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MS-DRG payment calculator (FY2027)

Choose an MS-DRG and where the stay is paid: an IPPS hospital by name or CMS Certification Number, a county, a wage index area or national rates. The calculator applies the FY2027 relative weight from IPPS Table 5, the standardized amounts and capital rate from Tables 1A-1D, the wage index and geographic adjustment factor from Table 3 or the hospital's own values from the FY2027 impact file, all as corrected by notice CMS-1849-CN3 and effective for discharges from October 1, 2026. At a hospital it adds the teaching, disproportionate share and uncompensated care amounts CMS modelled for that hospital. Results stay on this page; nothing is stored.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); IPPS Tables 1A-1E (standardized amounts and capital rate): FY2027 (final rule + CN3) (effective October 1, 2026); IPPS Table 3 (wage index and GAF by CBSA) and county-CBSA crosswalk: FY2027 (final rule + CN3, sheet 'Table 3 CN') (effective October 1, 2026); IPPS impact file (hospital wage index, case mix and payment factors): FY2027 (correction notice, September 2026) (effective October 1, 2026). Next CMS release: FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); FY2028 final rule (August 2027), effective October 1, 2027 for the IPPS Tables 1A-1E (standardized amounts and capital rate) and IPPS Table 3 (wage index and GAF by CBSA) and county-CBSA crosswalk and IPPS impact file (hospital wage index, case mix and payment factors).

Paid where

Worked examples

Computed from the FY2027 store when this page was built, at the full annual update (for the hospital row, the update CMS modelled for that hospital). Open a row to run it in the calculator above with every step of the arithmetic, the scenario switch and the notes for that location.

FY2027 MS-DRG payment estimates for example DRGs and locations
MS-DRGWhereWage indexOperatingCapitalTotal
DRG 470National rates1.0000 (Table 1B)$13,396.74$1,056.30$14,453.04
DRG 470Rural Alabama0.7515 (Table 1B)$11,332.71$868.60$12,201.31
DRG 470San Francisco-San Mateo-Redwood City, CA1.7304 (Table 1A)$19,854.82$1,537.67$21,392.49
DRG 291Urban Honolulu, HI (cost-of-living adjustment)1.1937 (Table 1A)$10,535.58$834.29$11,369.87
DRG 871New York-Presbyterian Hospital (CCN 330101)1.4269 (Table 1A)$16,958.03$1,330.72$18,288.75 + $7,359.35 add-ons = $25,648.10

Take the first row: MS-DRG 470 (Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC) has a FY2027 weight of 1.9563. At national rates the wage index is 1.0000, so the operating payment is 1.9563 x $6,848.00 = $13,396.74, the same figure the MS-DRG 470 page shows, and the capital payment is 1.9563 x $539.95 = $1,056.30. In rural Alabama the wage index of 0.7515 applies to the 62% labor share of Table 1B and lowers the operating payment to $11,332.71; in San Francisco the index of 1.7304 applies to the 66% labor share of Table 1A and raises it to $19,854.82, $8,522.11 more for the same stay. The last row adds what a large teaching hospital receives on top: an operating IME factor of 30.35% and an operating DSH factor of 6.58% of the operating payment, the capital IME and DSH factors, and $652.46 of interim uncompensated care per discharge.

How the calculator works

Operating = DRG weight x (labor-related amount x wage index + nonlabor amount x COLA)

Capital = DRG weight x $539.95 x GAF

Hospital add-ons = operating x (IME + DSH) + capital x (IME + DSH) + uncompensated care per discharge

The labor-related share is 66% of the standardized amount when the wage index is above 1 (Table 1A) and 62% when it is 1 or below (Table 1B); 1,347 of the 3,075 hospitals in the impact file are on Table 1A. Puerto Rico hospitals are paid from Table 1C, the national amounts with the 62% labor share, because no Puerto Rico area has a wage index above 1 in FY2027, and their update depends only on meaningful EHR use. The cost-of-living adjustment (COLA) multiplies the nonlabor share for the 19 hospitals in Alaska and Hawaii; everywhere else it is 1. The geographic adjustment factor (GAF) is the wage index raised to the power 0.6848, which reproduces all 516 Table 3 GAF values to four decimals; at a hospital the impact file's GAF also carries the capital cost-of-living adjustment. Each amount is rounded to the cent where the calculator shows it.

