Kentucky Medicaid Inpatient Hospital - DRG Pricing ... DRG... · Inpatient Hospital - DRG Pricing...

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Kentucky Medicaid Inpatient Hospital - DRG Pricing Variables DRG-Specific Variables - Correction Notice Federal Fiscal Year 2019 - CMS V36 MS-DRG FY 2019 FINAL Post- Acute DRG FY 2019 FINAL Special Pay DRG MDC TYPE MS-DRG Title Weights Geometric mean LOS Arithmetic mean LOS Acquisition Fee Add-on 001 No No PRE SURG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 26.4106 29.1 37.5 $70,000 002 No No PRE SURG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC 13.4227 15.1 18.0 $70,000 003 Yes No PRE SURG ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 18.2974 23.4 30.1 $0 004 Yes No PRE SURG TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 11.4192 19.5 23.6 $0 005 No No PRE SURG LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANT 10.2545 14.6 20.0 $55,000 006 No No PRE SURG LIVER TRANSPLANT W/O MCC 4.8655 7.9 8.6 $55,000 007 No No PRE SURG LUNG TRANSPLANT 10.6510 16.7 20.2 $65,000 008 No No PRE SURG SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT 5.2490 8.9 10.1 $40,000 010 No No PRE SURG PANCREAS TRANSPLANT 4.5139 7.8 8.5 $40,000 011 No No PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W 4.9124 10.9 13.4 $0 012 No No PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W C 3.8137 8.7 9.8 $0 013 No No PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W/O 2.3265 5.9 6.7 $0 014 No No PRE SURG ALLOGENEIC BONE MARROW TRANSPLANT 11.9503 24.1 27.4 $0 016 No No PRE SURG AUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC OR T-CELL IMMUNOTHER 6.5394 17.1 18.4 $0 017 No No PRE SURG AUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCC 4.3811 7.9 10.7 $0 020 No No 01 SURG INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC 10.4253 13.6 16.5 $0 021 No No 01 SURG INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC 7.9056 12.1 13.7 $0 022 No No 01 SURG INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC 5.1575 6.3 8.1 $0 023 Yes Yes 01 SURG CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC O 5.4601 7.3 10.2 $0 024 Yes Yes 01 SURG CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC 3.9194 4.3 5.7 $0 025 Yes No 01 SURG CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC 4.2775 6.7 8.8 $0 026 Yes No 01 SURG CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC 3.0157 4.3 5.7 $0 027 Yes No 01 SURG CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC 2.4057 2.1 2.7 $0 028 Yes Yes 01 SURG SPINAL PROCEDURES W MCC 5.3748 9.0 11.8 $0 029 Yes Yes 01 SURG SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS 3.1557 4.4 5.8 $0 030 Yes Yes 01 SURG SPINAL PROCEDURES W/O CC/MCC 2.1757 2.3 3.0 $0 031 Yes No 01 SURG VENTRICULAR SHUNT PROCEDURES W MCC 4.1829 7.2 10.1 $0 032 Yes No 01 SURG VENTRICULAR SHUNT PROCEDURES W CC 2.3021 3.3 4.8 $0 033 Yes No 01 SURG VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 1.6877 1.8 2.3 $0 034 No No 01 SURG CAROTID ARTERY STENT PROCEDURE W MCC 3.5998 4.7 6.8 $0 035 No No 01 SURG CAROTID ARTERY STENT PROCEDURE W CC 2.2203 2.1 3.0 $0
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Transcript of Kentucky Medicaid Inpatient Hospital - DRG Pricing ... DRG... · Inpatient Hospital - DRG Pricing...

