 36.7 30.6 

580 .............. Other skin, subcut tiss & breast proc w CC .................................................... 579 414 1.0027 34.9 29.1 

581 .............. Other skin, subcut tiss & breast proc w/o CC/MCC ........................................ 579 35 0.7370 29.7 24.8 

582 .............. Mastectomy for malignancy w CC/MCC 5 ....................................................... 582 3 1.6489 36.5 30.4 

583 .............. Mastectomy for malignancy w/o CC/MCC 9 .................................................... 582 0 1.6489 36.5 30.4 

584 .............. Breast biopsy, local excision & other breast procedures w CC/MCC 4 .......... 584 2 1.0950 30.3 25.3 

585 .............. Breast biopsy, local excision & other breast procedures w/o CC/MCC 9 ....... 584 0 1.0950 30.3 25.3 

592 .............. Skin ulcers w MCC .......................................................................................... 592 2,984 0.9267 27.0 22.5 

593 .............. Skin ulcers w CC ............................................................................................. 592 3,110 0.7339 26.8 22.3 

594 .............. Skin ulcers w/o CC/MCC ................................................................................. 592 437 0.6369 24.2 20.2 

595 .............. Major skin disorders w MCC ............................................................................ 595 30 0.8062 24.5 20.4 

596 .............. Major skin disorders w/o MCC ......................................................................... 595 54 0.5954 23.9 19.9 

597 .............. Malignant breast disorders w MCC 3 ............................................................... 597 13 0.8072 24.6 20.5 

598 .............. Malignant breast disorders w CC 2, 6 ............................................................... 597 17 0.6513 22.7 18.9 

599 .............. Malignant breast disorders w/o CC/MCC 2, 6 .................................................. 597 4 0.6513 22.7 18.9 

600 .............. Non-malignant breast disorders w CC/MCC 2 ................................................. 600 12 0.6513 22.7 18.9 

601 .............. Non-malignant breast disorders w/o CC/MCC 2 .............................................. 600 9 0.6513 22.7 18.9 

602 .............. Cellulitis w MCC ............................................................................................... 602 757 0.7127 22.4 18.7 

603 .............. Cellulitis w/o MCC ............................................................................................ 602 1,492 0.5136 19.4 16.2 

604 .............. Trauma to the skin, subcut tiss & breast w MCC 3 ......................................... 604 23 0.8072 24.6 20.5 

605 .............. Trauma to the skin, subcut tiss & breast w/o MCC ......................................... 604 60 0.5413 21.5 17.9 

606 .............. Minor skin disorders w MCC ............................................................................ 606 60 0.8986 23.2 19.3 

607 .............. Minor skin disorders w/o MCC ......................................................................... 606 84 0.6120 22.6 18.8 

614 .............. Adrenal & pituitary proceduresw CC/MCC 8 ................................................... 614 0 1.0950 30.3 25.3 

615 .............. Adrenal & pituitary procedures w/o CC/MCC 8 ............................................... 614 0 0.4800 19.9 16.6 

616 .............. Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC .................. 616 62 1.5681 41.0 34.2 

617 .............. Amputat of lower limb for endocrine,nutrit,& metabol dis w CC ..................... 616 116 1.1395 32.9 27.4 

618 .............. Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC 3 ....... 616 2 0.8072 24.6 20.5 

619 .............. O.R. procedures for obesity w MCC 3 ............................................................. 619 2 0.8072 24.6 20.5 

620 .............. O.R. procedures for obesity w CC 3, 6 ............................................................. 619 3 0.8072 24.6 20.5 

621 .............. O.R. procedures for obesity w/o CC/MCC 9 .................................................... 619 0 0.8072 24.6 20.5 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25109 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

622 .............. Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC ................. 622 165 1.2199 35.6 29.7 

623 .............. Skin grafts & wound debrid for endoc, nutrit & metab dis w CC .................... 622 338 0.9703 32.2 26.8 

624 .............. Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC 3 ..... 622 15 0.8072 24.6 20.5 

625 .............. Thyroid, parathyroid & thyroglossal procedures w MCC 8 .............................. 625 0 1.6489 36.5 30.4 

626 .............. Thyroid, parathyroid & thyroglossal procedures w CC 8 ................................. 625 0 1.0950 30.3 25.3 

627 .............. Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC 8 ..................... 625 0 0.4800 19.9 16.6 

628 .............. Other endocrine, nutrit & metab O.R. proc w MCC ........................................ 628 52 1.4033 35.9 29.9

629 .............. Other endocrine, nutrit & metab O.R. proc w CC ........................................... 628 88 1.1143 33.3 27.8 

630 .............. Other endocrine, nutrit & metab O.R. proc w/o CC/MCC 1 ............................ 628 5 0.4800 19.9 16.6 

637 .............. Diabetes w MCC .............................................................................................. 637 363 0.8347 25.8 21.5 

638 .............. Diabetes w CC ................................................................................................. 637 1,041 0.6491 24.1 20.1 

639 .............. Diabetes w/o CC/MCC ..................................................................................... 637 114 0.5241 20.1 16.8 

640 .............. Nutritional & misc metabolic disorders w MCC ............................................... 640 606 0.8190 23.2 19.3 

641 .............. Nutritional & misc metabolic disorders w/o MCC ............................................ 640 620 0.6364 22.0 18.3 

642 .............. Inborn errors of metabolism 2 .......................................................................... 642 4 0.6513 22.7 18.9 

643 .............. Endocrine disorders w MCC ............................................................................ 643 27 0.8880 27.3 22.8 

644 .............. Endocrine disorders w CC 3 ............................................................................ 643 18 0.8072 24.6 20.5 

645 .............. Endocrine disorders w/o CC/MCC 1 ................................................................ 643 6 0.4800 19.9 16.6 

652 .............. Kidney transplant 7 ........................................................................................... 652 0 0.0000 0.0 0.0 

653 .............. Major bladder procedures w MCC 8 ................................................................ 653 0 1.0950 30.3 25.3 

654 .............. Major bladder procedures w CC 8 ................................................................... 653 0 0.6513 22.7 18.9 

655 .............. Major bladder procedures w/o CC/MCC 8 ....................................................... 653 0 0.4800 19.9 16.6 

656 .............. Kidney & ureter procedures for neoplasm w MCC 9 ....................................... 656 0 0.8072 24.6 20.5 

657 .............. Kidney & ureter procedures forneoplasm w CC 3 ........................................... 656 1 0.8072 24.6 20.5 

658 .............. Kidney & ureter procedures for neoplasm w/o CC/MCC 9 .............................. 656 0 0.8072 24.6 20.5 

659 .............. Kidney & ureter procedures for non-neoplasm w MCC 4 ................................ 659 9 1.0950 30.3 25.3 

660 .............. Kidney & ureter procedures for non-neoplasm w CC2 ................................... 659 4 0.6513 22.7 18.9 

661 .............. Kidney & ureter procedures for non-neoplasm w/o CC/MCC 1 ...................... 659 1 0.4800 19.9 16.6 

662 .............. Minor bladder procedures w MCC 3 ................................................................ 662 2 0.8072 24.6 20.5 

663 .............. Minor bladder procedures w CC9 .................................................................... 662 0 0.8072 24.6 20.5 

664 .............. Minor bladder procedures w/o CC/MCC 5 ....................................................... 662 1 1.6489 36.5 30.4 

665 .............. Prostatectomy w MCC 3 .................................................................................. 665 2 0.8072 24.6 20.5 

666 .............. Prostatectomy w CC 8 ..................................................................................... 665 0 0.8072 24.6 20.5 

667 .............. Prostatectomy w/o CC/MCC 3 ......................................................................... 665 1 0.8072 24.6 20.5 

668 .............. Transurethral procedures w MCC 5 ................................................................. 668 8 1.6489 36.5 30.4 

669 .............. Transurethral procedures w CC 5 .................................................................... 668 5 1.6489 36.5 30.4 

670 .............. Transurethral procedures w/o CC/MCC 5 ........................................................ 668 1 1.6489 36.5 30.4 

671 .............. Urethral procedures w CC/MCC 8 ................................................................... 671 0 0.6513 22.7 18.9 

672 .............. Urethral procedures w/o CC/MCC 8 ................................................................ 671 0 0.4800 19.9 16.6 

673 .............. Other kidney & urinary tract procedures w MCC ............................................ 673 226 1.3376 33.5 27.9 

674 .............. Other kidney & urinary tract procedures w CC ............................................... 673 87 1.1684 30.6 25.5 

675 .............. Other kidney & urinary tract procedures w/o CC/MCC 4 ................................ 673 13 1.0950 30.3 25.3 

682 .............. Renal failure w MCC ........................................................................................ 682 1,334 0.8784 23.6 19.7 

683 .............. Renal failure w CC ........................................................................................... 682 726 0.7271 21.9 18.3 

684 .............. Renal failure w/o CC/MCC ............................................................................... 682 184 0.5951 20.1 16.8 

685 .............. Admit for renal dialysis ..................................................................................... 685 50 0.7543 25.9 21.6 

686 .............. Kidney & urinary tract neoplasms w MCC ....................................................... 686 31 0.9234 23.6 19.7 

687 .............. Kidney & urinary tract neoplasms w CC2 ........................................................ 686 17 0.6513 22.7 18.9 

688 .............. Kidney & urinary tract neoplasms w/o CC/MCC 1 ........................................... 686 3 0.4800 19.9 16.6 

689 .............. Kidney & urinary tract infections w MCC ......................................................... 689 760 0.6796 22.8 19.0 

690 .............. Kidney & urinary tract infections w/o MCC ...................................................... 689 727 0.5158 20.2 16.8 

691 .............. Urinary stones w esw lithotripsy w CC/MCC 5 ................................................ 691 4 1.6489 36.5 30.4 

692 .............. Urinary stones w esw lithotripsy w/o CC/MCC 9 ............................................. 691 0 1.6489 36.5 30.4 

693 .............. Urinary stones w/o esw lithotripsy w MCC 2 ................................................... 693 16 0.6513 22.7 18.9 

694 .............. Urinary stones w/ot esw lithotripsy w/o MCC 2, 6 ............................................ 693 12 0.6513 22.7 18.9 

695 .............. Kidney & urinary tract signs & symptoms w MCC 3 ........................................ 695 4 0.8072 24.6 20.5 

696 .............. Kidney & urinary tract signs & symptoms w/o MCC 1 ..................................... 695 1 0.4800 19.9 16.6 

697 .............. Urethral stricture 8 ............................................................................................ 697 0 0.4800 19.9 16.6 

698 .............. Other kidney & urinary tract diagnoses w MCC .............................................. 698 270 0.8112 22.7 18.9 

699 .............. Other kidney & urinary tract diagnoses w CC ................................................. 698 155 0.7032 22.2 18.5 

700 .............. Other kidney & urinary tract diagnoses w CC ................................................. 698 52 0.5387 20.2 16.8 

mmaher on DSK3CLS3C1PROD with $$_JOB

25110 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

707 .............. Major male pelvic procedures w CC/MCC 8 .................................................... 707 0 0.6513 22.7 18.9 

708 .............. Major male pelvic procedures w/o CC/MCC 8 ................................................. 707 0 0.4800 19.9 16.6 

709 .............. Penis procedures w CC/MCC 4 ....................................................................... 709 6 1.0950 30.3 25.3 

710 .............. Penis procedures w/o CC/MCC 9 .................................................................... 709 0 1.0950 30.3 25.3 

711 .............. Testes procedures w CC/MCC 4, 6 .................................................................. 711 7 1.0950 30.3 25.3 

712 .............. Testes procedures w/o CC/MCC 4, 6 ............................................................... 711 1 1.0950 30.3 25.3 

713 .............. Transurethral prostatectomy w CC/MCC 5 ...................................................... 713 1 1.6489 36.5 30.4 

714 .............. Transurethral prostatectomy w/o CC/MCC 1 ................................................... 713 1 0.4800 19.9 16.6 

715 .............. Other male reproductive system O.R. proc for malignancy w CC/MCC 5 ...... 715 1 1.6489 36.5 30.4 

716 .............. Other male reproductive system O.R. proc for malignancy w/o CC/MCC 9 ... 715 0 1.6489 36.5 30.4 

717 .............. Other male reproductive system O.R. proc exc malignancy w CC/MCC 4 ..... 717 17 1.0950 30.3 25.3 

718 .............. Other male reproductive system O.R. proc exc malignancy w/o CC/MCC 1 .. 717 2 0.4800 19.9 16.6 

722 .............. Malignancy, male reproductive system w MCC 3 ............................................ 722 12 0.8072 24.6 20.5 

723 .............. Malignancy, male reproductive system w CC2 ............................................... 722 7 0.6513 22.7 18.9 

724 .............. Malignancy, male reproductive system w/o CC/MCC 1 .................................. 722 2 0.4800 19.9 16.6 

725 .............. Benign prostatic hypertrophy w MCC 4 ........................................................... 725 2 1.0950 30.3 25.3 

726 .............. Benign prostatic hypertrophy w/o MCC 1 ........................................................ 725 3 0.4800 19.9 16.6 

727 .............. Inflammation of the male reproductive system w MCC ................................... 727 37 0.8768 25.9 21.6 

728 .............. Inflammation of the male reproductive system w/o MCC ................................ 727 57 0.5605 20.9 17.4 

729 .............. Other male reproductive system diagnoses w CC/MCC ................................. 729 34 1.0242 26.6 22.2 

730 .............. Other male reproductive system diagnoses w/o CC/MCC 2 ........................... 729 2 0.6513 22.7 18.9 

734 .............. Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC 8 .......... 734 0 1.0950 30.3 25.3 

735 .............. Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC 8 ....... 734 0 0.4800 19.9 16.6 

736 .............. Uterine & adnexa proc for ovarian or adnexal malignancy w MCC 8 ............. 736 0 1.0950 30.3 25.3 

737 .............. Uterine & adnexa proc for ovarian or adnexal malignancy w CC 8 ................ 736 0 0.8072 24.6 20.5 

738 .............. Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC 8 .... 736 0 0.4800 19.9 16.6 

739 .............. Uterine, adnexa proc for non-ovarian/adnexal malig w MCC 8 ....................... 739 0 1.0950 30.3 25.3 

740 .............. Uterine, adnexa proc for non-ovarian/adnexal malig w CC 8 .......................... 739 0 0.8072 24.6 20.5 

741 .............. Uterine, adnexa proc for non-ovarian/adnexal malig w/o CC/MCC 8 ............. 739 0 0.4800 19.9 16.6 

742 .............. Uterine & adnexa proc for non-malignancy w CC/MCC 8 ............................... 742 0 0.8072 24.6 20.5 

743 .............. Uterine & adnexa proc for non-malignancy w/o CC/MCC 8 ............................ 742 0 0.4800 19.9 16.6 

744 .............. D&C, conization, laparascopy & tubal interruption w CC/MCC 2 .................... 744 1 0.6513 22.7 18.9 

745 .............. D&C, conization, laparascopy & tubal interruption w/o CC/MCC 9 ................. 744 0 0.6513 22.7 18.9 

746 .............. Vagina, cervix & vulva procedures w CC/MCC 3 ............................................ 746 3 0.8072 24.6 20.5 

747 .............. Vagina, cervix & vulva procedures w/o CC/MCC 9 ......................................... 746 0 0.8072 24.6 20.5 

748 .............. Female reproductive system reconstructive procedures 8 .............................. 748 0 0.8072 24.6 20.5 

749 .............. Other female reproductive system O.R. procedures w CC/MCC 3 ................. 749 3 0.8072 24.6 20.5 

750 .............. Other female reproductive system O.R. procedures w/o CC/MCC 9 .............. 749 0 0.8072 24.6 20.5 

754 .............. Malignancy, female reproductive system w MCC 4 ......................................... 754 14 1.0950 30.3 25.3 

755 .............. Malignancy, female reproductive system w CC 3 ............................................ 754 15 0.8072 24.6 20.5 

756 .............. Malignancy, female reproductive system w/o CC/MCC 1 ............................... 754 1 0.4800 19.9 16.6 

757 .............. Infections, female reproductive system w MCC .............................................. 757 29 0.8441 22.6 18.8 

758 .............. Infections, female reproductive system w CC ................................................. 757 25 0.8274 27.2 22.7 

759 .............. Infections, female reproductive system w/o CC/MCC 1 .................................. 757 5 0.4800 19.9 16.6 

760 .............. Menstrual & other female reproductive system disorders w CC/MCC 4 ......... 760 3 1.0950 30.3 25.3 

761 .............. Menstrual & other female reproductive system disorders w/o CC/MCC 1 ...... 760 1 0.4800 19.9 16.6 

765 .............. Cesarean section w CC/MCC 8 ....................................................................... 765 0 0.6513 22.7 18.9 

mmaher on DSK3CLS3C1PROD with $$_JOB

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25111 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

766 .............. Cesarean section w/o CC/MCC 8 .................................................................... 765 0 0.6513 22.7 18.9 

767 .............. Vaginal delivery w sterilization &/or D&C8 ...................................................... 767 0 0.6513 22.7 18.9 

768 .............. Vaginal delivery w O.R. proc except steril &/or D&C8 .................................... 768 0 0.6513 22.7 18.9

769 .............. Postpartum & post abortion diagnoses w O.R. procedure 2 ........................... 769 1 0.6513 22.7 18.9 

770 .............. Abortion w D&C, aspiration curettage or hysterotomy 8 ................................. 770 0 0.6513 22.7 18.9 

774 .............. Vaginal delivery w complicating diagnoses 8 .................................................. 774 0 0.6513 22.7 18.9 

775 .............. Vaginal delivery w/o complicating diagnoses 8 ............................................... 775 0 0.6513 22.7 18.9 

