The CMS policy timeline this engine tracks — final rules, grouper versions, code sets, quarterly edit files — alongside product releases. Regulatory dates are CMS effective/issue dates; product dates are when the feature shipped here.
2026
Product
Outpatient claims: the 340B remedy offset and the calendar-year wage index
The outpatient claim pricer now multiplies non-drug APC payments (status indicators J1, J2, P, Q1, Q2, Q3, R, S, S1, T, U and V) by 0.9951, the CY2026 remedy offset in Addendum B, as Medicare does at every hospital paid under the outpatient system except those that enrolled after January 1, 2018. Drugs and ASC rates are not reduced; a colonoscopy (45385) at NewYork-Presbyterian goes from $1,493.75 to $1,486.43. The wage index stays on the calendar-year table: the FY2026 index in force on January 1 applies to every 2026 outpatient line, not the October 1 inpatient refresh. Compare settings, which prices one code, still shows the rate before the offset.
OPPS0.9951CY wage index
Product
The grouper defaults to the manual in force today: MS-DRG v44
A grouping request that names no manual now groups under the one in force on the day it runs, as CMS’s grouper does: MS-DRG v44 (FY2027) since October 1, 2026. It was pinned to v43.1. A claim with a discharge date still groups under the manual for that date. The grouper holds 11 manuals, v39 (FY2022) to v44 (FY2027).
v4411 manualsFY2022–FY2027
Product
Repriced claims as an 835 remittance
Inpatient (IPPS DRG) now downloads an X12 835 (005010X221A1) next to its repriced 837I and 837P files: one remittance for the hospital claim, one for each doctor’s claim on the Physician (837P) tab, or the whole stay in one file. CLP carries billed, paid and patient responsibility, with the MS-DRG and its weight on the hospital’s claim; CAS gives CO-45 for billed above allowed, and each doctor’s line gets its own SVC. A deductible, coinsurance, copay, prior payer or sequestration appears only when you enter it under From allowed to paid; otherwise the 835 pays the allowed amount. Built in your browser and never sent, with sample claims marked as test data.
835ERAX12 5010837I / 837P
Product
Repriced claims as an 837I and 837P
Inpatient (IPPS DRG) exports the priced claim as an X12 837 a payer or clearinghouse system can load: an 837I (005010X223A2) for the hospital claim, an 837P (005010X222A1) for each doctor’s claim on the Physician (837P) tab, or the whole stay in one file. The repriced result rides in the HCP segment, the way repricers hand claims back: the pricing method, the allowed amount, the savings against billed charges and, on the 837I, the priced MS-DRG, with an HCP on every priced 837P line too. The desk never keeps names, member IDs or addresses, so those carry plain placeholders and the receiving system matches on the claim ID. Built in your browser and never sent, with sample claims marked as test data; the desk’s own import reads the file back.
837I837PHCP repricingX12 5010
Grouper & codes
MS-DRG v44 and the FY2027 ICD-10 code sets effective
Fiscal 2027 begins: the v44 grouper (766 MS-DRGs) and the FY2027 ICD-10-CM and ICD-10-PCS code sets apply to discharges on or after October 1, 2026. This engine groups those discharges under v44 and prices them on the FY2027 IPPS final rule (CMS-1849-F, as corrected).
v44FY2027ICD-10
Rates & edits
October 2026 OPPS / ASC quarterly update effective
CMS’s October Addendum B and ASC Addendum AA quarterly updates apply to outpatient services from October 1, 2026, mostly drug and new-code changes. The October Addendum B is now loaded: 2026 outpatient lines price on it, with the remedy offset and the calendar-year wage index added on October 23 (the ASC side stays on the July Addendum AA).
Addendum BAddendum AAQ4 2026
CMS rule
FY2027 IPPS Final Rule (CMS-1849-F), as corrected by CMS-1849-CN3
The inpatient rates for discharges from October 1, 2026, as corrected by the notice published September 29, which recalculated weights, wage indexes and rates: a 2.3% update, a $6,848.00 operating standardized amount and a $539.95 capital rate for hospitals with the full update, and a $49,331 outlier fixed-loss amount (the uncorrected rule had $6,848.98, $540.03 and $49,346). This engine prices FY2027 discharges on the corrected figures.
CMS-1849-FCN3IPPSFY2027
Product
OCE / NCCI claim editing lands in the Outpatient module
Screen an outpatient claim through the official CMS edit files: 1.4M NCCI procedure-to-procedure pairs with modifier bypass (59/X{EPSU}), facility medically-unlikely unit limits with MAI levels, add-on-code primary checks, and OPPS status-indicator packaging — each finding tied to its OCE edit number, disposition, and CARC where one clearly matches.
NCCI PTPMUEAOCOCE
Product
Form-based grouping with full ICD-10 search, POA, and validation
The Group tabs gained a form entry mode: search 74,719 ICD-10-CM diagnoses and 79,115 ICD-10-PCS procedures by code or description (each diagnosis shows its CC/MCC level inline), set POA per diagnosis, and get HAC screening flags, per-code validation against the official FY2026 files, MDC titles, and a raw API response toggle.