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

001 No No PRE SURG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 26.4106 29.1 37.5 $70,000002 No No PRE SURG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC 13.4227 15.1 18.0 $70,000003 Yes No PRE SURG ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 18.2974 23.4 30.1 $0004 Yes No PRE SURG TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 11.4192 19.5 23.6 $0005 No No PRE SURG LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANT 10.2545 14.6 20.0 $55,000006 No No PRE SURG LIVER TRANSPLANT W/O MCC 4.8655 7.9 8.6 $55,000007 No No PRE SURG LUNG TRANSPLANT 10.6510 16.7 20.2 $65,000008 No No PRE SURG SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT 5.2490 8.9 10.1 $40,000010 No No PRE SURG PANCREAS TRANSPLANT 4.5139 7.8 8.5 $40,000011 No No PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W 4.9124 10.9 13.4 $0012 No No PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W C3.8137 8.7 9.8 $0013 No No PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W/O 2.3265 5.9 6.7 $0014 No No PRE SURG ALLOGENEIC BONE MARROW TRANSPLANT 11.9503 24.1 27.4 $0016 No No PRE SURG AUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC OR T-CELL IMMUNOTHER6.5394 17.1 18.4 $0017 No No PRE SURG AUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCC 4.3811 7.9 10.7 $0020 No No 01 SURG INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC 10.4253 13.6 16.5 $0021 No No 01 SURG INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC 7.9056 12.1 13.7 $0022 No No 01 SURG INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC 5.1575 6.3 8.1 $0023 Yes Yes 01 SURG CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC O 5.4601 7.3 10.2 $0024 Yes Yes 01 SURG CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC 3.9194 4.3 5.7 $0025 Yes No 01 SURG CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC 4.2775 6.7 8.8 $0026 Yes No 01 SURG CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC 3.0157 4.3 5.7 $0027 Yes No 01 SURG CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC 2.4057 2.1 2.7 $0028 Yes Yes 01 SURG SPINAL PROCEDURES W MCC 5.3748 9.0 11.8 $0029 Yes Yes 01 SURG SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS 3.1557 4.4 5.8 $0030 Yes Yes 01 SURG SPINAL PROCEDURES W/O CC/MCC 2.1757 2.3 3.0 $0031 Yes No 01 SURG VENTRICULAR SHUNT PROCEDURES W MCC 4.1829 7.2 10.1 $0032 Yes No 01 SURG VENTRICULAR SHUNT PROCEDURES W CC 2.3021 3.3 4.8 $0033 Yes No 01 SURG VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 1.6877 1.8 2.3 $0034 No No 01 SURG CAROTID ARTERY STENT PROCEDURE W MCC 3.5998 4.7 6.8 $0035 No No 01 SURG CAROTID ARTERY STENT PROCEDURE W CC 2.2203 2.1 3.0 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

036 No No 01 SURG CAROTID ARTERY STENT PROCEDURE W/O CC/MCC 1.7260 1.2 1.4 $0037 No No 01 SURG EXTRACRANIAL PROCEDURES W MCC 3.2098 5.1 7.4 $0038 No No 01 SURG EXTRACRANIAL PROCEDURES W CC 1.6717 2.2 3.1 $0039 No No 01 SURG EXTRACRANIAL PROCEDURES W/O CC/MCC 1.1324 1.3 1.5 $0040 Yes Yes 01 SURG PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC 3.9282 7.6 10.7 $0041 Yes Yes 01 SURG PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM2.3584 4.2 5.3 $0042 Yes Yes 01 SURG PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC 1.8715 2.5 3.1 $0052 No No 01 MED SPINAL DISORDERS & INJURIES W CC/MCC 1.7004 4.1 5.8 $0053 No No 01 MED SPINAL DISORDERS & INJURIES W/O CC/MCC 0.9141 2.7 3.3 $0054 Yes No 01 MED NERVOUS SYSTEM NEOPLASMS W MCC 1.3166 3.8 5.1 $0055 Yes No 01 MED NERVOUS SYSTEM NEOPLASMS W/O MCC 1.0472 3.1 4.4 $0056 Yes No 01 MED DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 2.1245 5.5 8.1 $0057 Yes No 01 MED DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC 1.2089 3.9 5.6 $0058 No No 01 MED MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC 1.7596 5.0 6.9 $0059 No No 01 MED MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC 1.0993 3.7 4.5 $0060 No No 01 MED MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC 0.8327 3.0 3.5 $0061 No No 01 MED ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THRO 2.8477 5.0 6.5 $0062 No No 01 MED ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THRO 1.9437 3.4 4.0 $0063 No No 01 MED ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THRO 1.6280 2.4 2.7 $0064 Yes No 01 MED INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC 1.8692 4.4 6.1 $0065 Yes No 01 MED INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS1.0315 3.1 3.8 $0066 Yes No 01 MED INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC 0.7268 2.1 2.5 $0067 No No 01 MED NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCC 1.5014 3.6 4.8 $0068 No No 01 MED NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC 0.8987 2.3 2.8 $0069 No No 01 MED TRANSIENT ISCHEMIA W/O THROMBOLYTIC 0.7655 2.1 2.5 $0070 Yes No 01 MED NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC 1.6453 4.5 6.2 $0071 Yes No 01 MED NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 0.9858 3.3 4.3 $0072 Yes No 01 MED NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC 0.7420 2.4 2.9 $0073 No No 01 MED CRANIAL & PERIPHERAL NERVE DISORDERS W MCC 1.4111 3.7 5.1 $0074 No No 01 MED CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC 0.9739 2.9 3.7 $0075 No No 01 MED VIRAL MENINGITIS W CC/MCC 1.4816 4.8 6.0 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

076 No No 01 MED VIRAL MENINGITIS W/O CC/MCC 0.8248 2.8 3.3 $0077 No No 01 MED HYPERTENSIVE ENCEPHALOPATHY W MCC 1.5520 4.1 5.2 $0078 No No 01 MED HYPERTENSIVE ENCEPHALOPATHY W CC 0.9701 3.1 3.8 $0079 No No 01 MED HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC 0.7465 2.1 2.5 $0080 No No 01 MED NONTRAUMATIC STUPOR & COMA W MCC 1.8788 4.5 6.8 $0081 No No 01 MED NONTRAUMATIC STUPOR & COMA W/O MCC 0.8546 2.7 3.7 $0082 No No 01 MED TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC 2.1586 3.8 6.0 $0083 No No 01 MED TRAUMATIC STUPOR & COMA, COMA >1 HR W CC 1.2950 3.2 4.2 $0084 No No 01 MED TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC 0.9233 2.2 2.7 $0085 Yes No 01 MED TRAUMATIC STUPOR & COMA, COMA

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