776 .............. Postpartum & post abortion diagnoses w/o O.R. procedure 4 ........................ 776 3 1.0950 30.3 25.3 

777 .............. Ectopic pregnancy 8 ......................................................................................... 777 0 0.6513 22.7 18.9 

778 .............. Threatened abortion 8 ...................................................................................... 778 0 0.4800 19.9 16.6 

779 .............. Abortion w/o D&C 8 .......................................................................................... 779 0 0.4800 19.9 16.6 

780 .............. False labor 8 ..................................................................................................... 780 0 0.4800 19.9 16.6 

781 .............. Other antepartum diagnoses w medical complications 4 ................................ 781 1 1.0950 30.3 25.3 

782 .............. Other antepartum diagnoses w/o medical complications 8 ............................. 782 0 0.4800 19.9 16.6 

789 .............. Neonates, died or transferred to another acute care facility 8 ........................ 789 0 0.4800 19.9 16.6 

790 .............. Extreme immaturity or respiratory distress syndrome, neonate 8 ................... 790 0 0.4800 19.9 16.6 

791 .............. Prematurity w major problems 8 ...................................................................... 791 0 1.0950 30.3 25.3 

792 .............. Prematurity w/o major problems 8 ................................................................... 792 0 0.4800 19.9 16.6 

793 .............. Full term neonate w major problems 8 ............................................................ 793 0 1.0950 30.3 25.3 

794 .............. Neonate w other significant problems 8 ........................................................... 794 0 1.0950 30.3 25.3 

795 .............. Normal newborn 8 ............................................................................................ 795 0 0.4800 19.9 16.6 

799 .............. Splenectomy w MCC 8 ..................................................................................... 799 0 1.0950 30.3 25.3 

800 .............. Splenectomy w CC 8 ........................................................................................ 799 0 0.8072 24.6 20.5 

801 .............. Splenectomy w/o CC/MCC 8 ........................................................................... 799 0 0.8072 24.6 20.5 

802 .............. Other O.R. proc of the blood & blood forming organs w MCC 5 .................... 802 7 1.6489 36.5 30.4 

803 .............. Other O.R. proc of the blood & blood forming organs w CC2 ........................ 802 3 0.6513 22.7 18.9 

804 .............. Other O.R. proc of the blood & blood forming organs w/o CC/MCC 9 ........... 802 0 0.6513 22.7 18.9 

808 .............. Major hematol/immun diag exc sickle cell crisis & coagul w MCC ................. 808 26 0.8185 22.7 18.9 

809 .............. Major hematol/immun diag exc sickle cell crisis & coagul w CC 3 ................. 808 24 0.8072 24.6 20.5 

810 .............. Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC 3 ..... 808 3 0.8072 24.6 20.5 

811 .............. Red blood cell disorders w MCC ..................................................................... 811 35 0.6773 22.8 19.0 

812 .............. Red blood cell disorders w/o MCC .................................................................. 811 48 0.5210 19.5 16.3 

813 .............. Coagulation disorders ...................................................................................... 813 49 0.7876 21.5 17.9 

814 .............. Reticuloendothelial & immunity disorders w MCC ........................................... 814 40 0.7805 22.6 18.8 

815 .............. Reticuloendothelial & immunity disorders w CC2 ............................................ 814 17 0.6513 22.7 18.9 

816 .............. Reticuloendothelial & immunity disorders w/o CC/MCC 2, 6 ............................ 814 6 0.6513 22.7 18.9 

820 .............. Lymphoma & leukemia w major O.R. procedure w MCC 9 ............................ 820 0 0.8072 24.6 20.5 

821 .............. Lymphoma & leukemia w major O.R. procedure w CC 3 ............................... 820 2 0.8072 24.6 20.5 

822 .............. Lymphoma & leukemia w major O.R. procedure w/o CC/MCC 9 ................... 820 0 0.8072 24.6 20.5 

823 .............. Lymphoma & non-acute leukemia w other O.R. proc w MCC 4 ..................... 823 12 1.0950 30.3 25.3 

824 .............. Lymphoma & non-acute leukemia w other O.R. proc w CC 4 ........................ 823 3 1.0950 30.3 25.3 

825 .............. Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC 1 ............ 823 1 0.4800 19.9 16.6 

826 .............. Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC 3 .................. 826 1 0.8072 24.6 20.5 

827 .............. Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC 8 ..................... 826 0 0.8072 24.6 20.5 

828 .............. Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC ? ......... 826 0 0.8072 24.6 20.5 

829 .............. Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC 5 .......... 829 9 1.6489 36.5 30.4 

830 .............. Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC 9 ....... 829 0 1.6489 36.5 30.4 

mmaher on DSK3CLS3C1PROD with $$_JOB

25112 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

834 .............. Acute leukemia w/o major O.R. procedure w MCC 3 ...................................... 834 20 0.8072 24.6 20.5 

835 .............. Acute leukemia w/o major O.R. procedure w CC 3 ......................................... 834 3 0.8072 24.6 20.5 

836 .............. Acute leukemia w/o major O.R. procedure w/o CC/MCC 1 ............................ 834 1 0.4800 19.9 16.6 

837 .............. Chemo w acute leukemia as sdxor w high dose chemo agent w MCC 5 ....... 837 1 1.6489 36.5 30.4 

838 .............. Chemo w acute leukemia as sdx or w high dose chemo agent w CC 3 ........ 837 2 0.8072 24.6 20.5 

839 .............. Chemo w acute leukemia as sdx or w high dose chemo agent w/o CC/MCC 9.837 0 0.8072 24.6 20.5 

840 .............. Lymphoma & non-acute leukemia w MCC ENT≤840 ...................................... 174 0.8758 20.8 17.3 

841 .............. Lymphoma & non-acute leukemia w CC ......................................................... 840 65 0.7405 20.1 16.8 

842 .............. Lymphoma & non-acute leukemia w/o CC/MCC 2 .......................................... 840 11 0.6513 22.7 18.9 

843 .............. Other myeloprolif dis or poorly diff neopl diag w MCC 4, 6 .............................. 843 19 1.0950 30.3 25.3 

844 .............. Other myeloprolif dis or poorly diff neopl diag w CC 4, 6 ................................. 843 13 1.0950 30.3 25.3 

845 .............. Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC 4, 6 .................... 843 3 1.0950 30.3 25.3 

846 .............. Chemotherapy w/o acute leukemia as secondary diagnosis w MCC ............. 846 31 1.8155 37.9 31.6 

847 .............. Chemotherapy w/o acute leukemia as secondary diagnosis w CC ................ 846 61 1.3078 27.6 23.0 

848 .............. Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC 2 846 1 0.6513 22.7 18.9 

849 .............. Radiotherapy .................................................................................................... 849 141 0.8756 23.5 19.6 

853 .............. Infectious & parasitic diseases w O.R. procedure w MCC ............................. 853 698 1.7901 38.1 31.8 

854 .............. Infectious & parasitic diseases w O.R. procedure w CC ................................ 853 94 1.1472 31.0 25.8 

855 .............. Infectious & parasitic diseases w O.R. procedure w/o CC/MCC 3 ................. 853 3 0.8072 24.6 20.5 

856 .............. Postoperative or post-traumatic infections w O.R. proc w MCC ..................... 856 338 1.5473 36.2 30.2 

857 .............. Postoperative or post-traumatic infections w O.R. proc w CC ........................ 856 230 1.0438 31.6 26.3 

858 .............. Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC ............ 856 30 0.8873 27.9 23.3 

862 .............. Postoperative & post-traumatic infections w MCC .......................................... 862 1,172 0.9120 25.1 20.9 

863 .............. Postoperative & post-traumatic infections w/o MCC ....................................... 862 1,298 0.6802 23.4 19.5 

864 .............. Fever of unknown origin 2 ................................................................................ 864 16 0.6513 22.7 18.9 

865 .............. Viral illness w MCC .......................................................................................... 865 56 0.8213 21.8 18.2 

866 .............. Viral illness w/o MCC ....................................................................................... 865 33 0.5498 21.2 17.7 

867 .............. Other infectious & parasitic diseases diagnoses w MCC ................................ 867 293 1.1329 23.6 19.7 

868 .............. Other infectious & parasitic diseases diagnoses w CC ................................... 867 80 0.7220 22.0 18.3

869 .............. Other infectious & parasitic diseases diagnoses w/o CC/MCC 1 .................... 867 11 0.4800 19.9 16.6 

870 .............. Septicemia w MV 96+ hours ............................................................................ 870 585 1.9084 30.4 25.3 

871 .............. Septicemia w/o MV 96+ hours w MCC ............................................................ 871 3,871 0.8437 23.5 19.6 

872 .............. Septicemia w/o MV 96+ hours w/o MCC ......................................................... 871 1,532 0.6551 21.8 18.2 

876 .............. O.R. procedure w principal diagnoses of mental illness 1 .............................. 876 5 0.4800 19.9 16.6 

880 .............. Acute adjustment reaction & psychosocial dysfunction 4 ................................ 880 21 1.0950 30.3 25.3 

881 .............. Depressive neuroses 1 ..................................................................................... 881 15 0.4800 19.9 16.6 

882 .............. Neuroses except depressive 1 ......................................................................... 882 16 0.4800 19.9 16.6 

883 .............. Disorders of personality & impulse control 1 ................................................... 883 15 0.4800 19.9 16.6 

884 .............. Organic disturbances & mental retardation ..................................................... 884 201 0.4785 23.2 19.3 

885 .............. Psychoses ........................................................................................................ 885 1,386 0.4066 23.7 19.8 

886 .............. Behavioral & developmental disorders 1 ......................................................... 886 18 0.4800 19.9 16.6 

887 .............. Other mental disorder diagnoses 8 .................................................................. 887 0 0.4800 19.9 16.6 

894 .............. Alcohol/drug abuse or dependence, left ama 1 ............................................... 894 1 0.4800 19.9 16.6 

895 .............. Alcohol/drug abuse or dependence w rehabilitation therapy 1 ........................ 895 1 0.4800 19.9 16.6 

896 .............. Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC 3 ....... 896 10 0.8072 24.6 20.5 

897 .............. Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC 2 .... 896 24 0.6513 22.7 18.9 

901 .............. Wound debridements for injuries w MCC ........................................................ 901 222 1.4003 35.2 29.3 

902 .............. Wound debridements for injuries w CC ........................................................... 901 159 1.0434 33.4 27.8 

903 .............. Wound debridements for injuries w/o CC/MCC 2 ............................................ 901 23 0.6513 22.7 18.9 

904 .............. Skin grafts for injuries w CC/MCC ................................................................... 904 87 1.3377 40.7 33.9 

905 .............. Skin grafts for injuries w/o CC/MCC 2 ............................................................. 904 8 0.6513 22.7 18.9 

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TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

906 .............. Hand procedures for injuries 1 ......................................................................... 906 1 0.4800 19.9 16.6 

907 .............. Other O.R. procedures for injuries w MCC ..................................................... 907 85 1.7294 36.8 30.7 

908 .............. Other O.R. procedures for injuries w CC ........................................................ 907 44 1.1963 34.2 28.5 

909 .............. Other O.R. procedures for injuries w/o CC/MCC 4 ......................................... 907 7 1.0950 30.3 25.3 

913 .............. Traumatic injury w MCC .................................................................................. 913 50 0.9333 26.8 22.3 

914 .............. Traumatic injury w/o MCC ............................................................................... 913 70 0.5330 21.3 17.8 

915 .............. Allergic reactions w MCC 9 .............................................................................. 915 0 0.4800 19.9 16.6 

916 .............. Allergic reactions w/o MCC 1 ........................................................................... 915 1 0.4800 19.9 16.6 

917 .............. Poisoning & toxic effects of drugs w MCC 2 ................................................... 917 7 0.6513 22.7 18.9 

918 .............. Poisoning & toxic effects of drugs w/o MCC 2 ................................................ 917 6 0.6513 22.7 18.9 

919 .............. Complications of treatment w MCC ................................................................. 919 1,066 1.0291 26.2 21.8 

920 .............. Complications of treatment w CC .................................................................... 919 811 0.7703 24.6 20.5 

921 .............. Complications of treatment w/o CC/MCC ........................................................ 919 113 0.6374 22.6 18.8 

922 .............. Other injury, poisoning & toxic effect diag w MCC 1 ....................................... 922 5 0.4800 19.9 16.6 

923 .............. Other injury, poisoning & toxic effect diag w/o MCC 1 .................................... 922 9 0.4800 19.9 16.6 

927 .............. Extensive burns or full thickness burns w MV 96+ hrs w skin graft 8 ............. 927 0 1.0950 30.3 25.3 

928 .............. Full thickness burn w skin graft or inhal inj w CC/MCC 4 ............................... 928 10 1.0950 30.3 25.3 

929 .............. Full thickness burn w skin graft or inhal inj w/o CC/MCC 2 ............................ 928 1 0.6513 22.7 18.9 

933 .............. Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft 4 .......... 933 7 1.0950 30.3 25.3 

934 .............. Full thickness burn w/o skin grft or inhal inj .................................................... 934 48 0.6866 24.2 20.2 

935 .............. Non-extensive burns ........................................................................................ 935 40 0.7294 24.9 20.8 

939 .............. O.R. proc w diagnoses of other contact w health services w MCC ................ 939 378 1.2925 33.8 28.2 

940 .............. O.R. proc w diagnoses of other contact w health services w CC ................... 939 210 1.0280 33.9 28.3 

941 .............. O.R. proc w diagnoses of other contact w health services w/o CC/MCC ...... 939 38 0.7470 28.9 24.1 

945 .............. Rehabilitation w CC/MCC ................................................................................ 945 2,173 0.5928 22.3 18.6 

946 .............. Rehabilitation w/o CC/MCC ............................................................................. 945 527 0.4271 18.9 15.8 

947 .............. Signs & symptoms w MCC .............................................................................. 947 88 0.6459 22.8 19.0 

948 .............. Signs & symptoms w/o MCC ........................................................................... 947 168 0.5300 23.5 19.6 

949 .............. Aftercare w CC/MCC ....................................................................................... 949 4,486 0.6728 22.1 18.4 

950 .............. Aftercare w/o CC/MCC .................................................................................... 949 839 0.4847 18.5 15.4 

951 .............. Other factors influencing health status ............................................................ 951 38 1.2107 24.0 20.0 

955 .............. Craniotomy for multiple significant trauma 8 .................................................... 955 0 1.6489 36.5 30.4 

956 .............. Limb reattachment, hip & femur proc for multiple significant trauma 2 ........... 956 1 0.6513 22.7 18.9 

957 .............. Other O.R. procedures for multiple significant trauma w MCC 5 .................... 957 3 1.6489 36.5 30.4 

958 .............. Other O.R. procedures for multiple significant trauma w CC 4 ....................... 957 1 1.0950 30.3 25.3 

959 .............. Other O.R. procedures for multiple significant trauma w/o CC/MCC 9 ........... 957 0 1.0950 30.3 25.3 

963 .............. Other multiple significant trauma w MCC 3 ..................................................... 963 12 0.8072 24.6 20.5 

964 .............. Other multiple significant trauma w CC 2 ........................................................ 963 9 0.6513 22.7 18.9 

965 .............. Other multiple significant trauma w/o CC/MCC 2 ............................................ 963 3 0.6513 22.7 18.9 

969 .............. HIV w extensive O.R. procedure w MCC 5 ..................................................... 969 7 1.6489 36.5 30.4 

970 .............. HIV w extensive O.R. procedure w/o MCC 5 .................................................. 969 3 1.6489 36.5 30.4 

974 .............. HIV w major related condition w MCC ............................................................ 974 160 0.9279 21.8 18.2 

975 .............. HIV w major related condition w CC ............................................................... 974 70 0.6707 20.7 17.3 

976 .............. HIV w major related condition w/o CC/MCC ................................................... 974 43 0.6703 19.2 16.0 

977 .............. HIV w or w/o other related condition 2 ............................................................ 977 21 0.6513 22.7 18.9 

981 .............. Extensive O.R. procedure unrelated to principal diagnosis w MCC ............... 981 1,065 2.2695 41.8 34.8 

982 .............. Extensive O.R. procedure unrelated to principal diagnosis w CC .................. 981 279 1.4994 37.8 31.5 

983 .............. Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC 4 ... 981 24 1.0950 30.3 25.3 

984 .............. Prostatic O.R. procedure unrelated to principal diagnosis w MCC 5 .............. 984 14 1.6489 36.5 30.4 

985 .............. Prostatic O.R. procedure unrelated to principal diagnosis w CC 4 ................. 984 13 1.0950 30.3 25.3 

986 .............. Prostatic O.R. procedure unrelated to principal diagnosis w/o CC/MCC 4 ..... 984 1 1.0950 30.3 25.3 

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TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 

6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued 

Proposed 

MS–LTC– 

DRG 

Proposed MS–LTC–DRG description Base MS– 

LTC–DRG 

FY 2006 

LTCH 

cases 

Proposed 

relative 

weight 

Proposed 

geometric 

average 

length of 

stay 

Proposed 

5/6ths of 

the Geometric average 

length of 

stay 

987 .............. Non-extensive O.R. proc unrelated to principal diagnosis w MCC ................. 987 391 1.8112 37.9 31.6 

988 .............. Non-extensive O.R. proc unrelated to principal diagnosis w CC .................... 987 182 1.0902 33.0 27.5 

989 .............. Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC 3 ..... 987 21 0.8072 24.6 20.5 

998 .............. Ungroupable 7 .................................................................................................. 998 0 0.0000 0.0 0.0 

999 .............. Principal diagnosis invalid as discharge diagnosis 7 ....................................... 999 0 0.0000 0.0 0.0 

1 Proposed relative weights for these proposed MS-LTC-DRGs were determined by assigning these cases to proposed low-volume quintile 1. 2 Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 2. 3 Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 3. 4 Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 4. 5 Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 5. 6 Proposed relative weights for these proposed MS–LTC–DRGs were determined after adjusting to account for nonmonotonicity (see step 4 in 

section II.I.4. of the Addendum of this proposed rule). 7 Proposed relative weights for these proposed MS–LTC–DRGs were assigned a proposed relative weight of 0.0000. 8 Proposed relative weights for these proposed MS–LTC–DRGs were determined by cross-walking these cases to the appropriate proposed 

MS–LTC–DRG and then assigning them to the appropriate proposed low volume quintile because they had no LTCH cases in the FY 2006 

MedPAR file (see step 5 in section II.I.4 of the Addendum of this proposed rule). 9 Proposed relative weights for these proposed MS–LTC–DRGs were determined by combining with its base MS–LTC–DRG because they had

no LTCH cases in the FY 2006 MedPAR file (see step 5 in section II.I.4 of the Addendum of this proposed rule). 

