About
About cmswebpricer.com
cmswebpricer.com prices Medicare and Medicaid claims the way the program pays them, one hospital, one date of service and one line at a time, and shows every step of the arithmetic. It is built and run by PayerParity, an independent healthcare reimbursement analytics practice.
What it prices
- Inpatient (IPPS): MS-DRG payment by hospital and discharge date, with operating and capital payment, IME, DSH, uncompensated care, transfers, cost outliers, and the Medicare Advantage out-of-network amount next to Original Medicare.
- Outpatient: OPPS and ASC side by side, whole-claim pricing and outpatient claim edits.
- Professional claims: physician fee schedule by locality and place of service, with NCCI and MUE edits and modifier rules.
- Skilled nursing and home health: PDPM per diem by day of stay, and 30-day home health periods under PDGM.
- Post-acute: LTCH, IRF, IPF, hospice and ESRD claims, each on its own Medicare payment system.
- Medicaid: APR-DRG inpatient pricing for New York, Texas, Colorado, Virginia and Washington, Virginia fee schedules, New York rate codes, and Maryland hospital claims at their approved rates.
- Checking and bulk work: an MS-DRG grouper with CDI review, a component-by-component check against the CMS Web Pricer, DRG comparison, claim import (837I, FHIR, XML, UB-04), batch repricing and a contract modeler.
Who it is for
Health plan and TPA teams first: provider reimbursement, contracting, pricing configuration and payment integrity. It is also used by coders and CDI specialists, auditors, and hospital revenue integrity teams who need the same number the payer should reach, with the reasoning written out.
How the numbers are checked
Every inpatient result can be checked against the CMS Web Pricer, line by line, from the result itself. In a run of 5,000 claims at 60 hospitals on October 23, 2026, all 5,000 came back within $1.00 of the CMS Web Pricer and 648 matched to the cent; the largest difference was $0.22. The accuracy study gives the method, the distribution and the comparison file.
Rates come from the published Medicare and state Medicaid files. New fiscal-year inpatient and skilled nursing rates load for discharges from October 1, calendar-year outpatient and physician rates for services from January 1, and quarterly updates as they are published. Each result names the rate year and the provider record it used.
Rates in force
- Inpatient (IPPS DRG): FY2027 final rule as corrected, for discharges from October 1, 2026; MS-DRG version 44.
- Professional, lab, drug and DME fee schedules: CY2026, October 2026 release.
- Outpatient & ASC: CY2026 OPPS and ASC rates, October 2026 update.
- SNF (PDPM): FY2027, from October 1, 2026.
- Home health (PDGM): CY2026.
- Post-acute: FY2027 LTCH, IRF, IPF and hospice rates; CY2026 ESRD.
- Medicaid: each state's current published inpatient rates, named on the pricer; Maryland at the approved rates for rate year 2026.
The release behind each figure: rates in force.
Free and full access
Anyone can use the site without an account. The free tier prices the 40 most common MS-DRGs at any hospital, batches of 10 claims, and up to 40 priced claims and 5 hospitals a day per network. An approved account or an API key lifts those limits; ask through the contact page. Do not enter patient names, member IDs or other patient identifiers: the tools need codes, dates and amounts only.
Independence. cmswebpricer.com is an independent estimator. It is not affiliated with, endorsed by, or sponsored by the Centers for Medicare & Medicaid Services or any government agency, and it is not a substitute for official claim adjudication. Results are estimates for planning, contracting and review.
Contact
PayerParity
info@payerparity.com · 281-625-7695 · Contact form · Book a walkthrough
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