116 No No 02 SURG INTRAOCULAR PROCEDURES W CC/MCC 1.7080 4.0 5.8 $0117 No No 02 SURG INTRAOCULAR PROCEDURES W/O CC/MCC 1.0025 2.3 3.1 $0121 No No 02 MED ACUTE MAJOR EYE INFECTIONS W CC/MCC 1.0593 4.0 5.2 $0122 No No 02 MED ACUTE MAJOR EYE INFECTIONS W/O CC/MCC 0.7058 3.2 4.1 $0123 No No 02 MED NEUROLOGICAL EYE DISORDERS 0.7529 2.0 2.5 $0124 No No 02 MED OTHER DISORDERS OF THE EYE W MCC 1.3313 3.6 4.9 $0125 No No 02 MED OTHER DISORDERS OF THE EYE W/O MCC 0.8102 2.6 3.3 $0129 No No 03 SURG MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE 2.4310 3.7 5.5 $0130 No No 03 SURG MAJOR HEAD & NECK PROCEDURES W/O CC/MCC 1.4912 2.3 2.9 $0131 No No 03 SURG CRANIAL/FACIAL PROCEDURES W CC/MCC 2.6284 4.2 5.7 $0132 No No 03 SURG CRANIAL/FACIAL PROCEDURES W/O CC/MCC 1.5286 2.0 2.5 $0133 No No 03 SURG OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC 2.0986 4.0 5.8 $0134 No No 03 SURG OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC 1.1987 2.0 2.5 $0135 No No 03 SURG SINUS & MASTOID PROCEDURES W CC/MCC 2.2982 4.4 6.4 $0136 No No 03 SURG SINUS & MASTOID PROCEDURES W/O CC/MCC 1.2125 1.8 2.8 $0137 No No 03 SURG MOUTH PROCEDURES W CC/MCC 1.3771 3.6 4.8 $0138 No No 03 SURG MOUTH PROCEDURES W/O CC/MCC 0.8452 2.0 2.4 $0139 No No 03 SURG SALIVARY GLAND PROCEDURES 1.1604 2.1 2.8 $0146 No No 03 MED EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC 1.9231 5.3 7.4 $0147 No No 03 MED EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC 1.2505 3.7 5.2 $0148 No No 03 MED EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC 0.7238 2.1 2.8 $0149 No No 03 MED DYSEQUILIBRIUM 0.7111 2.0 2.5 $0150 No No 03 MED EPISTAXIS W MCC 1.3275 3.5 4.8 $0151 No No 03 MED EPISTAXIS W/O MCC 0.7038 2.2 2.8 $0152 No No 03 MED OTITIS MEDIA & URI W MCC 1.0421 3.2 4.1 $0153 No No 03 MED OTITIS MEDIA & URI W/O MCC 0.7118 2.4 2.9 $0154 No No 03 MED OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC 1.4465 4.0 5.3 $0155 No No 03 MED OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC 0.8833 2.9 3.7 $0156 No No 03 MED OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC 0.6599 2.2 2.7 $0157 No No 03 MED DENTAL & ORAL DISEASES W MCC 1.6730 4.4 6.1 $0158 No No 03 MED DENTAL & ORAL DISEASES W CC 0.8903 2.8 3.6 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

159 No No 03 MED DENTAL & ORAL DISEASES W/O CC/MCC 0.6784 2.1 2.6 $0163 Yes No 04 SURG MAJOR CHEST PROCEDURES W MCC 4.9193 9.7 12.1 $0164 Yes No 04 SURG MAJOR CHEST PROCEDURES W CC 2.5689 4.8 5.9 $0165 Yes No 04 SURG MAJOR CHEST PROCEDURES W/O CC/MCC 1.8524 2.9 3.5 $0166 Yes No 04 SURG OTHER RESP SYSTEM O.R. PROCEDURES W MCC 3.4980 7.9 10.2 $0167 Yes No 04 SURG OTHER RESP SYSTEM O.R. PROCEDURES W CC 1.8976 4.3 5.6 $0168 Yes No 04 SURG OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC 1.3416 2.4 3.0 $0175 Yes No 04 MED PULMONARY EMBOLISM W MCC 1.4649 4.3 5.3 $0176 Yes No 04 MED PULMONARY EMBOLISM W/O MCC 0.8990 2.8 3.4 $0177 Yes No 04 MED RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 1.8408 5.5 6.8 $0178 Yes No 04 MED RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 1.2744 4.3 5.3 $0179 Yes No 04 MED RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC 0.9215 3.2 4.0 $0180 No No 04 MED RESPIRATORY NEOPLASMS W MCC 1.6960 4.9 6.5 $0181 No No 04 MED RESPIRATORY NEOPLASMS W CC 1.1409 3.4 4.5 $0182 No No 04 MED RESPIRATORY NEOPLASMS W/O CC/MCC 0.7951 2.2 2.8 $0183 No No 04 MED MAJOR CHEST TRAUMA W MCC 1.4909 4.4 5.5 $0184 No No 04 MED MAJOR CHEST TRAUMA W CC 1.0044 3.2 3.8 $0185 No No 04 MED MAJOR CHEST TRAUMA W/O CC/MCC 0.7323 2.4 2.8 $0186 Yes No 04 MED PLEURAL EFFUSION W MCC 1.5595 4.4 5.8 $0187 Yes No 04 MED PLEURAL EFFUSION