Appendix A—Regulatory Impact 

Analysis 

I. Overall Impact 

We have examined the impacts of this 

proposed rule as required by Executive Order 

12866 (September 1993, Regulatory Planning 

and Review) and the Regulatory Flexibility 

Act (RFA) (September 19, 1980, Pub. L. 96– 

354), section 1102(b) of the Social Security 

Act, the Unfunded Mandates Reform Act of 

1995 (Pub. L. 104–4), and Executive Order 

13132. 

Executive Order 12866 (as amended by 

Executive Order 13258, which merely 

reassigns responsibility of duties) directs 

agencies to assess all costs and benefits of 

available regulatory alternatives and, if 

regulation is necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and equity). A 

regulatory impact analysis (RIA) must be 

prepared for major rules with economically 

significant effects ($100 million or more in 

any 1 year). 

We have determined that this rule is a 

major rule as defined in 5 U.S.C. 804(2). We 

estimate that the proposed changes for FY 

2008 operating and capital payments will 

redistribute in excess of $100 million among 

different types of inpatient cases. The market 

basket update to the IPPS rates required by 

the statute, in conjunction with other 

proposed payment changes in this proposed 

rule, would result in an approximate $3.3 

billion increase in FY 2008 operating and 

capital payments. This amount does not 

reflect changes in hospital admissions or 

case-mix intensity in operating PPS 

payments, which would also affect overall 

payment changes. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses. For purposes of the RFA, small 

entities include small businesses, nonprofit 

organizations, and government agencies. 

Most hospitals and most other providers and 

suppliers are considered to be small entities, 

either by nonprofit status or by having 

revenues of $31 million in any 1 year. (For 

details on the latest standards for health care 

providers, we refer readers to the Small 

Business Administration Web site at: http:// 

sba.gov/idc/ groups/pubic/documents/sba— 

homepage/serv—sstd—tablepdf.pdf.) For 

purposes of the RFA, all hospitals and other 

providers and suppliers are considered to be 

small entities. Individuals and States are not 

included in the definition of a small entity. 

We believe that this proposed rule will have 

a significant impact on small entities as 

explained in this Appendix. Because we 

acknowledge that many of the affected 

entities are small entities, the analysis 

discussed throughout the preamble of this 

proposed rule constitutes our initial 

regulatory flexibility analysis. Therefore, we 

are soliciting comments on our estimates and 

analysis of the impact of the proposed rule 

on those small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory impact 

analysis for any proposed rule that may have 

a significant impact on the operations of a 

substantial number of small rural hospitals. 

This analysis must conform to the provisions 

of section 603 of the RFA. With the exception 

of hospitals located in certain New England 

counties, for purposes of section 1102(b) of 

the Act, we previously defined a small rural 

hospital as a hospital with fewer than 100 

beds that is located outside of a Metropolitan 

Statistical Area (MSA) or New England 

County Metropolitan Area (NECMA). 

However, under the current labor market 

definitions, we no longer employ NECMAs to 

define urban areas in New England. 

Therefore, we now define a small rural 

hospital as a hospital that is located outside 

of an MSA and has fewer than 100 beds. 

Section 601(g) of the Social Security 

Amendments of 1983 (Pub. L. 98–21) 

designated hospitals in certain New England 

counties as belonging to the adjacent 

NECMA. Thus, for purposes of the IPPS, we 

continue to classify these hospitals as urban 

hospitals. 

Section 202 of the Unfunded Mandates 

Reform Act of 1995 (Pub. L. 104–4) also 

requires that agencies assess anticipated costs 

and benefits before issuing any rule whose 

mandates require spending in any 1 year of 

$100 million in 1995 dollars, updated 

annually for inflation. That threshold level is 

currently approximately $120 million. This 

proposed rule will not mandate any 

requirements for State, local, or tribal 

governments, nor will it affect private sector 

costs. 

Executive Order 13132 establishes certain 

requirements that an agency must meet when 

it promulgates a proposed rule (and 

subsequent final rule) that imposes 

substantial direct requirement costs on State 

and local governments, preempts State law, 

or otherwise has Federalism implications. As 

stated above, this proposed rule would not 

have a substantial effect on State and local 

governments. 

The following analysis, in conjunction 

with the remainder of this document, 

demonstrates that this rule is consistent with 

the regulatory philosophy and principles 

identified in Executive Order 12866, the 

RFA, and section 1102(b) of the Act. The rule 

will affect payments to a substantial number 

of small rural hospitals, as well as other 

classes of hospitals, and the effects on some 

hospitals may be significant. 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25115 

II. Objectives 

The primary objective of the IPPS is to 

create incentives for hospitals to operate 

efficiently and minimize unnecessary costs 

while at the same time ensuring that 

payments are sufficient to adequately 

compensate hospitals for their legitimate 

costs. In addition, we share national goals of 

preserving the Medicare Hospital Insurance 

Trust Fund. 

We believe the proposed changes in this 

proposed rule would further each of these 

goals while maintaining the financial 

viability of the hospital industry and 

ensuring access to high quality health care 

for Medicare beneficiaries. We expect that 

these proposed changes would ensure that 

the outcomes of this payment system are 

reasonable and equitable while avoiding or 

minimizing unintended adverse 

consequences. 

III. Limitations of Our Analysis 

The following quantitative analysis 

presents the projected effects of our proposed 

policy changes, as well as statutory changes 

effective for FY 2008, on various hospital 

groups. We estimate the effects of individual 

proposed policy changes by estimating 

payments per case while holding all other 

payment policies constant. We use the best 

data available, but, generally, we do not 

attempt to predict behavioral responses to 

our proposed policy changes, and we do not 

make adjustments for future changes in such 

variables as admissions, lengths of stay, or 

case-mix. However, we believe that adoption 

of the MS–DRGs proposed in this proposed 

rule would create a risk of increased 

aggregate levels of payment as a result of 

more comprehensive documentation and 

coding. As explained earlier in this proposed 

rule, the Secretary has broad discretion under 

section 1886(d)(3)(A)(vi) of the Act to adjust 

the standardized amount so as to eliminate 

the effect of changes in coding or 

classification of discharges that do not reflect 

real changes in case-mix. Using this 

authority, the Medicare Actuary estimates 

that an adjustment of 4.8 percent over 2 years 

will be necessary to maintain budget 

neutrality for the transition to the MS–DRGs. 

We are proposing to reduce the IPPS 

standardized amounts by -2.4 percent each 

year for FY 2008 and FY 2009. The payment 

impacts shown below illustrate the impact of 

changes in hospital payment, including the 

proposed -2.4 percent adjustment to the IPPS 

standardized amounts both prior to and 

following the assumed growth in case-mix. 

As we have done in the previous rules, we 

are soliciting comments and information 

about the anticipated effects of these 

proposed changes on hospitals and our 

methodology for estimating them. 

IV. Hospitals Included In and Excluded 

From the IPPS 

The prospective payment systems for 

hospital inpatient operating and capitalrelated costs encompass nearly all general 

short-term, acute care hospitals that 

participate in the Medicare program. There 

were 35 Indian Health Service hospitals in 

our database, which we excluded from the 

analysis due to the special characteristics of 

the prospective payment methodology for 

these hospitals. Among other short-term, 

acute care hospitals, only the 45 such 

hospitals in Maryland remain excluded from 

the IPPS under the waiver at section 

1814(b)(3) of the Act. 

As of March 2007, there are 3,535 IPPS 

hospitals to be included in our analysis. This 

represents about 59 percent of all Medicareparticipating hospitals. The majority of this 

impact analysis focuses on this set of 

hospitals. There are also approximately 1,283 

CAHs. These small, limited service hospitals 

are paid on the basis of reasonable costs 

rather than under the IPPS. There are also 

1,186 specialty hospitals and 2,315 specialty 

units that are excluded from the IPPS. These 

specialty hospitals include IPFs, IRFs, 

LTCHs, RNHCIs, children’s hospitals, and 

cancer hospitals. Proposed changes in 

payments for IPFs and IRFs are made through 

other separate rulemaking. Payment impacts 

for these specialty hospitals and units, other 

than the reasonable cost updates for IPFs 

paid under a blend, are not included in this 

proposed rule. There is also a separate rule 

to update and propose changes to the LTCHs 

for its July 1 to June 30 rate year. However, 

we have traditionally used the IPPS rule to 

update the LTCH relative weights because 

the LTCH PPS uses the same DRGs as the 

IPPS, resulting in the LTCH relative weights 

being recalibrated according to the same 

schedule as the IPPS (that is, for each Federal 

fiscal year). The impacts of our proposed 

policy changes on LTCHs, where applicable, 

are discussed below. 

V. Effects on Excluded Hospitals and 

Hospital Units 

As of March 2007, there were 1,197 

hospitals excluded from the IPPS. Of these 

1,187 hospitals, 483 IPFs, 6 LTCHs, 81 

children’s hospitals, 11 cancer hospitals, and 

16 RNHCIs are either being paid, on a 

reasonable cost basis or have a portion of the 

PPS payment based on a reasonable cost 

subject to the rate-of-increase ceiling under §

413.40. The remaining providers, 216 IRFs 

and 371 LTCHs, are paid 100 percent of the 

Federal prospective rate under the IRF PPS 

and the LTCH PPS, respectively. As stated 

above, IRFs and IPFS are not affected by this 

proposed rule. The impacts of the changes to 

LTCHs are discussed separately below. In 

addition, there are 1,283 IPFs co-located in 

hospitals otherwise subject to IPPS, paid on 

a blend of the IPF PPS per diem payment and 

the reasonable cost-based payment and 996 

IRFs (paid under the IRF PPS) co-located in 

hospitals otherwise subject to the IPPS. 

Under § 413.40(a)(2)(i)(A), the rate-ofincrease ceiling is not applicable to the 93 

IPPS excluded hospitals and units in 

Maryland that are paid in accordance with 

the waiver at section 1814(b)(3) of the Act. 

In the past, hospitals and units excluded 

from the IPPS have been paid based on their 

reasonable costs subject to limits as 

established by the Tax Equity and Fiscal 

Responsibility Act of 1982 (TEFRA). 

Hospitals that continue to be paid fully on a 

reasonable cost basis are subject to TEFRA 

limits for FY 2008. For these hospitals 

(cancer and children’s hospitals), consistent 

with section 1886(b)(3)(B)(ii) of the Act, the 

proposed update will be the percentage 

increase in the FY 2008 IPPS operating 

market basket, currently estimated to be 3.3 

percent. In addition, in accordance with §

403.752(a) of the regulations, RNHCIs are 

paid under § 413.40, which also uses section 

1886(b)(3)(B)(ii) of the Act to update the 

percentage increase in the rate-of-increase 

limits. For RNHCIs, the update will be the 

percentage increase in the FY 2008 IPPS 

operating market basket increase, currently 

estimated to be 3.3 percent. 

Effective for cost reporting periods 

beginning on or after October 1, 2002, LTCHs 

that elected to be paid based on 100 percent 

of the LTCH PPS rule are paid, based on a 

Federal prospective payment amount that is 

updated annually. Existing LTCHs would 

receive a PPS blended payment that 

consisted of the Federal prospective payment 

rate and a reasonable cost-based payment rate 

over a 5-year transition period, unless the 

LTCH elected to be paid at 100 percent of the 

Federal prospective rate at the beginning of 

any of its cost reporting periods during the 

5-year transition period. In accordance with 

§ 412.533, for cost reporting periods 

beginning on or after October 1, 2006, the 

LTCH PPS transition blend percentages are 

100 percent of the Federal prospective 

payment amount and zero percent of the PPS 

amount calculated under reasonable cost 

principles. FY 2007 was the fifth year of the 

5-year transition period established under §

412.533. Because the reasonable cost 

principles amount is zero percent for cost 

reporting periods beginning during FY 2008, 

LTCHs no longer receive a portion of their 

payment that is based in part on a reasonable 

cost subject to the rate-of-increase ceiling. 

Thus, there is no longer a need for an update 

factor for LTCHs’ TEFRA target amount for 

FY 2008. 

The final rule implementing the IPF PPS 

(69 FR 66922) established a 3-year transition 

to the IPF PPS during which some providers 

will receive a blend of the IPF PPS per diem 

payment and the TEFRA reasonable costbased payment. For purposes of determining 

what the TEFRA payment to the IPF will be, 

we updated the IPF’s TEFRA target amount 

by the excluded hospital market basket 

percentage increase of 3.4 percent. 

The impact on excluded hospitals and 

hospital units of the proposed update in the 

rate-of-increase limit depends on the 

cumulative cost increases experienced by 

each excluded hospital or unit since its 

applicable base period. For excluded 

hospitals and units that have maintained 

their cost increases at a level below the rateof-increase limits since their base period, the 

major effect is on the level of incentive 

payments these hospitals and hospital units 

receive. Conversely, for excluded hospitals 

and hospital units with per-case cost 

increases above the cumulative update in 

their rate-of-increase limits, the major effect 

is the amount of excess costs that will not be 

reimbursed. 

We note that, under § 413.40(d)(3), an 

excluded hospital or unit whose costs exceed 

110 percent of its rate-of-increase limit 

receives its rate-of-increase limit plus 50 

percent of the difference between its 

reasonable costs and 110 percent of the limit, 

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not to exceed 110 percent of its limit. In 

addition, under the various provisions set 

forth in § 413.40, certain excluded hospitals 

and hospital units can obtain payment 

adjustments for justifiable increases in 

operating costs that exceed the limit. 

VI. Quantitative Effects of the Proposed 

Policy Changes Under the IPPS for 

Operating Costs 

A. Basis and Methodology of Estimates 

In this proposed rule, we are announcing 

proposed policy changes and proposed 

payment rate updates for the IPPS for 

operating costs. Proposed changes to the 

capital payments are discussed in section 

VIII. of this Appendix. 

Based on the overall percentage change in 

payments per case estimated using our 

payment simulation model, we estimate that 

proposed total FY 2008 operating payments 

would increase 3.3 percent compared to FY 

2007 largely due to the statutorily mandated 

update to the IPPS rates. This amount reflects 

an adjustment of -2.4 percent to the IPPS 

standardized amounts to offset an anticipated 

increase in payments resulting from 

improved documentation and coding that 

does not represent real increases in 

underlying resource demands and patient 

acuity due to the proposed adoption of MS– 

DRGs. The impacts do not illustrate changes 

in hospital admissions or real case-mix 

intensity, which would also affect overall 

payment changes. 

We have prepared separate impact analyses 

of the proposed changes to each system. This 

section deals with proposed changes to the 

operating prospective payment system. Our 

payment simulation model relies on the most 

recent available data to enable us to estimate 

the impacts on payments per case of certain 

changes in this proposed rule. However, 

there are other proposed changes for which 

we do not have data available that would 

allow us to estimate the payment impacts 

using this model. For those proposed 

changes, we have attempted to predict the 

payment impacts based upon our experience 

and other more limited data. 

The data used in developing the 

quantitative analyses of proposed changes in 

payments per case presented below are taken 

from the FY 2006 MedPAR file and the most 

current Provider-Specific File that is used for 

payment purposes. Although the analyses of 

the changes to the operating PPS do not 

incorporate cost data, data from the most 

recently available hospital cost report were 

used to categorize hospitals. Our analysis has 

several qualifications. First, in this analysis, 

we do not make adjustments for future 

changes in such variables as admissions, 

lengths of stay, or underlying growth in real 

case-mix. Second, due to the interdependent 

nature of the IPPS payment components, it is 

very difficult to precisely quantify the impact 

associated with each proposed change. Third, 

we use various sources for the data used to 

categorize hospitals in the tables. In some 

cases, particularly the number of beds, there 

is a fair degree of variation in the data from 

different sources. We have attempted to 

construct these variables with the best 

available source overall. However, for 

individual hospitals, some 

miscategorizations are possible. 

Using cases from the FY 2006 MedPAR 

file, we simulated payments under the 

operating IPPS given various combinations of 

payment parameters. Any short-term, acute 

care hospitals not paid under the IPPS 

(Indian Health Service hospitals and 

hospitals in Maryland) were excluded from 

the simulations. The impact of payments 

under the capital IPPS, or the impact of 

payments for costs other than inpatient 

operating costs, are not analyzed in this 

section. Estimated payment impacts of 

proposed FY 2008 changes to the capital 

IPPS are discussed in section VIII of this 

Appendix. The proposed changes discussed 

separately below are the following: 

<bullet≤ The effects of the proposed annual 

reclassification of diagnoses and procedures 

and the proposed recalibration of the DRG 

relative weights required by section 

1886(d)(4)(C) of the Act. 