Standardized amount (full update)
$6,848.00
$4,519.68 + $2,328.32 in Table 1A
Capital federal rate
$539.95
Table 1D
IPPS hospitals
3,075
FY2027 impact file (CN3)
Wage index areas
516
52 rural state areas
Counties
3,222
FY2027 county to CBSA crosswalk
MS-DRGs with a weight
766
Table 5 (CN3)

Standardized amounts by annual update

A hospital that did not submit quality data under the Hospital IQR Program, or is not a meaningful EHR user, receives a lower annual update and starts from a lower standardized amount. The calculator selects the scenario CMS modelled for each hospital in the impact file and lets you switch it.

FY2027 national adjusted operating standardized amounts (IPPS Tables 1A and 1B, CMS-1849-CN3)
ScenarioUpdateTable 1A (WI > 1)Table 1B (WI <= 1)Total
Submitted quality data and a meaningful EHR user+2.3%$4,519.68 + $2,328.32$4,245.76 + $2,602.24$6,848.00
Submitted quality data, not a meaningful EHR user-0.1%$4,413.65 + $2,273.70$4,146.16 + $2,541.19$6,687.35
Did not submit quality data, a meaningful EHR user+1.5%$4,484.34 + $2,310.11$4,212.56 + $2,581.89$6,794.45
Did not submit quality data, not a meaningful EHR user-0.9%$4,378.30 + $2,255.49$4,112.95 + $2,520.84$6,633.79
In the FY2027 impact file CMS modelled 81 hospitals with the quality-data reduction and 63 with the EHR reduction; the Medicare contractor applies the final determination.

Where each input comes from

Relative weights and the geometric mean length of stay come from the MS-DRG pages, which are built from Table 5 as corrected by CMS-1849-CN3; the calculator and the MS-DRG reference therefore always agree. The correction notice re-posted the wage index tables, but the text copy of Table 3 inside the corrected ZIP is identical to the final rule's; the corrected values are only in the workbook's “Table 3 CN” sheet, which is what the calculator reads. Rural Alabama, for example, moves from 0.7514 in the final rule to 0.7515 after the correction. A county resolves to its urban CBSA through the FY2027 county to CBSA crosswalk, or to its state's rural area when it is outside every CBSA; CBSAs that cross state lines carry a separate wage index for each state because the rural and imputed floors are state-specific, so those areas are listed once per state.

Hospital values come from the FY2027 IPPS impact file (correction notice version): the wage index after reclassification, floors and the cap, the COLA and GAF, the operating and capital IME and DSH factors and the uncompensated care amount per claim. CMS states that these are the values it used to model FY2027 payments and that the Provider Specific File the contractors pay from can differ, so a hospital estimate here is a model, not a rate notice. The same file supplies the hospital case mix indexes ranked in the FY2027 hospital case mix index report.

What the estimate leaves out

  • Outlier payments: a case qualifies when its cost exceeds the DRG payment plus the FY2027 fixed-loss threshold, which CMS sets in the final rule text, not in the tables used here.
  • New-technology add-on payments for the specific technologies CMS approves each year.
  • Transfer adjustments: a stay shorter than the geometric mean that ends in a transfer to another IPPS hospital, or to post-acute care for DRGs on the post-acute transfer list, is paid per diem up to the full amount.
  • Hospital-specific rates: sole community hospitals are paid the higher of the federal rate and their hospital-specific rate, and Medicare-dependent hospitals can receive part of the difference.
  • Value-based purchasing, Hospital Readmissions Reduction Program and Hospital-Acquired Condition Reduction Program adjustments, the low-volume adjustment, and the beneficiary deductible and coinsurance.
  • Hospitals paid outside IPPS: critical access hospitals, psychiatric, rehabilitation and long-term care hospitals and units, children's and cancer hospitals. Maryland hospitals appear in the impact file but are paid under Maryland's all-payer hospital rate system, which operates under a CMS model agreement, rather than under IPPS rates.