W CC 1.0540 3.3 4.1 $0188 Yes No 04 MED PLEURAL EFFUSION W/O CC/MCC 0.7672 2.4 3.0 $0189 No No 04 MED PULMONARY EDEMA & RESPIRATORY FAILURE 1.2353 3.8 4.8 $0190 Yes No 04 MED CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 1.1907 3.8 4.7 $0191 Yes No 04 MED CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 0.9139 3.1 3.7 $0192 Yes No 04 MED CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC 0.7241 2.5 3.0 $0193 Yes No 04 MED SIMPLE PNEUMONIA & PLEURISY W MCC 1.3167 4.2 5.2 $0194 Yes No 04 MED SIMPLE PNEUMONIA & PLEURISY W CC 0.9002 3.3 3.9 $0195 Yes No 04 MED SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 0.6868 2.6 3.1 $0196 Yes No 04 MED INTERSTITIAL LUNG DISEASE W MCC 1.6381 4.8 6.2 $0197 Yes No 04 MED INTERSTITIAL LUNG DISEASE W CC 1.0017 3.3 4.0 $0198 Yes No 04 MED INTERSTITIAL LUNG DISEASE W/O CC/MCC 0.7585 2.5 3.1 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

199 No No 04 MED PNEUMOTHORAX W MCC 1.7828 5.3 6.9 $0200 No No 04 MED PNEUMOTHORAX W CC 1.0748 3.4 4.3 $0201 No No 04 MED PNEUMOTHORAX W/O CC/MCC 0.6989 2.4 3.0 $0202 No No 04 MED BRONCHITIS & ASTHMA W CC/MCC 0.9401 3.0 3.7 $0203 No No 04 MED BRONCHITIS & ASTHMA W/O CC/MCC 0.6970 2.4 2.9 $0204 No No 04 MED RESPIRATORY SIGNS & SYMPTOMS 0.7676 2.2 2.8 $0205 Yes No 04 MED OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC 1.5179 4.0 5.4 $0206 Yes No 04 MED OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC 0.8635 2.5 3.1 $0207 Yes No 04 MED RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS OR PER 5.5965 12.0 13.9 $0208 No No 04 MED RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

239 Yes No 05 SURG AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC 4.7093 10.2 13.0 $0240 Yes No 05 SURG AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC 2.7449 7.0 8.5 $0241 Yes No 05 SURG AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC 1.5960 4.4 5.2 $0242 Yes No 05 SURG PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 3.7369 5.4 7.0 $0243 Yes No 05 SURG PERMANENT CARDIAC PACEMAKER IMPLANT W CC 2.5543 3.3 4.0 $0244 Yes No 05 SURG PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC 2.1108 2.3 2.7 $0245 No No 05 SURG AICD GENERATOR PROCEDURES 5.0121 4.4 6.1 $0246 No No 05 SURG PERCUTANEOUS CARDIOVASCULAR PROCEDURES W DRUG-ELUTING STENT W M 3.2388 4.1 5.4 $0247 No No 05 SURG PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC 2.0771 2.2 2.6 $0248 No No 05 SURG PERCUTANEOUS CARDIOVASCULAR PROCEDURES W NON-DRUG-ELUTING STENT 3.1726 4.7 6.3 $0249 No No 05 SURG PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC 1.9901 2.4 3.0 $0250 No No 05 SURG PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC 2.5868 3.9 5.3 $0251 No No 05 SURG PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC 1.6778 2.2 2.7 $0252 No No 05 SURG OTHER VASCULAR PROCEDURES W MCC 3.2598 5.3 7.6 $0253 No No 05 SURG OTHER VASCULAR PROCEDURES W CC 2.5943 4.1 5.4 $0254 No No 05 SURG OTHER VASCULAR PROCEDURES W/O CC/MCC 1.8100 2.3 2.8 $0255 Yes No 05 SURG UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC 2.5403 6.5 8.1 $0256 Yes No 05 SURG UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC 1.7487 5.2 6.2 $0257 Yes No 05 SURG UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC 1.1261 3.5 4.3 $0258 No No 05 