<bullet≤ The effects of the proposed 

changes in hospitals’ wage index values 

reflecting wage data from hospitals’ cost 

reporting periods beginning during FY 2004, 

compared to the FY 2003 wage data. 

<bullet≤ The effects of the proposed wage 

and recalibration budget neutrality factors. 

<bullet≤ The effects of the expiration of the 

labor market area transition for those 

hospitals that were urban under the old labor 

market area designations and are now 

considered rural hospitals. 

<bullet≤ The effects of the expiration of the 

3-year provision for applying an imputed 

rural floor to States that have no rural areas 

and to States that have rural areas but no 

IPPS hospitals are located in those areas (69 

FR 49109). 

<bullet≤ The effects of geographic 

reclassifications by the MGCRB that will be 

effective in FY 2008. 

<bullet≤ The effects of the proposed 

adjustment to the application of the rural 

floor budget neutrality provision on the wage 

index instead of on the standardized amount. 

<bullet≤ The effects of the September 30, 

2007 expiration of section 508 of Pub. L. 

108–173, which allowed qualifying hospitals 

to appeal the wage index classification 

otherwise and apply for reclassification to 

another area of the State in which the 

hospital is located (or, at the discretion of the 

Secretary, to an area within a contiguous 

State). 

<bullet≤ The effects of section 505 of Pub. 

L. 108–173, which provides for an increase 

in a hospital’s wage index if the hospital 

qualifies by meeting a threshold percentage 

of residents of the county where the hospital 

is located who commute to work at hospitals 

in counties with higher wage indexes. 

<bullet≤ The effect of the budget neutrality 

adjustment being made for the adoption of 

the proposed MS-DRGs under section 

1886(d)(3)(A)(iv) of the Act for the change in 

aggregate payments that is a result of changes 

in the coding or classification of discharges 

that do not reflect real changes in case-mix. 

<bullet≤ The total estimated change in 

payments based on proposed FY 2008 

policies relative to payments based on FY 

2007 policies. 

To illustrate the impacts of the proposed 

FY 2008 changes, our analysis begins with a 

FY 2007 baseline simulation model using: 

the proposed FY 2008 update of 3.3 percent; 

the FY 2007 DRG GROUPER (Version 24.0); 

the most current CBSA designations for 

hospitals based on OMB’s MSA definitions; 

the FY 2007 wage index; and no MGCRB 

reclassifications. Outlier payments are set at 

5.1 percent of total operating DRG and outlier 

payments. 

Section 1886(b)(3)(B)(viii) of the Act, as 

added by section 5001(a) of Pub. L. 109–171, 

provides that for FY 2007 and subsequent 

years, the update factor will be reduced by 

2.0 percentage points for any hospital that 

does not submit quality data in a form and 

manner and at a time specified by the 

Secretary. At the time this impact was 

prepared, 147 providers did not receive the 

full market basket rate-of-increase for FY 

2007 because they failed the quality data 

submission process. For purposes of the 

simulations shown below, we modeled the 

proposed payment changes for FY 2008 using 

a reduced update for these 147 hospitals. 

However, we do not have enough 

information to determine which hospitals 

will not receive the full market basket rateof-increase for FY 2008 at this time. 

Each proposed and statutory policy change 

is then added incrementally to this baseline, 

finally arriving at an FY 2008 model 

incorporating all of the proposed changes. 

This simulation allows us to isolate the 

effects of each proposed change. 

Our final comparison illustrates the 

proposed percent change in payments per 

case from FY 2007 to FY 2008. Three factors 

not discussed separately have significant 

impacts here. The first is the update to the 

standardized amount. In accordance with 

section 1886(b)(3)(B)(i) of the Act, we are 

updating the standardized amounts for FY 

2008 using the most recently forecasted 

hospital market basket increase for FY 2008 

of 3.3 percent. (Hospitals that fail to comply 

with the quality data submission requirement 

to receive the full update will receive an 

update reduced by 2.0 percentage points to 

1.3 percent.) Under section 1886(b)(3)(B)(iv) 

of the Act, the updates to the hospitalspecific amounts for SCHs and for MDHs are 

also equal to the market basket increase, or 

3.3 percent. 

A second significant factor that affects the 

proposed changes in hospitals’ payments per 

case from FY 2007 to FY 2008 is the change 

in a hospital’s geographic reclassification 

status from one year to the next. That is, 

payments may be reduced for hospitals 

reclassified in FY 2007 that are no longer 

reclassified in FY 2008. Conversely, 

payments may increase for hospitals not 

reclassified in FY 2007 that are reclassified 

in FY 2008. Particularly with the expiration 

of section 508 of Pub. L. 108–173, the 

reclassification provision, these impacts can 

be quite substantial, so if a relatively small 

number of hospitals in a particular category 

lose their reclassification status, the 

percentage change in payments for the 

category may be below the national mean. 

A third significant factor is that we 

currently estimate that actual outlier 

payments during FY 2007 will be 4.9 percent 

of total DRG payments. When the FY 2007 

final rule was published, we projected FY 

2007 outlier payments would be 5.1 percent 

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of total DRG plus outlier payments; the 

average standardized amounts were offset 

correspondingly. The effects of the lower 

than expected outlier payments during FY 

2008 (as discussed in the Addendum to this 

proposed rule) are reflected in the analyses 

below comparing our current estimates of FY 

2007 payments per case to estimated FY 2008 

payments per case (with outlier payments 

projected to equal 5.1 percent of total DRG 

payments). 

B. Analysis of Table I 

Table I displays the results of our analysis 

of the proposed changes for FY 2008. The 

table categorizes hospitals by various 

geographic and special payment 

consideration groups to illustrate the varying 

impacts on different types of hospitals. The 

top row of the table shows the overall impact 

on the 3,535 hospitals included in the 

analysis. 

The next four rows of Table I contain 

hospitals categorized according to their 

geographic location: All urban, which is 

further divided into large urban and other 

urban; and rural. There are 2,540 hospitals 

located in urban areas included in our 

analysis. Among these, there are 1,409 

hospitals located in large urban areas 

(populations over 1 million), and 1,131 

hospitals in other urban areas (populations of 

1 million or fewer). In addition, there are 995 

hospitals in rural areas. The next two 

groupings are by bed-size categories, shown 

separately for urban and rural hospitals. The 

final groupings by geographic location are by 

census divisions, also shown separately for 

urban and rural hospitals. 

The second part of Table I shows hospital 

groups based on hospitals’ FY 2008 payment 

classifications, including any 

reclassifications under section 1886(d)(10) of 

the Act. For example, the rows labeled urban, 

large urban, other urban, and rural show that 

the number of hospitals paid based on these 

categorizations after consideration of 

geographic reclassifications (including 

reclassifications under section 1886(d)(8)(B) 

and section 1886(d)(8)(E) of the Act that have 

implications for capital payments) are 2,619, 

1,436, 1,183 and 916, respectively. 

The next three groupings examine the 

impacts of the proposed changes on hospitals 

grouped by whether or not they have GME 

residency programs (teaching hospitals that 

receive an IME adjustment) or receive DSH 

payments, or some combination of these two 

adjustments. There are 2,479 nonteaching 

hospitals in our analysis, 816 teaching 

hospitals with fewer than 100 residents, and 

240 teaching hospitals with 100 or more 

residents. 

In the DSH categories, hospitals are 

grouped according to their DSH payment 

status, and whether they are considered 

urban or rural for DSH purposes. The next 

category groups together hospitals considered 

urban after geographic reclassification, in 

terms of whether they receive the IME 

adjustment, the DSH adjustment, both, or 

neither. 

The next five rows examine the impacts of 

the proposed changes on rural hospitals by 

special payment groups (SCHs, RRCs, and 

MDHs), as well as rural hospitals not 

receiving a special payment designation. 

There were 59 RRCs, 45 SCHs, 21 MDHs, 17 

hospitals that are both SCHs and RRCs, and 

1 hospital that is both MDH and RRC. 

The next series of groupings concern the 

geographic reclassification status of 

hospitals. The first grouping displays all 

urban hospitals that were reclassified by the 

MGCRB for FY 2008. The second grouping 

shows the MGCRB rural reclassifications. 

The final two groupings are based on the 

type of ownership and the hospital’s 

Medicare utilization expressed as a percent 

of total patient days. These data were taken 

from the FY 2004 Medicare cost reports. 

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BILLING CODE 4120–01–C 

C. Effects of the Proposed Changes to the 

DRG Reclassifications and Relative CostBased Weights (Column 2) 

In Column 2 of Table I, we present the 

combined effects of the proposed DRG 

reclassifications and recalibration, as 

discussed in section II. of the preamble to 

this proposed rule. Section 1886(d)(4)(C)(i) of 

the Act requires us annually to make 

appropriate classification changes in order to 

reflect changes in treatment patterns, 

technology, and any other factors that may 

change the relative use of hospital resources. 

As discussed in the preamble of this 

proposed rule, we are proposing to continue 

the 3-year transition from charge-based to 

cost-based relative weights. The proposed 

relative weights for FY 2008 will be 2⁄3 costbased and 1⁄3 charge-based. Further, we are 

proposing to adopt MS–DRGs that would 

increase the number of DRGs from 538 to 

745. In column 2, we compare aggregate 

payments using the proposed FY 2008 MS– 

DRGS (GROUPER Version 25.0) and blended 

relative weights to the FY 2007 CMS DRG 

blended relative weights (GROUPER Version 

24.0). The proposed methods of calculating 

the relative weights and the reclassification 

changes to the GROUPER are described in 

more detail in section II.H. of the preamble 

to this proposed rule. We note that, 

consistent with section 1886(d)(4)(C)(iii) of 

the Act, we are proposing to apply a budget 

neutrality factor to ensure that the overall 

payment impact of the proposed DRG 

changes (combined with the proposed wage 

index changes) is budget neutral. This 

proposed budget neutrality factor of 0.999317 

is applied to payments in Column 4 and not 

Column 2 because it is a combined DRG 

reclassification and recalibration and wage 

index budget neutrality factor. 

We estimate that proposed changes to the 

relative weights and DRGs will increase 

payments to hospitals located in large urban 

areas (populations over 1 million) by 

approximately 0.9 percent. These changes 

generally increase payments to hospitals in 

all urban areas (0.4 percent) and large 

teaching hospitals (0.7 percent). Rural 

hospitals will generally experience a 

decrease in payments from these changes (- 

1.8 percent). However, it is important to 

evaluate these changes together with the cost 

weights that we adopted in the FY 2007 IPPS 

final rule. We are adopting cost weights over 

a transition period from FY 2007 to FY 2009. 

The cost weights generally increased 

payments to rural hospitals. Column 2 shows 

the changes for the proposed rule only and 

therefore reflects the full payment impact of 

the MS–DRGs while showing only the FY 

2008 portion of the transition to cost weights 

finalized in last year’s rule. In FY 2007, we 

are paying hospitals using a blend of 1⁄3 cost 

and 2⁄3 charge relative weights. In FY 2008, 

we will pay hospitals using a blend of 2⁄3 cost 

and 1⁄3 charge relative weights. In FY 2009, 

we will pay hospitals using 100 percent cost 

relative weights. Therefore, there will likely 

be some additional increases in payments to 

rural hospitals from the final year of the 

transition to fully implemented cost weights 

that are not illustrated in the above table. 

Cardiac specialty hospitals would experience 

the greatest decline in payments (4.0 percent) 

from the proposed changes to adopt MS– 

DRGs and the blended relative cost weights. 

D. Effects of Proposed Wage Index Changes 

(Column 3) 

Section 1886(d)(3)(E) of the Act requires 

that, beginning October 1, 1993, we annually 

update the wage data used to calculate the 

wage index. In accordance with this 

requirement, the proposed wage index for FY 

2008 is based on data submitted for hospital 

cost reporting periods beginning on or after 

October 1, 2003 and before October 1, 2004. 

The estimated impact of the proposed wage 

data on hospital payments is isolated in 

Column 3 by holding the other payment 

parameters constant in this simulation. That 

is, Column 3 shows the percentage changes 

in payments when going from a model using 

the FY 2007 wage index, based on FY 2003 

wage data and having a 100-percent 

occupational mix adjustment applied, to a 

model using the FY 2008 pre-reclassification 

wage index, adjusted for occupational mix, 

based on FY 2004 wage data. The wage data 

collected on the FY 2004 cost report include 

overhead costs for contract labor that were 

not collected on FY 2003 and earlier cost 

reports. The impacts below incorporate the 

effects of the FY 2004 wage data collected on 

hospital cost reports, including additional 

overhead costs for contract labor compared to 

the wage data from FY 2003 cost reports that 

were used to calculate the FY 2007 wage 

index. 

Column 3 shows the impacts of updating 

the wage data using FY 2004 cost reports. 

Overall, the new wage data will lead to a -0.1 

percent change for all hospitals. This 

decrease could be attributed to fluctuations 

in the wage data. Among the regions, the 

largest increase is in the rural Pacific region, 

which experiences a 0.5 percent increase. 

The largest decline from updating the wage 

data is seen in the Puerto Rico region (a 0.5 

percent decrease). 

In looking at the wage data itself, the 

national average hourly wage increased 4.3 

percent compared to FY 2007. Therefore, the 

only manner in which to maintain or exceed 

the previous year’s wage index was to match 

or exceed the national 4.3 percent increase in 

average hourly wage. Of the 3,486 hospitals 

with wage data for both FYs 2007 and 2008, 

1,709, or 49.0 percent, experienced an 

average hourly wage increase of 4.3 percent 

or more. 

The following chart compares the shifts in 

wage index values for hospitals for FY 2008 

relative to FY 2007. Among urban hospitals, 

52 will experience an increase of more than 

5 percent and less than 10 percent and 6 will 

experience an increase of more than 10 

percent. Among rural hospitals, 21 will 

experience an increase of more than 5 

percent and less than 10 percent, and 4 will 

experience an increase of more than 10 

percent. However, 965 rural hospitals will 

experience increases or decreases of less than 

5 percent, while 2,384 urban hospitals will 

experience increases or decreases of less than 

5 percent. Thirty-three urban hospitals will 

experience decreases in their wage index 

values of more than 5 percent and less than 

10 percent. Twenty-one urban hospitals will 

experience decreases in their wage index 

values of greater than 10 percent. No rural 

hospitals will experience decreases of more 

than 5 percent. 

The following chart shows the projected 

impact for urban and rural hospitals. 

Percentage change in area wage index values 

Number of hospitals 

Urban Rural 

Increase more than 10 percent ............................................................................................................................................... 6 4 

Increase more than 5 percent and less than 10 percent ........................................................................................................ 52 21 

Increase or decrease less than 5 percent ............................................................................................................................... 2,384 965 

Decrease more than 5 percent and less than 10 percent ...................................................................................................... 33 0 

Decrease more than 10 percent .............................................................................................................................................. 21 0 

E. Combined Effects of Proposed DRG and 

Wage Index Changes (Column 4) 

Section 1886(d)(4)(C)(iii) of the Act 

requires that changes to DRG reclassifications 

and the relative weights cannot increase or 

decrease aggregate payments. In addition, 

section 1886(d)(3)(E) of the Act specifies that 

any updates or adjustments to the wage index 

are to be budget neutral. As noted in the 

Addendum to this proposed rule, in 

determining the budget neutrality factor, we 

equated simulated aggregate payments for FY 

2007 and FY 2008 using the FY 2006 

Medicare utilization data after applying the 

proposed changes to the DRG relative 

weights and the wage index. 

We computed a wage and DRG 

recalibration budget neutrality factor of 

0.999317. The 0.0 percent impact for all 

hospitals demonstrates that these proposed 

changes, in combination with the proposed 

budget neutrality factor, are budget neutral. 

In Table I, the combined overall impacts of 

the effects of both the proposed DRG 

reclassifications and the updated wage index 

are shown in Column 4. The estimated 

changes shown in this column reflect the 

combined effects of the proposed changes in 

Columns 2 and 3 and the budget neutrality 

factor for the revised FY 2008 wage index. 

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Due to the proposed changes to the 

application of the rural floor budget 

neutrality, this column does not include the 

wage index floor for urban areas as required 

by section 4410 of Pub. L. 105–33. The effects 

of that provision are included in Column 7. 

There also may be some variation of plus or 

minus 0.1 percentage point due to rounding. 

F. Effects of the Expiration of the 3-Year 

Provision Allowing Urban Hospitals That 

Were Converted to Rural as a Result of the 

FY 2005 Labor Market Area Changes To 

Maintain the Wage Index of the Urban Labor 

Market Area in Which They Were Formerly 

Located (Column 5) 

The policy adopted in FY 2005 for urban 

hospitals that became rural under the new 

labor market area definitions is to expire in 

FY 2008. In FY 2005, we adopted a policy 

that allowed urban hospitals that became 

rural under the new labor market area regions 

to maintain the wage index assignment of the 

MSA where they were located for the 3-year 

period FY 2005, FY 2006, and FY 2007. 

Beginning in FY 2008, these hospitals will 

receive their statewide rural wage index or 

their FY 2008 MGCRB reclassified wage 

index. Column 5 shows the impact of the 

expiration of the labor market area transition 

for those hospitals that were urban under the 

old labor market area designations and are 

now considered rural hospitals. Currently, 

the rural hospital row shows a 0.2 percent 

decrease from the end of the provision as 

these hold harmless hospitals are now 

considered geographically rural and are now 

receiving the wage index of the MSA where 

they are currently located. 