ICD-10-CMICD-10-PCSPOAHAC
Product
Grouper runs five manual versions — v39 through v43.1
Group claims under any MS-DRG manual from FY2022 to FY2026, matching the discharge date's version — the same version-picker workflow big groupers offer, backed by version-keyed reference tables.
v39–v43.1FY2022–FY2026
Product
NY Medicaid inpatient APR-DRG pricing
Price NY Medicaid FFS discharges from the state-published datasets: 1,272 APR-DRG × severity service-intensity weights (grouper v34) and per-hospital rate factors for the 1/1/2025 period — SIW × case-payment rate plus IME, capital, DME, and ALC per-diems. APR-DRG assignment itself stays 3M-licensed; you supply the DRG.
APR-DRGNY DOHMedicaid
Product
Outpatient pricing module: OPPS/APC vs ASC, plus EAPG
One tab prices a procedure in both outpatient settings from the July 2026 rate tables — wage-adjusted, with the site-of-service differential — and adds a Medicaid EAPG mode that computes payer-factor payments (base rate × weight × units, less consolidation discounting).
OPPSAPCASCEAPG
Product
Verified against the official CMS pricer — to the cent
The Verify tab prices the same claim through this engine and CMS's own Inpatient PPS pricer live, side by side. Five reference cases reconcile within a rounding cent, and the 60-second product film shows the whole engine end to end.
The July OPPS Addendum B and ASC Addendum AA quarterly updates take effect — the tables this calculator prices outpatient claims with — alongside the Q3 2026 NCCI PTP, MUE, and add-on-code edit files.
Addendum BAddendum AANCCI Q3
Grouper & codes
MS-DRG v43.1 mid-year update — 80 new ICD-10-PCS codes
CMS's April update adds 80 new procedure codes effective for discharges on or after April 1, 2026 — largely new-technology procedures — with grouper logic updated for their OR/non-OR assignments. It was this engine's default manual until October 21, 2026.
v43.1ICD-10-PCSnew technology
Rates & edits
CY2026 OPPS & ASC payment rates effective
The CY2026 outpatient conversion factors take effect — OPPS $91.415 and ASC $56.322 — with the annual status-indicator and APC reshuffles, plus the Q1 2026 NCCI quarterly files.
CY2026conversion factorNCCI Q1
2025
CMS rule
CY2026 OPPS / ASC Final Rule (CMS-1834-FC)
CMS finalizes calendar-2026 hospital outpatient and ambulatory surgical center payment policy: conversion-factor updates, APC weight recalibration, covered-procedures list changes, and the site-of-service differential this calculator's outpatient module computes.
CMS-1834-FCOPPSASC
Grouper & codes
MS-DRG v43.0 and the FY2026 ICD-10 code sets effective
Fiscal-2026 begins: the v43 grouper, the annual ICD-10-CM/PCS updates, refreshed CC/MCC severity designations, and new relative weights all apply to discharges on or after October 1, 2025.
v43.0FY2026ICD-10
CMS rule
FY2026 IPPS Final Rule (CMS-1833-F)
The inpatient rule for fiscal 2026: standardized amounts, wage indices for 3,253 hospitals, IME/DSH factors, uncompensated-care amounts and the $40,397 outlier fixed-loss threshold. This engine priced discharges from Oct 1, 2025 to Sep 30, 2026 on it, and still prices those dates on it.
CMS-1833-FIPPSwage indexoutlier
Grouper & codes
MS-DRG v42.1 mid-year update
April ICD-10-PCS additions land in the grouper for discharges on or after April 1, 2025 — the mid-year cadence CMS adopted for new-technology procedure codes.
v42.1ICD-10-PCS
Rates & edits
CY2025 outpatient rates + NY Medicaid APR-DRG rate period
CY2025 OPPS/ASC rates take effect, and NY Medicaid opens its 1/1/2025 inpatient APR-DRG rate period — the per-hospital case-payment rates and v34 weight table this calculator's NY Medicaid tab prices from.
CY2025APR-DRGNY DOH
2024
CMS rule
CY2025 OPPS / ASC Final Rule (CMS-1809-FC)
Calendar-2025 outpatient policy: a ~2.9% payment update, APC recalibration, and continued site-neutrality debate — the annual rhythm of the outpatient rules this module tracks.
CMS-1809-FCOPPSASC
Grouper & codes
MS-DRG v42.0 and the FY2025 ICD-10 code sets effective
FY2025 brings the v42 grouper and the annual code update — 252 new ICD-10-CM diagnosis codes — with the usual severity-designation and relative-weight refresh for discharges on or after October 1, 2024.
v42.0FY2025252 new codes
CMS rule
FY2025 IPPS Final Rule (CMS-1808-F)
A ~2.9% operating payment update, wage-index policy refinements, and new-technology add-on payment changes for fiscal 2025 inpatient discharges.
CMS-1808-FIPPSFY2025
Grouper & codes
MS-DRG v41.1 mid-year update
New April ICD-10-PCS procedure codes enter the grouper for discharges on or after April 1, 2024, continuing the twice-yearly code cadence.
v41.1ICD-10-PCS
2023
Grouper & codes
MS-DRG v41.0 and the FY2024 ICD-10 code sets effective
FY2024 begins with the v41 grouper and one of the larger annual updates — 395 new ICD-10-CM diagnosis codes — applying to discharges on or after October 1, 2023.
v41.0FY2024395 new codes
CMS rule
FY2024 IPPS Final Rule (CMS-1785-F)
A 3.1% operating payment update for fiscal 2024, plus wage-index and DSH policy changes — the oldest rule year in this engine's multi-version grouper range.