SURG CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC 2.9888 5.0 6.4 $0259 No No 05 SURG CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC 2.0970 2.7 3.4 $0260 No No 05 SURG CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC 3.6195 6.8 9.2 $0261 No No 05 SURG CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC 1.9918 3.3 4.2 $0262 No No 05 SURG CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC 1.6309 2.3 2.7 $0263 No No 05 SURG VEIN LIGATION & STRIPPING 2.3922 4.2 6.3 $0264 Yes No 05 SURG OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 3.1586 6.5 9.2 $0265 No No 05 SURG AICD LEAD PROCEDURES 3.1167 3.7 5.1 $0266 Yes Yes 05 SURG ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC 7.1915 4.0 6.1 $0267 Yes Yes 05 SURG ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC 5.8481 2.3 2.9 $0268 No No 05 SURG AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC 6.7037 6.4 9.5 $0269 No No 05 SURG AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MC 4.1509 1.7 2.4 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

270 No No 05 SURG OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC 5.0617 6.6 9.5 $0271 No No 05 SURG OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC 3.4938 4.3 5.8 $0272 No No 05 SURG OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC 2.6181 2.1 2.8 $0273 Yes Yes 05 SURG PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC 3.6525 5.3 7.3 $0274 Yes Yes 05 SURG PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC 2.9783 2.0 2.6 $0280 Yes No 05 MED ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC 1.6571 4.2 5.4 $0281 Yes No 05 MED ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 0.9796 2.6 3.2 $0282 Yes No 05 MED ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC 0.7490 1.8 2.2 $0283 No No 05 MED ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC 1.8047 3.0 4.8 $0284 No No 05 MED ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC 0.7666 1.7 2.3 $0285 No No 05 MED ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC 0.5964 1.3 1.6 $0286 No No 05 MED CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC 2.1808 5.2 6.9 $0287 No No 05 MED CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC 1.1389 2.4 3.0 $0288 Yes No 05 MED ACUTE & SUBACUTE ENDOCARDITIS W MCC 2.6941 7.3 9.6 $0289 Yes No 05 MED ACUTE & SUBACUTE ENDOCARDITIS W CC 1.7099 5.4 6.7 $0290 Yes No 05 MED ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC 1.0114 3.4 4.3 $0291 Yes No 05 MED HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE 1.3454 4.1 5.2 $0292 Yes No 05 MED HEART FAILURE & SHOCK W CC 0.9198 3.3 4.0 $0293 Yes No 05 MED HEART FAILURE & SHOCK W/O CC/MCC 0.6656 2.4 2.8 $0294 No No 05 MED DEEP VEIN THROMBOPHLEBITIS W CC/MCC 1.1608 3.4 4.4 $0295 No No 05 MED DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC 0.5513 2.3 3.1 $0296 No No 05 MED CARDIAC ARREST, UNEXPLAINED W MCC OR PERIPHERAL EXTRACORPOREAL ME 1.5355 2.0 3.2 $0297 No No 05 MED CARDIAC ARREST, UNEXPLAINED W CC 0.6524 1.3 1.5 $0298 No No 05 MED CARDIAC ARREST, UNEXPLAINED W/O CC/MCC 0.4825 1.1 1.2 $0299 Yes No 05 MED PERIPHERAL VASCULAR DISORDERS W MCC 1.4504 3.9 5.2 $0300 Yes No 05 MED PERIPHERAL VASCULAR DISORDERS W CC 1.0237 3.3 4.1 $0301 Yes No 05 MED PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 0.7262 2.3 2.8 $0302 No No 05 MED ATHEROSCLEROSIS W MCC 1.0695 2.7 3.6 $0303 No No 05 MED ATHEROSCLEROSIS W/O MCC 0.6655 1.9 2.3 $0304 No No 05 MED HYPERTENSION W MCC 1.0811 3.0 3.9 $0305 No No 05 MED HYPERTENSION W/O MCC 0.7199 2.2 2.7 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