G. Effects of MGCRB Reclassifications 

(Column 6) 

Our impact analysis to this point has 

assumed hospitals are paid on the basis of 

their actual geographic location (with the 

exception of ongoing policies that provide 

that certain hospitals receive payments on 

other bases than where they are 

geographically located). The proposed 

changes in Column 6 reflect the per case 

payment impact of moving from this baseline 

to a simulation incorporating the MGCRB 

decisions for FY 2008 which affect hospitals’ 

wage index area assignments. 

By February 28 of each year, the MGCRB 

makes reclassification determinations that 

will be effective for the next fiscal year, 

which begins on October 1. The MGCRB may 

approve a hospital’s reclassification request 

for the purpose of using another area’s wage 

index value. The proposed FY 2008 wage 

index values incorporate all of the MGCRB’s 

reclassification decisions for FY 2008. The 

wage index values also reflect any decisions 

made by the CMS Administrator through the 

appeals and review process through February 

28, 2007. 

The overall effect of geographic 

reclassification is required by section 

1886(d)(8)(D) of the Act to be budget neutral. 

Therefore, we are proposing to apply an 

adjustment of 0.991938 to ensure that the 

effects of the section 1886(d)(10) 

reclassifications are budget neutral. (See 

section II.A. of the Addendum to this 

proposed rule.) Geographic reclassification 

generally benefits hospitals in rural areas. We 

estimate that geographic reclassification will 

increase payments to rural hospitals by an 

average of 1.7 percent. 

H. Effects of the Adjustment to the 

Application of the Rural Floor (Column 7) 

As discussed in section III.G. of the 

preamble of this proposed rule, section 4410 

of Pub. L. 105–33 established the rural floor 

by requiring that the wage index for a 

hospital in any urban area cannot be less 

than the area wage index determined for the 

state’s rural area. Since FY 1998, we have 

implemented this provision by adjusting the 

standardized amounts. In this proposed rule, 

we are proposing to change how we apply 

budget neutrality to the rural floor beginning 

in FY 2008. Rather than applying a budget 

neutrality adjustment to the standardized 

amount, a uniform budget neutrality 

adjustment would be applied to the wage 

index. Therefore, we are proposing to apply 

an adjustment to the wage index of 0.997084 

(-0.29 percent) to ensure that the rural floor 

adjustments are budget neutral as indicated 

by the zero effect on payments to hospitals 

overall. 

Column 7 shows the projected impact of 

change in the application of the rural floor. 

The column compares the postreclassification FY 2008 wage index of 

providers before the rural floor adjustment 

and the post-reclassification FY 2008 wage 

index of providers with the rural floor 

adjustment. Only urban hospitals can benefit 

from the rural floor provision. Because the 

provision is budget neutral, all other 

hospitals (that is, all rural hospitals and those 

urban hospitals to which the adjustment is 

not made) will experience a decrease in 

payments due to the budget neutrality 

adjustment. We project rural hospitals will 

experience a 0.1 percent decrease in 

payments. We project hospitals located in 

other urban areas (populations of 1 million 

or fewer) will experience a 0.1 percent 

increase in payments. The rural floor will 

benefit 77 percent of the hospitals in New 

Hampshire (10) and 45 percent of the 

hospitals in Connecticut (15), explaining the 

average increase of 1 percent shown in the 

table for hospitals located in New England. 

The average increase among hospitals in the 

Pacific region is estimated at 0.4 percent and 

is explained by application of the rural floor 

to 34 percent of the hospitals in California 

(114) and 18 percent of the hospitals in 

Washington (9). 

I. Effects of the Expiration of the Imputed 

Rural Floor (Column 8) 

The FY 2005 IPPS final rule (69 FR 49109) 

established a temporary imputed rural floor 

for all urban States from FY 2005 to FY 2007. 

The rural floor requires that an urban wage 

index cannot be lower than the wage index 

for any rural hospital in that State. Therefore, 

an imputed rural floor was established for 

States that do not have rural areas or rural 

IPPS hospitals. The provision will expire at 

the end of FY 2007 unless we were to adopt 

a change to the regulation to continue it for 

FY 2008. 

Column 8 shows the effects of the 

expiration of the imputed rural floor. Only 

hospitals located in Massachusetts and New 

Jersey were affected by the provision. 

However, as explained in section III.G. of the 

preamble of this proposed rule, the imputed 

rural floor will no longer apply in 

Massachusetts even if it were to be continued 

because one hospital acquired rural status 

under § 412.103 of the regulations. Urban 

providers in New England (MA) and the MidAtlantic region (NJ) will experience a 

decrease by 0.1 percent and by 0.2 percent 

respectively from the imputed rural floor no 

longer being applied in those States. 

J. Effects of the Expiration of Section 508 of 

Pub. L. 108–173 (Column 9) 

Section 508 of Pub. L. 108–173 will expire 

on September 30, 2007. As stated in the FY 

2007 IPPS final rule (71 FR 48333), we 

established procedural rules under section 

1886(d)(10)(D)(v) of the Act to address 

specific circumstances where individual and 

group reclassifications involve a section 508 

hospital. In the final rule, the rules were 

designed to recognize the special 

circumstances of section 508 hospital 

reclassifications ending mid-year during FY 

2007 and were intended to allow previously 

approved reclassifications to continue 

through March 31, 2007, and new section 

1886(d)(10) reclassifications to begin April 1, 

2007, upon the conclusion of the section 508 

reclassifications. Under these procedural 

rules, some section 1886(d)(10) hospital 

reclassifications are only in effect for the 

second half of the fiscal year. However, 

Division B, Title I, section 106(a) of the 

MIEA-TRHCA (Pub. L. 109–432) extended 

any geographic reclassifications of hospitals 

that would expire on March 31, 2007, by 6 

months until September 30, 2007. For FY 

2008, the providers that had been reclassified 

under section 508 in FY 2007 will receive 

payment using the wage index for the area 

where they are currently located. The impact 

of the expiration of the policy is modeled in 

Column 9 of Table I. Section 508 of Pub. L. 

108–173 was not a budget neutral provision 

of statute. Its enactment increased total 

payments for Medicare inpatient hospital 

services. Therefore, relative to FY 2007, the 

expiration of section 508 of Pub. L. 108–173 

will reduce Medicare inpatient hospital 

payments by an estimated 0.1 percent. 

K. Effects of the Proposed Wage Index 

Adjustment for Out-Migration (Column 10) 

Section 1886(d)(13) of the Act, as added by 

section 505 of Pub. L. 108–173, provides for 

an increase in the wage index for hospitals 

located in certain counties that have a 

relatively high percentage of hospital 

employees who reside in the county, but 

work in a different area with a higher wage 

index. Hospitals located in counties that 

qualify for the payment adjustment are to 

receive an increase in the wage index that is 

equal to a weighted average of the difference 

between the wage index of the resident 

county, post-reclassification and the higher 

wage index work area(s), weighted by the 

overall percentage of workers who are 

employed in an area with a higher wage 

index. With the out-migration adjustment, 

rural providers will experience a 0.1 percent 

increase in payments in FY 2008 relative to 

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no adjustment at all. We included these 

additional payments to providers in the 

impact table shown above, and we estimate 

the impact of these providers receiving the 

out-migration increase to be approximately 

$15 million. 

L. Effects of All Proposed Changes With CMI 

Adjustment Prior to Assumed Growth 

(Column 11) 

Column 11 compares our estimate of 

payments per case between FY 2007 and FY 

2008 with all proposed changes reflected in 

this proposed rule for FY 2008 including a 

0.976 adjustment to the payment rates to 

account for anticipated improvements in 

documentation and coding that is expected to 

increase case-mix. We generally apply an 

adjustment to the DRGs to ensure budget 

neutrality assuming constant utilization. 

However, with the proposed adoption of the 

MS-DRGs, the number of DRGs will expand 

from 538 to 745. Therefore, we expect an 

increase in the CMI due to improved coding 

and have applied an additional adjustment to 

achieve budget neutrality. However, because 

we modeled the impact, including the 

adjustment for anticipated case-mix increase 

but not the actual case-mix increase itself in 

column 11, this column illustrates a total 

payment changes that is less than what is 

anticipated to occur. 

M. Effects of All Proposed Changes With CMI 

Adjustment and Assumed Growth (Column 

12) 

Column 12 compares our estimate of 

payments per case between FY 2007 and FY 

2008, incorporating all proposed changes 

reflected in this proposed rule for FY 2008 

(including statutory changes). This column 

includes all of the proposed policy changes 

and assumes the 2.4 percent increase in casemix from improved documentation and 

coding will occur equally across all hospitals. 

Column 12 reflects the impact of all 

proposed FY 2008 changes relative to FY 

2007, including those shown in Columns 2 

through 10. The average increase for all 

hospitals is approximately 3.3 percent. This 

increase includes the effects of the proposed 

3.3 percent market basket update. It also 

reflects the 0.2 percentage point difference 

between the projected outlier payments in FY 

2008 (5.1 percent of total DRG payments) and 

the current estimate of the percentage of 

actual outlier payments in FY 2007 (4.9 

percent), as described in the introduction to 

this Appendix and the Addendum to this 

proposed rule. As a result, payments are 

projected to be 0.2 percentage points lower 

in FY 2007 than originally estimated, 

resulting in a 0.2 percentage point greater 

increase for FY 2008 than would otherwise 

occur. In addition, the impact of expiration 

of section 508 of Pub. L. 108–173 

reclassification accounts for a 0.1 percent 

decrease in estimated payments. As stated 

earlier, section 1886(d)(13) of the Act 

provides for an increase in the wage index for 

hospitals located in certain counties that 

have a relatively high percentage of hospital 

employees who reside in the county, but 

work in a different area with a higher wage 

index. This provision of the statute is not 

budget neutral. Although the out-migration 

adjustment will increase payments to some 

hospitals in FY 2008 relative to not having 

an adjustment at all, the total number of 

hospitals receiving the adjustment will be 

less in FY 2008 than FY 2007, resulting in 

a 0.1 percent reduction in total IPPS 

payments. There might also be interactive 

effects among the various factors comprising 

the payment system that we are not able to 

isolate. For these reasons, the values in 

Column 10 may not equal the product of the 

percentage changes described above. 

The proposed overall change in payments 

per case for hospitals in FY 2008 is estimated 

to increase by 3.3 percent. Hospitals in urban 

areas would experience an estimated 3.6 

percent increase in payments per case 

compared to FY 2007. Hospitals in large 

urban areas would experience an estimated 

4.2 percent increase and hospitals in other 

urban areas would experience an estimated 

2.8 percent increase in payments per case in 

FY 2008. Hospitals’ payments per case in 

rural areas are estimated to increase 0.9 

percent. 

Among urban census divisions, the largest 

estimated payment increases would be 4.7 

percent in the Pacific region and 4.2 percent 

in the South Atlantic region. The smallest 

urban increase is estimated at 2.6 percent in 

the New England region. 

Among rural regions in Column 12, the 

providers in the West South Central region 

experience an estimated decrease in 

payments by 0.7 percent. The Pacific and 

South Atlantic regions would benefit the 

most, with 2.0 and 1.8 percent estimated 

increases, respectively. 

Among special categories of rural hospitals 

in Column 12, the one MDH/RRC provider 

would experience an estimated decrease in 

payments of 0.8 percent and MDH providers 

would receive an estimated increase of 0.3 

percent. RRCs would experience an 

estimated increase in payments by 2.5 

percent. 

Urban hospitals reclassified for FY 2008 

are anticipated to receive an increase of 3.3 

percent, while urban hospitals that not 

reclassified for FY 2008 are expected to 

receive an increase of 3.6 percent. Rural 

hospitals reclassifying for FY 2008 are 

anticipated to receive a 1.5 percent payment 

increase. 

N. Effects of Proposed Policy on Payment 

Adjustments for Low-Volume Hospitals 

For FY 2008, we are proposing to continue 

to apply the volume adjustment criteria we 

specified in the FY 2005 IPPS final rule (69 

FR 49099). We expect that three providers 

would receive the low-volume adjustment for 

FY 2008. We included these additional 

payments to providers in the impact table 

shown above and we estimate the impact of 

these providers receiving the additional 25- 

percent payment increase to be 

approximately $50,000. 

O. Impact Analysis of Table II 

Table II presents the projected impact of 

the proposed changes for FY 2008 for urban 

and rural hospitals and for the different 

categories of hospitals shown in Table I. It 

compares the estimated payments per case 

for FY 2007 with the proposed average 

estimated per case payments for FY 2008, as 

calculated under our models. Thus, this table 

presents, in terms of the average dollar 

amounts paid per discharge, the combined 

effects of the proposed changes presented in 

Table I. The proposed percentage changes 

shown in the last column of Table II equal 

the percentage changes in average payments 

from Column 12 of Table I. 

TABLE II.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2008 OPERATING PROSPECTIVE PAYMENT SYSTEM

[Payments per case] 

Number of 

hospitals 

(1) 

Average FY 

2007 payment per 

case 1

(2) 

Average proposed FY 

2008 payment per 

case 1

(3) 

All proposed 

FY 2008 

changes 

(4) 

All hospitals ....................................................................................................................................... 3535 9004 9299 3.3 

By Geographic Location: 

Urban hospitals .......................................................................................................................... 2540 9343 9678 3.6 

Large urban areas (populations over 1 million) ......................................................................... 1409 9750 10156 4.2 

Other urban areas (populations of 1 million or fewer) .............................................................. 1131 8854 9103 2.8 

Rural hospitals ........................................................................................................................... 995 7060 7123 0.9 

Bed Size (Urban): 

0–99 beds .................................................................................................................................. 632 7236 7263 0.4 

100–199 beds ............................................................................................................................ 849 7904 8170 3.4 

200–299 beds ............................................................................................................................ 480 8815 9120 3.5 

300–499 beds ............................................................................................................................ 412 9749 10136 4.0 

500 or more beds ...................................................................................................................... 167 11762 12234 4.0 

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TABLE II.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2008 OPERATING PROSPECTIVE PAYMENT SYSTEM— 

Continued 

[Payments per case] 

Number of 

hospitals 

(1) 

Average FY 

2007 payment per 

case 1

(2) 

Average proposed FY 

2008 payment per 

case 1

(3) 

All proposed 

FY 2008 

changes 

(4) 

Bed Size (Rural): 

0–49 beds .................................................................................................................................. 342 6161 6065 -1.6 

50–99 beds ................................................................................................................................ 369 6558 6588 0.5 

100–149 beds ............................................................................................................................ 172 6867 6960 1.3 

150–199 beds ............................................................................................................................ 67 7626 7735 1.4 

200 or more beds ...................................................................................................................... 45 8759 8938 2.0 

Urban by Region: 

New England .............................................................................................................................. 126 9748 10001 2.6 

Middle Atlantic ............................................................................................................................ 350 10243 10529 2.8 

South Atlantic ............................................................................................................................. 388 8801 9175 4.2 

East North Central ..................................................................................................................... 395 8890 9197 3.4 

East South Central ..................................................................................................................... 166 8512 8784 3.2 

West North Central .................................................................................................................... 156 9064 9321 2.8 

West South Central .................................................................................................................... 358 8819 9174 4.0 

Mountain .................................................................................................................................... 153 9507 9826 3.3 

Pacific ......................................................................................................................................... 395 11136 11657 4.7 

Puerto Rico ................................................................................................................................ 53 4368 4525 3.6 

Rural by Region: 

New England .............................................................................................................................. 19 9675 9714 0.4 

Middle Atlantic ............................................................................................................................ 72 7466 7525 0.8 

South Atlantic ............................................................................................................................. 173 6579 6700 1.8 

East North Central ..................................................................................................................... 124 7521 7574 0.7 

East South Central ..................................................................................................................... 177 6400 6479 1.2 

West North Central .................................................................................................................... 115 7743 7792 0.6 

West South Central .................................................................................................................... 194 6381 6339 -0.7 

Mountain .................................................................................................................................... 80 7766 7834 0.9 

Pacific ......................................................................................................................................... 41 8725 8896 2.0 

By Payment Classification: 

Urban hospitals .......................................................................................................................... 2619 9298 9629 3.6 

Large urban areas (populations over 1 million) ......................................................................... 1436 9725 10127 4.1 

Other urban areas (populations of 1 million or fewer) .............................................................. 1183 8789 9034 2.8 

Rural areas ................................................................................................................................ 916 7175 7242 0.9 

Teaching Status: 

Non-teaching .............................................................................................................................. 2479 7648 7851 2.7 

Fewer than 100 Residents ......................................................................................................... 816 9067 9384 3.5 

100 or more Residents .............................................................................................................. 240 13006 13533 4.1 

Urban DSH: 

Non-DSH .................................................................................................................................... 879 8146 8307 2.0 

100 or more beds ...................................................................................................................... 1527 9792 10182 4.0 

Less than 100 beds ................................................................................................................... 359 6574 6697 1.9 

Rural DSH: 

SCH ............................................................................................................................................ 391 6992 7013 0.3 

RRC ........................................................................................................................................... 189 7686 7818 1.7 

100 or more beds ...................................................................................................................... 36 5902 6028 2.1 

Less than 100 beds ................................................................................................................... 154 5333 5353 0.4 

Urban teaching and DSH: 

Both teaching and DSH ............................................................................................................. 805 10750 11185 4.0 

Teaching and no DSH ............................................................................................................... 192 8861 9078 2.5 

No teaching and DSH ................................................................................................................ 1081 7990 8283 3.7 

No teaching and no DSH ........................................................................................................... 541 7664 7812 1.9 

Rural Hospital Types: 

RRC ........................................................................................................................................... 59 8155 8358 2.5 

SCH ............................................................................................................................................ 45 9225 9301 0.8 

MDH ........................................................................................................................................... 21 6321 6339 0.3 

SCH and RRC ........................................................................................................................... 17 9968 10239 2.7 

MDH and RRC ........................................................................................................................... 1 9755 9674 -0.8 

Type of Ownership: 

Voluntary .................................................................................................................................... 2069 9136 9424 3.2 

Proprietary .................................................................................................................................. 823 8173 8478 3.7 

Government ............................................................................................................................... 598 9270 9593 3.5 

Medicare Utilization as a Percent of Inpatient Days: 

0–25 ........................................................................................................................................... 230 12731 13443 5.6 

25–50 ......................................................................................................................................... 1292 10160 10570 4.0 

50–65 ......................................................................................................................................... 1453 7913 8116 2.6 

Over 65 ...................................................................................................................................... 441 7240 7331 1.2 

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TABLE II.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2008 OPERATING PROSPECTIVE PAYMENT SYSTEM— 

Continued 

[Payments per case] 

Number of 

hospitals 

(1) 

Average FY 

2007 payment per 

case 1

(2) 

Average proposed FY 

2008 payment per 

case 1

(3) 

All proposed 

FY 2008 

changes 

(4) 

Hospitals Reclassified by the Medicare Geographic Classification Review Board: 

FY 2008 Reclassifications: 

All Reclassified Hospitals FY 2008 ............................................................................................ 801 8695 8938 2.8 

All Non-Reclassified Hospitals FY 2008 .................................................................................... 2734 9106 9417 3.4 

Urban Reclassified Hospitals FY 2008 ...................................................................................... 434 9273 9581 3.3 

Urban Non-reclassified Hospitals FY 2008 ............................................................................... 2105 9359 9701 3.6 

Rural Reclassified Hospitals FY 2008 ....................................................................................... 367 7555 7669 1.5 

Rural Nonreclassified Hospitals FY 2008 .................................................................................. 568 6411 6392 -0.3 

All Section 401 Reclassified Hospitals ...................................................................................... 31 8647 8799 1.8 

Other Reclassified Hospitals (Section 1886(d)(8)(B)) ............................................................... 61 6635 6729 1.4 

Former Section 508 Hospitals ................................................................................................... 107 9766 9814 0.5 

Specialty Hospitals: 

Cardiac Specialty Hospitals ....................................................................................................... 22 10736 10676 -0.6 

1 These payment amounts per case do not reflect any estimates of annual case-mix increase. 

VII. Effects of Other Proposed Policy 

Changes 

In addition to those proposed policy 

changes discussed above that we are able to 

model using our IPPS payment simulation 

model, we are proposing to make various 

other changes in this proposed rule. 