For the grouping itself, the MS-DRG code lookup shows which groups a diagnosis or procedure code leads to and whether a secondary diagnosis is a CC or MCC, and the FY2027 weight changes report shows which groups gained or lost the most against FY2026. Outpatient and physician services use other schedules: see the Medicare fee lookup and the fee schedules reference.

Where QuickIntell fits beyond the calculator

The calculator prices one stay from the CMS tables. QuickIntell's inpatient billing workflow brings DRG review, charge scrubbing and pre-bill documentation queries to the coder before the claim drops, with human review, and contract management in QuickRCM compares expected reimbursement with what each payer actually pays.

See inpatient billing and DRG codingSee contract management in QuickRCMBook a meeting

Frequently asked questions

How is an MS-DRG payment calculated?

Medicare multiplies the MS-DRG relative weight by the hospital's wage-adjusted standardized amount (the labor-related share times the wage index plus the nonlabor share) for the operating payment, and by the capital federal rate times the geographic adjustment factor for the capital payment. For FY2027 the full-update standardized amount is $6,848.00 and the capital rate is $539.95. Teaching, disproportionate share, outlier and other adjustments are then applied to each stay.

What is the FY2027 IPPS standardized amount?

$6,848.00 for a hospital that submitted quality data and is a meaningful EHR user (a 2.3% update), split $4,519.68 labor and $2,328.32 nonlabor when the wage index is above 1 (Table 1A) and $4,245.76 and $2,602.24 otherwise (Table 1B). The reduced-update amounts run from $6,633.79 to $6,794.45. These are the values after correction notice CMS-1849-CN3.

Why does a hospital's wage index differ from its area's Table 3 value?

Table 3 gives one wage index per labor market area (one per state where an area crosses state lines). A hospital can be paid on another area's index after an MGCRB or Lugar reclassification, can be redesignated rural, can be held to the rural or imputed floor, and is protected by the cap on year-over-year decreases. 1,251 of the 3,075 hospitals in the FY2027 impact file carry a reclassification or redesignation, so the calculator uses the impact file value when you choose a hospital and the Table 3 value for a county or area.

Does the calculator include outlier payments?

No. A case becomes a cost outlier when its estimated cost (covered charges times the hospital's cost-to-charge ratio) exceeds the payment for the case plus the fixed-loss threshold CMS sets in the final rule, and Medicare then pays 80 percent of the excess (90 percent for the burn MS-DRGs). The calculator has no charges to work from, so it shows the payment without an outlier.

What do the IME, DSH and uncompensated care amounts mean?

Teaching hospitals receive an indirect medical education (IME) adjustment that grows with their resident-to-bed ratio, and hospitals that treat a large share of low-income patients receive a disproportionate share (DSH) adjustment. The operating DSH factor in the impact file already reflects the 75 percent reduction that section 1886(r) of the Social Security Act requires, and DSH-eligible hospitals also receive an uncompensated care payment, which Medicare pays as an interim amount per discharge. 1,327 hospitals have an IME factor, 2,571 an operating DSH factor and 2,264 an uncompensated care amount for FY2027.

Why is there no payment for some MS-DRGs?

MS-DRG 998 (principal diagnosis invalid as discharge diagnosis) and 999 (ungroupable) have no relative weight in Table 5. A claim that groups to either one cannot be paid until it is corrected, so the calculator rejects them.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational estimate built from CMS public use files. It is not a payment determination: the Medicare contractor pays from the Provider Specific File and the claim, including adjustments this calculator leaves out. Medicare Advantage and commercial contracts set their own inpatient rates. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.