306 No No 05 MED CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC 1.4088 3.8 5.2 $0307 No No 05 MED CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC 0.8560 2.4 3.1 $0308 No No 05 MED CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC 1.2036 3.6 4.6 $0309 No No 05 MED CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 0.7635 2.5 3.0 $0310 No No 05 MED CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC 0.5623 1.9 2.2 $0311 No No 05 MED ANGINA PECTORIS 0.6872 1.9 2.4 $0312 No No 05 MED SYNCOPE & COLLAPSE 0.8015 2.3 2.9 $0313 No No 05 MED CHEST PAIN 0.7073 1.7 2.1 $0314 Yes No 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 2.0231 4.8 6.5 $0315 Yes No 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 0.9559 2.8 3.6 $0316 Yes No 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC 0.7513 2.0 2.4 $0326 Yes No 06 SURG STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC 5.2559 10.1 13.5 $0327 Yes No 06 SURG STOMACH, ESOPHAGEAL & DUODENAL PROC W CC 2.4843 4.9 6.7 $0328 Yes No 06 SURG STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC 1.5421 2.2 2.8 $0329 Yes No 06 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC 4.9927 10.8 13.4 $0330 Yes No 06 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 2.5233 6.2 7.4 $0331 Yes No 06 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 1.6947 3.7 4.2 $0332 Yes No 06 SURG RECTAL RESECTION W MCC 3.3982 6.9 8.8 $0333 Yes No 06 SURG RECTAL RESECTION W CC 1.9278 4.4 5.4 $0334 Yes No 06 SURG RECTAL RESECTION W/O CC/MCC 1.3062 2.4 2.9 $0335 Yes No 06 SURG PERITONEAL ADHESIOLYSIS W MCC 4.0620 10.1 12.3 $0336 Yes No 06 SURG PERITONEAL ADHESIOLYSIS W CC 2.2982 6.3 7.7 $0337 Yes No 06 SURG PERITONEAL ADHESIOLYSIS W/O CC/MCC 1.6033 3.9 4.8 $0338 No No 06 SURG APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC 2.8648 6.6 8.2 $0339 No No 06 SURG APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 1.7406 4.3 5.2 $0340 No No 06 SURG APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC 1.1878 2.4 2.9 $0341 No No 06 SURG APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC 2.2845 4.6 6.3 $0342 No No 06 SURG APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC 1.4188 2.7 3.5 $0343 No No 06 SURG APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC 1.0853 1.7 2.0 $0344 No No 06 SURG MINOR SMALL & LARGE BOWEL PROCEDURES W MCC 2.9872 7.6 10.1 $0345 No No 06 SURG MINOR SMALL & LARGE BOWEL PROCEDURES W CC 1.6376 4.6 5.7 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