Generally, we have limited or no specific 

data available with which to estimate the 

impacts of these proposed changes. Our 

estimates of the likely impacts associated 

with these other proposed changes are 

discussed below. 

A. Effects of Proposed Policy on HospitalAcquired Conditions, Including Infections 

In section II.F. of the preamble of this 

proposed rule, we discuss our proposal to 

implement section 5001(c) of Pub. L. 109– 

171, which requires the Secretary to identify, 

by October 1, 2007, at least two conditions 

that are (a) high cost or high volume or both, 

(2) result in the assignment of a case to a DRG 

that has a higher payment when present as 

a secondary diagnosis, and (c) could 

reasonably have been prevented through 

application of evidence-based guidelines. For 

discharges occurring on or after October 1, 

2008, hospitals will not receive additional 

payment for cases in which one of the 

selected conditions was not present on 

admission. That is, the case will be paid as 

though the secondary diagnosis was not 

present. However, the statute also requires 

the Secretary to continue counting the 

condition as a secondary diagnosis that 

results in a higher IPPS payment when doing 

the budget neutrality calculations for DRG 

reclassifications and recalibration. Therefore, 

we do our budget neutrality calculations as 

though the payment provision did not apply 

but Medicare will make a lower payment to 

the hospital for the specific case that 

includes the secondary diagnosis. Thus, the 

provision will result in cost savings to the 

Medicare program. 

Although we believe there will be modest 

savings to the Medicare program from 

implementation of this provision, we cannot 

estimate them at this time. To estimate 

savings associated with this provision, we 

would need to know the frequency that the 

selected conditions are not present on 

admission in the Medicare population. 

Medicare will not begin collecting this 

information from hospitals until October 1, 

2007. Therefore, there is currently no data 

upon which to estimate the savings of this 

provision. The provision does not go into 

effect until October 1, 2008. For this reason, 

there will be no savings for FY 2008. Any 

savings associated with this provision will 

not be realized until FY 2009. Based on the 

data available to us for next year’s IPPS rule, 

we will estimate the savings associated with 

the conditions we selected under this 

provision for FY 2009 and subsequent years. 

We further note that the provision will 

only apply when the selected conditions are 

the only secondary diagnosis present on the 

claim that will lead to higher payment. 

Therefore, if a nonselected secondary 

diagnosis that leads to the same higher 

payment is on the claim, the case will 

continue to be assigned to the higher paying 

DRG and there will be no savings to Medicare 

from the case. Our analysis of the Medicare 

claims suggests that patients will generally 

have multiple secondary diagnoses during a 

hospital stay. Patients having one MCC or CC 

will frequently have additional conditions 

that also lead to higher payment. In only a 

small percentage of the cases did we find that 

a patient had only one secondary diagnosis 

that would lead to higher payment, and in 

these cases, we have no information to 

suggest whether the condition was acquired 

after admission. Therefore, we believe the 

savings associated with this provision are 

likely to be very modest. Again, once we 

have data on the frequency of occurrence of 

the selected conditions after admission, we 

will refine our analysis. 

B. Effects of Proposed MS–LTC–DRG 

Reclassifications and Relative Weights for 

LTCHs 

In section II.I. of the preamble to this final 

rule, we discuss the proposed changes to 

adopt MS–LTC–DRG relative weights for FY 

2008, which are based on the Version 25.0 of 

the CMS GROUPER (including the changes in 

the classifications, relative weights, and 

geometric mean length of stay for each 

proposed MS–LTC–DRG). We noted in the 

same section that, in the FY 2008 LTCH PPS 

proposed rule (72 FR 4784 through 4786), we 

proposed that, beginning with the MS–LTC– 

DRG update for FY 2008, the annual update 

to the proposed MS–LTC–DRG classifications 

and relative weights would be done in a 

budget neutral manner, such that estimated 

aggregate LTCH PPS payments would be 

unaffected; that is, they would be neither 

greater than nor less than the estimated 

aggregate LTCH PPS payments that would 

have been made without the proposed MS– 

LTC–DRG classification and relative weight 

changes. However, if the budget neutrality 

policy had not been proposed, we are 

estimating that, under the current payment 

policies (RY 2007), using the most recent 

available claims data (FY 2006 MedPAR files) 

for the 376 LTCHs in our database, the 

proposed changes to the MS–LTC–DRG 

classifications and relative weights for FY 

2008 would have resulted in an aggregate 

decrease in LTCH PPS payments of 

approximately 1.6 percent. In applying the 

budget neutrality adjustment described 

above, we assumed constant utilization. 

However, with the proposed adoption of the 

MS–LTC–DRGs, we expect an increase in 

coding or classification of discharges that do 

not reflect real change in case-mix due to the 

adoption of the new patient classification 

system. Therefore, we have applied an 

additional adjustment of 0.976 to the 

proposed MS–LTC–DRG relative weights for 

the anticipated increase in case-mix due to 

improved documentation and coding. 

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C. Effects of Proposed New Technology AddOn Payments 

In section II.I. of the preamble to this 

proposed rule, we discuss proposed add-on 

payments for new medical services and 

technologies. As explained in that section, 

we are not required to ensure that any addon payments for new technology under 

section 1886(d)(5)(K) of the Act are budget 

neutral. As discussed earlier in this proposed 

rule, we have yet to determine whether 

Wingspan[supreg] meets the criteria for new 

technology add-on payments for FY 2008. 

Therefore, it is premature to estimate the 

potential payment impact in FY 2008 of any 

potential decision to make new technology 

add-on payments for Wingspan[supreg]. In 

addition, for FY 2008, we have proposed to 

discontinue new technology add-on 

payments for GORE TAG, Restore[supreg], 

and X STOP. In the FY 2007 IPPS final rule 

(71 FR 48344), we estimated that FY 2007 

IPPS new technology add-on payments 

would be $16.61 million, $6.01 million, and 

$9.35 million, respectively, for these 

technologies. We have no additional 

information to further refine these estimates. 

Therefore, we estimate that Medicare’s new 

technology add-on payments will decline by 

approximately $32 million (the sum of our 

estimates for FY 2007) in FY 2008 compared 

to FY 2007. 

D. Effects of Requirements for Hospital 

Reporting of Quality Data for Annual 

Hospital Payment Update 

In section IV.A. of the preamble of this 

proposed rule, we discuss the requirements 

for hospitals to report quality data in order 

for hospitals to receive the full annual 

hospital payment update for FY 2008 and FY 

2009. We also note that, for the FY 2008 

payment update, hospitals must pass our 

validation requirement of a minimum of 80 

percent reliability, based upon our chartaudit validation process, for the first three 

quarters of data from CY 2006. These data 

were due to the QIO Clinical Warehouse by 

August 15, 2006 (first quarter CY 2006 

discharges), November 15, 2006 (second 

quarter CY 2006 discharges), and February 

15, 2007 (third quarter CY 2006 discharges). 

We have continued our efforts to ensure that 

QIOs provide assistance to all hospitals that 

wish to submit data. In the preamble of this 

proposed rule, we are providing additional 

validation criteria to ensure that the quality 

data being sent to CMS are accurate. The 

requirement of 5 charts per hospital will 

result in approximately 21,500 charts per 

quarter total submitted to the agency. We 

reimburse hospitals for the cost of sending 

charts to the Clinical Data Abstraction Center 

(CDAC) at the rate of 12 cents per page for 

copying and approximately $4.00 per chart 

for postage. Our experience shows that the 

average chart received at the CDAC is 

approximately 150 pages. Thus, the agency 

will have expenditures of approximately 

$473,200 per quarter to collect the charts. 

Given that we reimburse for the data 

collection effort, we believe that a 

requirement for five charts per hospital per 

quarter represents a minimal burden to the 

participating hospital. 

E. Effects of Proposed Policy on Cancellation 

of Classification of Acquired Rural Status 

and Rural Referral Centers 

In section IV.C.2. of the preamble of this 

proposed rule, we are proposing to revise our 

regulations to change the effective date of 

cancellation of acquired rural status for rural 

referral centers from ‘‘the hospital’s next full 

cost reporting period following the date of its 

request for cancellation’’ to the next cost 

reporting period for hospitals paid on the 

basis of reasonable costs (such as CAHs) and 

for hospitals under the IPPS, after at least one 

12-month cost reporting period as rural and 

not until the beginning of the Federal fiscal 

year following the date of its request for 

cancellation. Currently, there are about 100 

IPPS hospitals that have acquired rural 

status. During this fiscal year (FY 2007), we 

have only received requests for cancellations 

from five hospitals. However, this number 

may increase if the current policy is not 

changed. We anticipate that the proposed 

policy change would, at a minimum, affect 

these five hospitals. However, we estimate 

that the proposed policy change would not 

have a significant impact on IPPS hospitals. 

F. Effects of Proposed Policy on Payment for 

IME and Direct GME 

In section IV.D.3. of the preamble of this 

proposed rule, we discuss our proposed 

changes related to whether vacation and sick 

leave as well as orientation should be 

included in the FTE count for IME and direct 

GME payment purposes. We are proposing, 

for cost reporting periods beginning on or 

after October, 1, 2007, for direct GME and 

IME, that time spent by residents on vacation 

or sick leave be removed from the total time 

considered to constitute an FTE resident. In 

addition, we are proposing to continue our 

existing policy to count time spent by 

residents in orientation activities for both 

IME and direct GME payment purposes. 

Because we are proposing to remove vacation 

and sick leave from the total time considered 

to constitute an FTE resident, we believe the 

impact of this change would be negligible. In 

addition, there is no impact from the 

clarification of the policy for orientation time 

since it is not a change in policy. 

G. Effects of Proposed Policy Changes 

Relating to Emergency Services Under 

EMTALA During an Emergency Period 

In section IV.F. of the preamble of this 

proposed rule, we are proposing to amend 

the EMTALA regulations regarding EMTALA 

implementation in emergency areas during 

an emergency period. Section 1135 of the Act 

authorizes the Secretary to temporarily waive 

or modify the application of several 

requirements and their implementing 

regulations as they relate to actions taken in 

an emergency area during an emergency 

period. The EMTALA regulations (§

489.24(a)(2)) now specify that sanctions for 

inappropriate transfer during a national 

emergency do not apply to a hospital with a 

dedicated emergency department located in 

an emergency area. 

To make our regulations better reflect the 

scope of the authority under section 1135 of 

the Act, we are proposing to revise them to 

clarify that such waivers also may apply to 

sanctions for the redirection or relocation of 

an individual to an alternate location to 

receive a medical screening examination 

where that direction or relocation occurs 

pursuant to a State emergency preparedness 

plan. We also are proposing to revise the 

regulations to incorporate changes made by 

the Pandemic and All-Hazards Preparedness 

Act. That legislation amended section 1135 

of the Act to state that, in the case of a public 

health emergency that involves a pandemic 

infectious disease, sanctions for the direction 

or relocation of an individual to an 

alternative location for screening may be 

waived based on either a State emergency 

preparedness plan or a State pandemic 

preparedness plan, whichever applies in the 

State. In addition, section 1135 of the Act 

was amended to create an exception to the 

otherwise applicable 72-hour limitation on 

the duration of waivers or modifications of 

sanctions for EMTALA violations in cases 

where a public health emergency involves a 

pandemic infectious disease (such as 

pandemic influenza). 

As described more fully earlier in this 

preamble, these changes are not discretionary 

and do not impose any substantive new 

requirements. On the contrary, they merely 

update our regulations to make them 

consistent with current statutory 

requirements. Because of this, we are 

estimating no impact on Medicare 

expenditures and no significant impact on 

hospitals with emergency departments. 

H. Effects of Proposed Policy on Disclosure 

of Physician Ownership in Hospitals and 

Patient Safety Measures 

In section IV.G. of the preamble of this 

proposed rule, we discuss our proposals to 

adopt a requirement relating to disclosure of 

physician ownership in hospitals and to 

increase patient safety measures. In the 

strategic and implementing plan included in 

our ‘‘Final Report to the Congress and 

Strategic and Implementing Plan’’ required 

under section 5006 of the Deficit Reduction 

Act of 2005, we stated that we would adopt 

a disclosure requirement that would require 

hospitals to disclose to patients whether they 

are physician-owned and, if so, the names of 

the physician-owners. In addition, we 

recognize that patients should be made aware 

of whether or not a physician is present in 

the hospital at all times, and the hospital’s 

plans to address patients’ emergency medical 

conditions when a physician is not present. 

We believe this proposed rule would 

impose minimal additional costs on 

hospitals. We believe the cost of 

implementing these provisions borne by 

hospitals would be limited to a one-time cost 

associated with completing minor revisions 

to portions of the medical staff bylaws and 

policies and procedures related to patient 

admission and registration, as well as 

providing written notification to patients and 

affected staff. In addition, the proposed 

changes concerning disclosure of physician 

ownership in hospitals are consistent with 

current practices of members of the 

physician-owned specialty hospital 

associations. Therefore, we do not believe 

that these proposed changes will have any 

significant economic impact on hospitals. 

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25130 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

I. Effects of Implementation of Rural 

Community Hospital Demonstration Program 

In section IV.H. of the preamble to this 

proposed rule, we discuss our 

implementation of section 410A of Pub. L. 

108–173 that required the Secretary to 

establish a demonstration that will modify 

reimbursement for inpatient services for up 

to 15 small rural hospitals. Section 

410A(c)(2) requires that ‘‘in conducting the 

demonstration program under this section, 

the Secretary shall ensure that the aggregate 

payments made by the Secretary do not 

exceed the amount which the Secretary 

would have paid if the demonstration 

program under this section was not 

implemented.’’ As discussed in section IV.H. 

of the preamble to this proposed rule, we are 

satisfying this requirement by adjusting 

national IPPS rates by a factor that is 

sufficient to account for the added costs of 

this demonstration. We estimate that the 

average additional annual payment for FY 

2008 that would be made to each 

participating hospital under the 

demonstration would be approximately 

$1,075,765. We based this estimate on the 

recent historical experience of the difference 

between inpatient cost and payment for 

hospitals that are participating in the 

demonstration. For the 9 participating 

hospitals, the total annual impact of the 

demonstration program is estimated to be 

$9,681,893. The proposed adjustment factor 

to the Federal rate used in calculating 

Medicare inpatient prospective payments as 

a result of the demonstration is 0.999899. 

J. Effects of Proposed Policy on Services 

Furnished to Beneficiaries in Custody of 

Penal Authorities 

In section VII. of the preamble of this 

proposed rule, we discuss our proposal to 

revise our regulations relating to the special 

conditions under which Medicare payment 

may be made for services furnished to 

individuals in custody of penal authorities. 

We are proposing to indicate that, for 

purposes of Medicare payment, individuals 

who are in custody include, but are not 

limited to, individuals who are under arrest, 

incarcerated, imprisoned, escaped from 

confinement, under supervised release, 

required to reside in mental health facilities, 

required to reside in halfway houses, 

required to live under home detention, or 

confined completely or partially in any way 

under a penal statute or rule. This proposed 

definition is in accordance with how custody 

has been defined by Federal courts for 

purposes of the habeas corpus protections of 

the Constitution and is consistent with 

current CMS policy. We anticipate that this 

proposed change would have no measurable 

impact on Medicare expenditures. 

