Compare a DRG price with the CMS Web Pricer

Independent pricing tool. Not affiliated with, endorsed by, or operated by CMS or any government agency. Estimates are not a claims determination.

Claim

The claim to compare

All five fields are needed: the same claim goes to our engine and to the CMS Web Pricer.

Ours vs the CMS Web Pricer

Sample comparison for DRG 871 at NewYork-Presbyterian, saved from a live run. Change the claim and press Compare with the CMS Web Pricer to check your own.

Reconciliation, component by component

Matched inputs

Reading the result

Comparison basis

Medicare Advantage, out of network, is what the CMS Web Pricer calls an HMO paid claim; the flag covers every MA plan, HMO or PPO. It is the Original Medicare amount less the operating IME, which Medicare pays the hospital directly. An in-network MA claim pays the plan's contract rate instead.

If the two differ

    About this check

    This is an independent tool. It prices the claim through our engine and sends the same claim to the CMS Web Pricer at webpricer.cms.gov, then lines the two up. cmswebpricer.com is not affiliated with, endorsed by, or operated by CMS.

    A match within $1.00 or 0.5% counts as a match: cent-level differences come from rounding order.

    Why compare with the CMS Web Pricer

    Payment integrity and audit work needs a second, independent figure. This page prices the claim on our engine and on the CMS Web Pricer at the same time and lines the two up component by component, with the difference on every row.

    When the totals differ, the matched-inputs strip shows the wage index and provider record dates each side used, the usual causes of a gap, and whether a pass-through or a managed care claim explains it.

    Questions

    Is the CMS Web Pricer the official amount?

    It is CMS's own estimate tool. Actual payment is set when the Medicare contractor processes the claim.

    Why might the two differ?

    Provider file timing, pass-through costs that the CMS Web Pricer leaves out, and HMO paid-claim handling are the common reasons.

    What inputs are needed?

    DRG, hospital, discharge date, length of stay and covered charges.