VIII. Impact of Proposed Changes in the 

Capital IPPS 

A. General Considerations 

Fiscal year (FY) 2001 was the last year of 

the 10-year transition period established to 

phase in the PPS for hospital capital-related 

costs. During the transition period, hospitals 

were paid under one of two payment 

methodologies: fully prospective or hold 

harmless. Under the fully prospective 

methodology, hospitals were paid a blend of 

the capital Federal rate and their hospitalspecific rate (see § 412.340). Under the holdharmless methodology, unless a hospital 

elected payment based on 100 percent of the 

capital Federal rate, hospitals were paid 85 

percent of reasonable costs for old capital 

costs (100 percent for SCHs) plus an amount 

for new capital costs based on a proportion 

of the capital Federal rate (see § 412.344). As 

we state in section V. of the preamble of this 

proposed rule, with the 10-year transition 

period ending with hospital cost reporting 

periods beginning on or after October 1, 2001 

(FY 2002), beginning in FY 2002 capital 

prospective payment system payments for 

most hospitals are based solely on the capital 

Federal rate. Therefore, we no longer include 

information on obligated capital costs or 

projections of old capital costs and new 

capital costs, which were factors needed to 

calculate payments during the transition 

period, for our impact analysis. In accordance with § 412.312, the basic 

methodology for determining a capital PPS 

payment includes a large urban add-on 

adjustment. However, as discussed above and 

in section V. of the preamble of this proposed 

rule, we are proposing to eliminate the large 

urban add-on adjustment to capital IPPS 

payments in FY 2008. The proposed basic 

methodology for calculating capital IPPS 

payments in FY 2008 would be: (Standard 

Federal Rate) x (DRG weight) x (GAF) x 

(COLA for hospitals located in Alaska and 

Hawaii) x (1 + Disproportionate Share 

Adjustment Factor + IME Adjustment Factor, 

if applicable). In addition, hospitals may also receive 

outlier payments for those cases that qualify 

under the threshold established for each 

fiscal year. The data used in developing the impact 

analysis presented below are taken from the 

December 2006 update of the FY 2006 

MedPAR file and the December 2006 update 

of the Provider-Specific File that is used for 

payment purposes. Although the analyses of 

the proposed changes to the capital 

prospective payment system do not 

incorporate cost data, we used the December 

2006 update of the most recently available 

hospital cost report data (FYs 2004 and 2005) 

to categorize hospitals. Our analysis has 

several qualifications. In general, we do not 

make adjustments for behavioral changes that 

hospitals may adopt in response to proposed 

policy changes. However, as discussed in 

section III. of the Addendum to this proposed 

rule, we proposed that the capital rates 

would be adjusted to account for upcoding 

under the proposed MS–DRGs. Furthermore, 

due to the interdependent nature of the IPPS, 

it is very difficult to precisely quantify the 

impact associated with each proposed 

change. In addition, we draw upon various 

sources for the data used to categorize 

hospitals in the tables. In some cases (for 

instance, the number of beds), there is a fair 

degree of variation in the data from different 

sources. We have attempted to construct 

these variables with the best available 

sources overall. However, for individual 

hospitals, some miscategorizations are 

possible. Using cases from the December 2006 

update of the FY 2006 MedPAR file, we 

simulated payments under the capital PPS 

for FY 2007 and FY 2008 for a comparison 

of total payments per case. Any short-term, 

acute care hospitals not paid under the 

general IPPS (Indian Health Service hospitals 

and hospitals in Maryland) are excluded 

from the simulations. 

As we explain in section III.A. of the 

Addendum to this proposed rule, payments 

are no longer made under the regular 

exceptions provision under § § 412.348(b) 

through (e). Therefore, we no longer use the 

actuarial capital cost model (described in 

Appendix B of the August 1, 2001 proposed 

rule (66 FR 40099)). We modeled payments 

for each hospital by multiplying the capital 

Federal rate by the GAF and the hospital’s 

case-mix. We then added estimated payments 

for indirect medical education, 

disproportionate share, large urban add-on, 

and outliers, if applicable. (We note that, 

consistent with our proposal to eliminate the 

large urban add-on beginning in FY 2008, 

such estimated payments under this policy 

are only reflected in the payments we 

modeled for FY 2007 and were not included 

in the payments we modeled for FY 2008.) 

For purposes of this impact analysis, the 

model includes the following assumptions: <bullet≤ We estimate that the Medicare 

case-mix index will increase by 1.0 percent 

in both FYs 2007 and 2008. (We note that 

this does not reflect the proposed adjustment 

to the capital rates to account for assumed 

growth in case mix due to improvement in 

documentation and coding (upcoding) under 

the proposed MS–DRGs, as discussed in 

section III. of the Addendum of this proposed 

rule.) 

<bullet≤ We estimate that the Medicare 

discharges will be 12.925 million in FY 2007 

and 12.995 million in FY 2008 for an 

estimated 0.54 percent increase from FY 2007 

to FY 2008. 

<bullet≤ The capital Federal rate was 

updated beginning in FY 1996 by an 

analytical framework that considers changes 

in the prices associated with capital-related 

costs and adjustments to account for forecast 

error, changes in the case-mix index, 

allowable changes in intensity, and other 

factors. As discussed in section V. of the 

preamble and section III.A. of the Addendum 

to this proposed rule, the proposed FY 2008 

update for rural hospitals is 0.8 percent. We 

are proposing a 0.0 percent update for urban 

hospitals in FY 2008. <bullet≤ In addition to the proposed FY 

2008 update factors, the proposed FY 2008 

capital Federal rate for both urban and rural 

hospitals was calculated based on a proposed 

GAF/DRG budget neutrality factor of 1.0018, 

a proposed outlier adjustment factor of 

0.9484, and a proposed exceptions 

adjustment factor of 0.9997. <bullet≤ For FY 2008, as discussed in 

section V. of the preamble and section III.A. 

of the Addendum to this proposed rule, the 

proposed FY 2008 capital rates for all 

hospitals was further adjusted by a factor of 

0.976 (or -2.4 percent) to maintain budget 

neutrality if the proposed MS–DRGs are 

implemented by eliminating the effect of 

changes in coding or classification of 

discharges that do not reflect real case mix 

changes. 

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B. Results 

We used the actuarial model described 

above to estimate the potential impact of our 

proposed changes for FY 2008 on total 

capital payments per case, using a universe 

of 3,535 hospitals. As described above, the 

individual hospital payment parameters are 

taken from the best available data, including 

the December 2006 update of the FY 2006 

MedPAR file, the December 2006 update to 

the Provider-Specific File, and the most 

recent cost report data from the December 

2006 update of HCRIS. In Table III, we 

present a comparison of total payments per 

case for FY 2007 compared to proposed FY 

2008 based on the proposed FY 2008 

payment policies. Column 2 shows estimates 

of payments per case under our model for FY 

2007. Column 3 shows estimates of payments 

per case under our model for FY 2008. 

Column 4 shows the total percentage change 

in payments from FY 2007 to FY 2008. The 

change represented in Column 4 includes the 

proposed 0.8 percent update to the capital 

Federal rate for rural hospitals and a 0.0 

percent update for urban hospitals, a 1.0 

percent increase in case-mix, changes in the 

adjustments to the capital Federal rate (for 

example, the effect of the hospital wage 

index on the GAF), reclassifications by the 

MGCRB, and the proposed additional 2.4 

percent reduction to all of the rates to 

account for upcoding or changes in coding 

that do not reflect real changes in case-mix 

if the proposed MS–DRGs are implemented. 

The comparisons are provided by: (1) 

geographic location; (2) region; and (3) 

payment classification. 

The simulation results show that, on 

average, capital payments per case can be 

expected to decrease 0.7 percent in FY 2008. 

In addition to the proposed 0.0 percent 

update for urban hospitals, this projected 

decrease in capital payments per case can be 

attributed to the proposed -2.4 percent 

adjustment to all hospitals to account for 

assumed growth in case mix due to 

improvements in documentation and coding 

prior to the assumed growth occurring if the 

proposed MS–DRGs are implemented. 

Although the proposed GAF/DRG factor is 

expected to increase payments slightly (0.18 

percent) in FY 2008 as compared to FY 2007, 

the proposed outlier factor is expected to 

contribute to the estimated decrease in 

capital payments from FY 2007 to FY 2008 

by 0.88 percent. 

The results of our comparisons by 

geographic location and by region are 

consistent with the results we expected after 

proposing to eliminate the large urban addon adjustment, and the proposed 0.0 percent 

update for urban hospitals. The geographic 

comparison shows that urban hospitals are 

expected to experience a 0.6 percent decrease 

in IPPS capital payments per case, while 

rural hospitals are expected to experience a 

0.9 percent decrease in capital payments per 

case. This difference is mostly due to the 

proposed MS–DRGs. Specifically, based on 

existing hospital claims data, under the 

proposed MS–DRGs, the better recognition of 

severity of illness is expected to increase 

payments to urban hospitals that treat a more 

acutely ill mix of patients and improvement 

in the DRG system will increase their 

payments. Similarly, however, the improved 

recognition of severity of illness will 

decrease payments to rural hospitals because 

they are treating less severely ill patients. 

Therefore we project a lower increase in 

estimated payments for rural hospitals due to 

the proposed DRG changes as compared to 

urban hospitals. In addition to the effect of 

the proposed DRG changes, the capital 

impact is also somewhat affected by the 

proposed wage-index changes because the 

GAF values are derived from the proposed 

wage index. Another factor contributing to 

the decrease in payments for rural hospitals 

is the expiration of the 3-year hold harmless 

provision for urban hospitals that were 

converted to rural under the new CBSAs in 

FY 2005. The policy allowed urban hospitals 

under the old labor market area designations 

that became rural under the CBSAs to receive 

payment using the wage index of the MSA 

where they were previously classified as 

urban for 3 years: FY 2005 through FY 2007. 

Beginning in FY 2008, these rural hospitals 

will receive the wage index for the area that 

they are currently located in. As a result, 

rural hospitals will experience a decrease in 

payments because of the addition of these 

formerly urban hospitals. 

More than half of all regions are estimated 

to experience a decrease in total capital 

payments per case from FY 2007 to FY 2008. 

These decreases vary by region and range 

from a -2.3 percent in the Middle Atlantic 

urban region to a -0.7 in the East South 

Central urban region. For most of the regions 

projected to experience a larger than average 

decrease in capital payments, the difference 

is mostly due to changes in the proposed 

GAF and the elimination of the large urban 

add-on adjustment. In the regions 

experiencing an increase in total capital 

payments per case, the range is from 0.7 in 

the Pacific rural region to a 0.1 percent 

increase in the South Atlantic rural region. 

For most of the regions projected to 

experience an increase in capital payments, 

it is mostly due to changes to adopt the 

proposed MS–DRGs. The change in payments 

per case for all hospitals is -0.7 percent. 

By type of ownership, voluntary hospitals 

are estimated to experience a decrease of -1.0 

percent in capital payments per case, while 

proprietary and government hospitals are 

estimated to experience 0.1 percent and 0.2 

percent increases in payments, respectively. 

Government hospitals and proprietary 

hospitals are projected to have slight 

increases in capital payments mostly due to 

a smaller than average estimated decrease in 

payments due to proposed changes in the 

GAF and a slightly larger than average 

estimated increase in payments due to 

proposed changes to adopt MS–DRGs. 

Section 1886(d)(10) of the Act established 

the MGCRB. Before FY 2005, hospitals could 

apply to the MGCRB for reclassification for 

purposes of the standardized amount, wage 

index, or both. Section 401(c) of Pub. L. 108– 

173 equalized the standardized amounts 

under the operating IPPS. Therefore, 

beginning in FY 2005, there is no longer 

reclassification for the purposes of the 

standardized amounts; however, hospitals 

still may apply for reclassification for 

purposes of the wage index for FY 2008. 

Reclassification for wage index purposes also 

affects the GAF because that factor is 

constructed from the hospital wage index. 

To present the effects of the hospitals being 

reclassified for FY 2008, we show the average 

payments per case for reclassified hospitals 

for FY 2007. Rural nonreclassified hospitals 

are expected to have the largest decrease in 

payments (-2.0 percent), as compared to the 

-0.3 percent for rural reclassified hospitals for 

FY 2008. This difference is mostly due to 

proposed changes in the GAF and proposed 

changes to adopt MS–DRGs. Urban hospitals 

are expected to experience a decrease in 

payments of 0.9 percent and 0.6 percent, 

respectively, for reclassified and 

nonreclassified hospitals. This difference is 

mostly due to the proposed elimination of 

the large urban add-on. 

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25132 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE

[FY 2007 payments compared to FY 2008 payments] 

Number of 

hospitals 

Average FY 

2007 payments/case 

Average FY 

2008 payments/case Change 

By Geographic Location: 

All hospitals ................................................................................................................................ 3,535 758 753 -0.7 

Large urban areas (populations over 1 million) ......................................................................... 1,409 842 833 -1.1 

Other urban areas (populations of 1 million or fewer) .............................................................. 1,131 747 747 0.0 

Rural areas ................................................................................................................................ 995 524 519 -0.9 

Urban hospitals .......................................................................................................................... 2,540 799 794 -0.6 

0–99 beds .................................................................................................................................. 632 628 618 -1.7 

100–199 beds ............................................................................................................................ 849 683 677 -0.8 

200–299 beds ............................................................................................................................ 480 754 748 -0.8 

300–499 beds ............................................................................................................................ 412 828 824 -0.5 

500 or more beds ...................................................................................................................... 167 1,002 999 -0.3 

Rural hospitals ........................................................................................................................... 995 524 519 -0.9 

0–49 beds .................................................................................................................................. 342 430 418 -2.8 

50–99 beds ................................................................................................................................ 369 480 473 -1.5 

100–149 beds ............................................................................................................................ 172 523 521 -0.3 

150–199 beds ............................................................................................................................ 67 576 573 -0.5 

200 or more beds ...................................................................................................................... 45 657 656 -0.1 

By Region: 

Urban by Region ........................................................................................................................ 2,540 799 794 -0.6 

New England .............................................................................................................................. 126 847 830 -2.1 

Middle Atlantic ............................................................................................................................ 350 875 855 -2.3 

South Atlantic ............................................................................................................................. 388 756 759 0.3 

East North Central ..................................................................................................................... 395 783 777 -0.8 

East South Central ..................................................................................................................... 166 723 718 -0.7 

West North Central .................................................................................................................... 156 780 772 -1.0 

West South Central .................................................................................................................... 358 749 750 0.2 

Mountain .................................................................................................................................... 153 797 799 0.2 

Pacific ......................................................................................................................................... 395 914 918 0.5 

Puerto Rico ................................................................................................................................ 53 348 344 -1.2 

Rural by Region ......................................................................................................................... 995 524 519 -0.9 

New England .............................................................................................................................. 19 694 683 -1.5 

Middle Atlantic ............................................................................................................................ 72 536 531 -0.8 

South Atlantic ............................................................................................................................. 173 508 508 0.1 

East North Central ..................................................................................................................... 124 557 548 -1.6 

East South Central ..................................................................................................................... 177 487 481 -1.2 

West North Central .................................................................................................................... 115 556 550 -1.1 

West South Central .................................................................................................................... 194 478 469 -2.0 

Mountain .................................................................................................................................... 80 522 524 0.4 

Pacific ......................................................................................................................................... 41 634 639 0.7 

By Payment Classification: 

All hospitals ................................................................................................................................ 3,535 758 753 -0.7 

Large urban areas (populations over 1 million) ......................................................................... 1,436 840 831 -1.1 

Other urban areas (populations of 1 million or fewer) .............................................................. 1,183 742 742 0.1 

Rural areas ................................................................................................................................ 916 527 522 -1.0 

Teaching Status: 

Non-teaching .............................................................................................................................. 2,479 640 636 -0.6 

Fewer than 100 Residents ......................................................................................................... 816 770 764 -0.8 

100 or more Residents .............................................................................................................. 240 1,096 1,090 -0.5 

Urban DSH: 

100 or more beds ...................................................................................................................... 1,527 823 820 -0.2 

Less than 100 beds ................................................................................................................... 359 551 542 -1.7 

Rural DSH: 

Sole Community (SCH/EACH) .................................................................................................. 391 469 463 -1.3 

Referral Center (RRC/EACH) .................................................................................................... 189 584 583 -0.2 

Other Rural: 

100 or more beds ...................................................................................................................... 36 479 478 -0.2 

Less than 100 beds ................................................................................................................... 154 433 425 -1.8 

Urban teaching and DSH: 

Both teaching and DSH ............................................................................................................. 805 902 899 -0.4 

Teaching and no DSH ............................................................................................................... 192 807 788 -2.3 

No teaching and DSH ................................................................................................................ 1,081 672 672 -0.1 

No teaching and no DSH ........................................................................................................... 541 704 694 -1.4 

Rural Hospital Types: 

Non special status hospitals ...................................................................................................... 2,477 801 796 -0.6 

RRC/EACH ................................................................................................................................ 59 693 692 -0.2 

SCH/EACH ................................................................................................................................. 45 633 623 -1.5 

Medicare-dependent hospitals (MDH) ....................................................................................... 21 450 433 -3.7 

SCH, RRC and EACH ............................................................................................................... 17 741 740 0.0 

Hospitals Reclassified by the Medicare Geographic Classification Review Board: 

FY2008 Reclassifications: 

All Urban Reclassified ................................................................................................................ 434 793 786 -0.9 

All Urban Non-Reclassified ........................................................................................................ 2,105 800 796 -0.6 

All Rural Reclassified ................................................................................................................. 367 570 568 -0.3 

All Rural Non-Reclassified ......................................................................................................... 568 459 450 -2.0 

Other Reclassified Hospitals (Section 1886(d)(8)(B)) ............................................................... 61 511 501 -2.1 

Type of Ownership: 

Voluntary .................................................................................................................................... 2,069 776 768 -1.0 

Proprietary .................................................................................................................................. 823 689 690 0.1 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25133 

TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued 

[FY 2007 payments compared to FY 2008 payments] 

Number of 

hospitals 

Average FY 

2007 payments/case 

Average FY 

2008 payments/case Change 

Government ............................................................................................................................... 598 745 746 0.2 

Medicare Utilization as a Percent of Inpatient Days: 

0–25 ........................................................................................................................................... 230 1,001 1,006 0.5 

25–50 ......................................................................................................................................... 1,292 857 854 -0.4 

50–65 ......................................................................................................................................... 1,453 672 666 -1.0 

Over 65 ...................................................................................................................................... 441 605 594 -1.8 

IX. Alternatives Considered 

This proposed rule contains a range of 

proposed policies. The preamble of this 

proposed rule provides descriptions of the 

statutory provisions that are addressed, 

identifies those proposed policies when 

discretion has been exercised, presents 

rationale for our decisions and, where 

relevant, alternatives that were considered. 

X. Overall Conclusion 

The changes we are proposing in this 

proposed rule would affect all classes of 

hospitals. Some hospitals are expected to 

experience significant gains and others less 

significant gains, but overall hospitals are 

projected to experience positive updates in 

IPPS payments in FY 2008. Table I of section 

VI of this Appendix demonstrates the 

estimated distributional impact of the IPPS 

budget neutrality requirements for proposed 

DRG and wage index changes, and for the 

wage index reclassifications under the 

MGCRB. Table I also shows an overall 

increase of 3.3 percent in operating 

payments, an estimated increase of $3.28 

billion, which includes hospital reporting of 

quality data program costs ($1.89 million) 

and all operating payment policies as 

described in section VI. of this Appendix. 

Capital payments are estimated to decrease 

by 0.7 percent per case, as shown in Table 

III of section VIII. of this Appendix. 

Therefore, we project that capital payments 

will decline by $13 million in FY 2008 

compared to FY 2007. The operating and 

capital payments should result in a net 

increase of $3.269 billion to IPPS providers. 

The discussions presented in the previous 

pages, in combination with the rest of this 

proposed rule, constitute a regulatory impact 

analysis. 

XI. Accounting Statement 

As required by OMB Circular A–4 

(available at http://www.whitehousegov/ 

omb/circulars/a004/a-4.pdf), in Table IV 

below, we have prepared an accounting 

statement showing the classification of the 

expenditures associated with the provisions 

of this proposed rule. This table provides our 

best estimate of the increase in Medicare 

payments on providers as a result of the 

proposed changes to the IPPS presented in 

this rule. All expenditures are classified as 

transfers to Medicare providers. 

TABLE IV.—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES FROM FY 2007 TO FY 

2008 

Category Transfers 

Annualized Monetized 

Transfers.

$3.269 Billion. 

From Whom to Whom Federal Government 

to IPPS Medicare 

Providers. 

Total ................... $3.269 Billion. 

XII. Executive Order 12866 

In accordance with the provisions of 

Executive Order 12866, the Office of 

Management and Budget reviewed this 

proposed rule. 

of Update Factors for Operating Cost Rates of 

Payment for Inpatient Hospital Services 

(If you choose to comment on issues in this 

section, please include the caption ‘‘Update 

Factors’’ at the beginning of your comment.) 

I. Background 

Section 1886(e)(4)(A) of the Act requires 

that the Secretary, taking into consideration 

the recommendations of the MedPAC, 

recommend update factors for inpatient 

hospital services for each fiscal year that take 

into account the amounts necessary for the 

efficient and effective delivery of medically 

appropriate and necessary care of high 

quality. Under section 1886(e)(5)(B) of the 

Act, we are required to publish the proposed 

and final update factors recommended by the 

Secretary in the proposed and final IPPS 

rules, respectively. Accordingly, this 

Appendix provides the recommendations of 

appropriate update factors for the IPPS 

standardized amount, the hospital-specific 

rates for SCHs and MDHs, and the rate-ofincrease limits for hospitals and hospital 

units excluded from the IPPS, as well as IPFs 

and IRFs. We also discuss our response to 

MedPAC’s recommended update factors for 

inpatient hospital services. 

II. Inpatient Hospital Update for FY 2008 

Section 1886(b)(3)(B)(i)(XX) of the Act, as 

amended by section 5001(a) of Pub. L. 109– 

171, sets the FY 2008 percentage increase in 

the operating cost standardized amount equal 

to the rate-of-increase in the hospital market 

basket for IPPS hospitals in all areas, subject 

to the hospital submitting quality 

information under rules established by the 

Secretary in accordance with 

1886(b)(3)(B)(viii) of the Act. For hospitals 

that do not provide these data, the update is 

equal to the market basket percentage 

increase less 2.0 percentage points. 

Consistent with current law, based on the 

Office of the Actuary’s first quarter 2007 

forecast of the FY 2008 market basket 

increase, we are estimating that the FY 2008 

update to the standardized amount will be 

3.3 percent (that is, the current estimate of 

the market basket rate-of-increase) for 

hospitals in all areas, provided the hospital 

submits quality data in accordance with our 

rules. For hospitals that do not submit 

quality data, we are estimating that the 

update to the standardized amount will be 

1.3 percent (that is, the current estimate of 

the market basket rate-of-increase minus 2.0 

percentage points). 

Section 1886(b)(3)(B)(iv) of the Act sets the 

FY 2008 percentage increase in the hospitalspecific rates applicable to SCHs and MDHs 

equal to the rate set forth in section 

1886(b)(3)(B)(i) of the Act (that is, the same 

update factor as for all other hospitals subject 

to the IPPS, or the rate-of-increase in the 

market basket). Therefore, the update to the 

hospital-specific rates applicable to SCHs 

and MDHs is also estimated to be 3.3 percent. 

Section 1886(b)(3)(B)(ii) of the Act is used 

for purposes of determining the percentage 

increase in the rate-of-increase limits for 

children’s and cancer hospitals. Section 

1886(b)(3)(B)(ii) of the Act sets the 

percentage increase in the rate-of-increase 

limits equal to the market basket percentage 

increase. In accordance with § 403.752(a) of 

the regulations, RNHCIs are paid under §

413.40, which also uses section 

1886(b)(3)(B)(ii) of the Act to update the 

percentage increase in the rate-of-increase 

limits. Section 1886(j)(3)(C) of the Act 

addresses the increase factor for the Federal 

prospective payment rate of IRFs. Section 

123 of Pub. L. 106–113, as amended by 

section 307(b) of Pub. L. 106–554, provides 

the statutory authority for updating payment 

rates under the LTCH PPS. As discussed 

below, for cost reporting periods beginning 

on or after October 1, 2006, LTCHs that are 

not defined as new under § 412.23(e)(4), and 

that had not elected to be paid under 100 

percent of the Federal rate are paid 100 

percent of the adjusted Federal PPS rate. 

Therefore, because no portion of LTCHs’ 

prospective payments will be based on 

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25134 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 

reasonable cost concepts for cost reporting 

periods beginning on or after October 1, 

2006, we are not proposing a rate-of-increase 

percentage for FY 2008 for LTCHs to be used 

under § 413.40. In addition, section 124 of 

Pub. L. 106–113 provides the statutory 

authority for updating all aspects of the 

payment rates for IPFs. Under this broad 

authority, IPFs that are not defined as new 

under § 412.426(c) will be paid under a 

blend methodology for cost reporting periods 

beginning on or after January 1, 2005, and 

before January 1, 2008. The methodology 

blends the estimated Federal per diem 

payment amount and a facility-specific 

payment amount. The portion of the IPF PPS 

payment that is based on reasonable cost 

principles is updated in accordance with 42 

CFR Part 413, which uses section 

1886(b)(3)(B)(ii) of the Act to determine the 

percentage increase in the rate-of-increase 

limits. For the reasonable cost-based portion 

of an IPF’s PPS blended payments, we are 

proposing our current estimate of the 

excluded hospital market basket increase (3.4 

percent) to update the target amounts. New 

IPFs are paid based on 100 percent of the 

Federal per diem payment amount. 

Currently, children’s hospitals, cancer 

hospitals, and RNHCIs are the remaining 

three types of hospitals still reimbursed 

under the reasonable cost methodology. We 

are providing our current estimate of the FY 

2008 IPPS operating market basket 

percentage increase (3.3 percent) to update 

the target limits for children’s hospitals, 

cancer hospitals, and RNHCIs. 

Effective for cost reporting periods 

beginning on or after October 1, 2002, LTCHs 

have been paid under the LTCH PPS, which 

was implemented with a 5-year transition 

period for LTCHs not defined as new under 

§ 412.23(e)(4) (hereafter referred to as 

‘‘existing’’). (See 67 FR 55954.) An existing 

LTCH could have elected to be paid at 100 

percent of the adjusted Federal prospective 

rate at the start of any of its cost reporting 

periods during the transition period. During 

this transition period, if an existing LTCH 

did not elect to be paid at 100 percent of the 

adjusted Federal prospective payment rate, it 

received a PPS payment that consisted of a 

blend of its reasonable cost-based payment 

and the Federal prospective payment rate. 

For cost reporting periods beginning on or 

after October 1, 2006, no portion of a LTCH’s 

PPS payments can be based on reasonable 

cost concepts. Consequently, there is no need 

to propose to update the target limit under 

§ 413.40 effective October 1, 2007 for LTCHs. 

In the RY 2008 LTCH PPS proposed rule 

(72 FR 4791 through 4792), we recommended 

an update of 0.71 percent (that is, the latest 

estimate of the market basket rate-of-increase 

of 3.2 percent minus an adjustment factor of 

2.49 percentage points for case-mix growth 

due to improved coding) to the LTCH PPS 

Federal rate for RY 2008. 

Effective for cost reporting periods 

beginning on or after January 1, 2005, IPFs 

are paid under the IPF PPS. IPF PPS 

payments are based on a Federal per diem 

rate that is derived from the sum of the 

average routine operating, ancillary, and 

capital costs for each patient day of 

psychiatric care in an IPF, adjusted for 

budget neutrality. For cost reporting periods 

beginning on or after January 1, 2005, and 

before January 1, 2008, existing IPFs (those 

not defined as ‘‘new’’ under § 412.426(c)) are 

paid based on a blend of the reasonable costbased PPS payments and the Federal per 

diem base rate. For cost reporting periods 

beginning on or after January 1, 2008, 

existing IPFs will be paid based on 100 

percent of the Federal per diem rate. For 

purposes of the update factor for FY 2008, 

the portion of the IPF PPS transitional blend 

payment based on reasonable costs would be 

determined by updating the IPF’s TEFRA 

limit by the current estimate of the excluded 

hospital market basket, which is estimated to 

be 3.4 percent. The update factor of 4.3 

percent to the Federal per diem rate for July 

1, 2006 through June 30, 2007 was provided 

in the rate year (RY) 2007 IPF PPS final rule 

(71 FR 27046). The Federal per diem rate for 

RY 2008 will be updated in the RY 2008 

update notice that is scheduled for 

publication in May 2007. 

IRFs are paid under the IRF PPS for cost 

reporting periods beginning on or after 

January 1, 2002. For cost reporting periods 

beginning on or after October 1, 2002 (FY 

2003), and thereafter, the Federal prospective 

payments to IRFs are based on 100 percent 

of the adjusted Federal IRF prospective 

payment amount, updated annually. (See 69 

FR 45721). Under section 1886(j)(3)(C) of the 

Act, the FY 2008 IRF PPS update will equal 

3.3 percent based on the Global Insight, Inc.’s 

first quarter 2007 forecast with historical data 

through the fourth quarter of 2006. We expect 

that the market basket will be updated with 

more recent data to the extent the data are 

available. 

III. Secretary’s Recommendation 

MedPAC is recommending an inpatient 

hospital update equal to the market basket 

rate of increase for FY 2008. MedPAC’s 

rationale for this update recommendation is 

described in more detail below. Using the 

2007 first quarter forecast from the Office of 

the Actuary of the FY 2008 market basket 

increase and an adjustment factor based on 

the FY 2008 President’s Budget, we are 

recommending an update to the standardized 

amount of 2.65 percent (that is, the market 

basket rate-of-increase of 3.3 percent minus 

an adjustment factor of 0.65 percentage 

points). We are recommending that this same 

update factor apply to SCHs and MDHs. Our 

rationale for this recommended update is 

described below. 

In addition to making a recommendation 

for IPPS hospitals, in accordance with 

section 1886(e)(4)(A) of the Act, we are also 

recommending update factors for all other 

types of hospitals. Consistent with the 

President’s budget, we are recommending an 

update based on the market basket increase 

for children’s hospitals, cancer hospitals, and 

RNHCIs of 3.3 percent. For IPFs that are 

currently paid on a PPS blended payment 

basis, a portion of which is based on 

reasonable cost-principles and Federal 

prospective payment amounts, we are 

recommending an update factor of 3.4 

percent for the portion of the payment that 

is based on reasonable costs. Consistent with 

the President’s Budget, based on Global 

Insight Inc.’s 1st quarter 2007 forecast of the 

RPL market basket increase, we are 

recommending an update equal to the market 

basket increase of 3.2 percent for the Federal 

per diem payment amount. 

In the RY 2008 LTCH PPS proposed rule 

(72 FR 4791 through 4792), we recommended 

an update of 0.71 percent (that is, the most 

recent estimate of the market basket rate-ofincrease of 3.2 percent minus an adjustment 

factor of 2.49 percentage points for case-mix 

growth due to improved coding) to the 

Federal rate for RY 2008. We will provide the 

final update in the LTCH final rule. Finally, 

consistent with the President’s FY 2008 

Budget, we are recommending that the 

Federal rate to the IRF PPS remain 

unchanged for FY 2008. 

For fiscal years prior to FY 2008, section 

1886(e)(3) of the Act directed the Secretary 

to report to the Congress an initial estimate 

of his recommendation of an appropriate 

payment inflation update for inpatient 

hospital services for the upcoming fiscal year 

not later than March 1. Section 1886(d)(4)(C) 

of the Act further required the Secretary to 

include recommendations with respect to 

adjustments to the DRG weighting factors in 

the March 1 Report to Congress. In addition, 

sections 1886(e)(4)(A) and (e)(5)(B) of the Act 

require that the Secretary recommend update 

factors in each of the IPPS proposed and final 

rules, taking into account MedPAC’s 

recommendation. Thus, the statute required 

the Secretary to make update 

recommendations in both a March 1 Report 

to Congress, and later in the IPPS proposed 

and final rules. Historically, the only 

difference between the recommendation we 

provided in the March 1 Report to Congress 

and the IPPS proposed rule was the use of 

a later estimate of the market basket increase 

for the proposed rule. Section 106(c) of Pub. 

L. 109–432 eliminated the requirement to 

make the Report to Congress recommending 

an update and adjustments to DRG weighting 

factors by March 1. In accordance with 

section 106(c) of Pub. L. 109–432, we are 

making the Secretary’s only recommendation 

for an update factor in the IPPS rules. 

IV. MedPAC Recommendation for Assessing 

Payment Adequacy and Updating Payments 

in Traditional Medicare 

In its March 2007 Report to Congress, 

MedPAC assessed the adequacy of current 

payments and costs, and the relationship 

between payments and an appropriate cost 

base, utilizing an established methodology 

used by MedPAC in the past several years. 

MedPAC recommended an update to the 

hospital inpatient rates equal to the increase 

in the hospital market basket in FY 2008, 

concurrent with implementation of a quality 

incentive payment program. MedPAC also 

recommended that CMS put pressure on 

hospitals to control their costs rather than 

accommodate the current rate of cost growth. 

MedPAC noted that, notwithstanding 

negative overall Medicare margins, most of 

the indicators of Medicare payment adequacy 

to hospitals are positive, including 

beneficiaries’ access to care, increased access 

to capital, and service volume increases. 

MedPAC also noted that this 

recommendation ‘‘should have no impact on 

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Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25135 

beneficiary access to care and is not expected 

to affect providers’ willingness and ability to 

provide care to Medicare beneficiaries.’’ 

Response: We agree with MedPAC that 

hospitals should control costs rather than 

accommodate the current rate of growth. An 

update equal to less than the market basket 

will pressure hospitals to control their costs, 

consistent with MedPAC’s recommendation. 

As MedPAC noted, rising hospital costs are 

resulting in margins for some hospitals that 

are below zero. As discussed in section II. of 

the preamble of this proposed rule, CMS is 

refining the DRGs to better account for 

severity illness and is basing the DRG 

weights on cost rather than charges. We 

believe that these refinements will better 

match Medicare payments to the cost of care 

and provide incentives for hospitals to be 

more efficient in controlling costs. For these 

reasons, we are recommending an inpatient 

hospital update equal to the market basket 

increase minus an adjustment factor of 0.65 

percentage points for hospitals paid under 

the IPPS for FY 2008. 

We note that, because the operating and 

capital prospective payment systems remain 

separate, we are proposing to continue to use 

separate updates for operating and capital 

payments. The proposed update to the 

capital payment rate is discussed in section 

III. of the Addendum to this proposed rule. 

[FR Doc. 07–1920 Filed 4–13–07; 4:15 pm] 

BILLING CODE 4120–01–P 

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