346 No No 06 SURG MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 1.2366 3.2 3.8 $0347 No No 06 SURG ANAL & STOMAL PROCEDURES W MCC 2.4111 5.7 7.8 $0348 No No 06 SURG ANAL & STOMAL PROCEDURES W CC 1.4000 3.6 4.7 $0349 No No 06 SURG ANAL & STOMAL PROCEDURES W/O CC/MCC 0.9497 2.1 2.6 $0350 No No 06 SURG INGUINAL & FEMORAL HERNIA PROCEDURES W MCC 2.4465 5.1 6.9 $0351 No No 06 SURG INGUINAL & FEMORAL HERNIA PROCEDURES W CC 1.5001 3.4 4.1 $0352 No No 06 SURG INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC 1.0535 2.1 2.5 $0353 No No 06 SURG HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC 2.9659 6.0 7.8 $0354 No No 06 SURG HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC 1.7310 3.8 4.7 $0355 No No 06 SURG HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC 1.3548 2.5 3.0 $0356 Yes No 06 SURG OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC 3.9757 7.8 10.3 $0357 Yes No 06 SURG OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 2.1367 4.7 5.9 $0358 Yes No 06 SURG OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 1.3483 2.8 3.5 $0368 No No 06 MED MAJOR ESOPHAGEAL DISORDERS W MCC 1.9440 4.7 6.2 $0369 No No 06 MED MAJOR ESOPHAGEAL DISORDERS W CC 1.1088 3.2 3.9 $0370 No No 06 MED MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC 0.7433 2.2 2.8 $0371 Yes No 06 MED MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC 1.7388 5.4 7.0 $0372 Yes No 06 MED MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC 1.0384 4.0 4.9 $0373 Yes No 06 MED MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC0.7576 3.1 3.7 $0374 Yes No 06 MED DIGESTIVE MALIGNANCY W MCC 2.0650 5.6 7.5 $0375 Yes No 06 MED DIGESTIVE MALIGNANCY W CC 1.2067 3.7 4.8 $0376 Yes No 06 MED DIGESTIVE MALIGNANCY W/O CC/MCC 0.9157 2.5 3.1 $0377 Yes No 06 MED G.I. HEMORRHAGE W MCC 1.7888 4.5 5.7 $0378 Yes No 06 MED G.I. HEMORRHAGE W CC 0.9903 3.0 3.6 $0379 Yes No 06 MED G.I. HEMORRHAGE W/O CC/MCC 0.6532 2.1 2.5 $0380 Yes No 06 MED COMPLICATED PEPTIC ULCER W MCC 1.9460 5.1 6.6 $0381 Yes No 06 MED COMPLICATED PEPTIC ULCER W CC 1.0950 3.3 4.0 $0382 Yes No 06 MED COMPLICATED PEPTIC ULCER W/O CC/MCC 0.7678 2.5 2.9 $0383 No No 06 MED UNCOMPLICATED PEPTIC ULCER W MCC 1.3510 4.0 5.0 $0384 No No 06 MED UNCOMPLICATED PEPTIC ULCER W/O MCC 0.8553 2.6 3.2 $0385 No No 06 MED INFLAMMATORY BOWEL DISEASE W MCC 1.6979 5.3 7.3 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

386 No No 06 MED INFLAMMATORY BOWEL DISEASE W CC 0.9801 3.5 4.4 $0387 No No 06 MED INFLAMMATORY BOWEL DISEASE W/O CC/MCC 0.6967 2.8 3.3 $0388 Yes No 06 MED G.I. OBSTRUCTION W MCC 1.5307 4.8 6.4 $0389 Yes No 06 MED G.I. OBSTRUCTION W CC 0.8432 3.3 4.0 $0390 Yes No 06 MED G.I. OBSTRUCTION W/O CC/MCC 0.5910 2.5 2.9 $0391 No No 06 MED ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC 1.2215 3.7 4.9 $0392 No No 06 MED ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 0.7554 2.6 3.2 $0393 No No 06 MED OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC 1.6326 4.4 6.1 $0394 No No 06 MED OTHER DIGESTIVE SYSTEM DIAGNOSES W CC 0.9411 3.1 4.0 $0395 No No 06 MED OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC 0.6765 2.3 2.8 $0405 Yes No 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.3791 9.6 12.8 $0406 Yes No 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8326 5.6 7.0 $0407 Yes No 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 2.0068 3.8 4.5 $0408 No No 07 SURG BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC 4.0465 9.2 11.9 $0409 No No 07 SURG BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC 2.3227 5.6 6.9 $0410 No No 07 SURG BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC 1.6526 3.7 4.5 $0411 No No 07 SURG CHOLECYSTECTOMY W C.D.E. W MCC 3.9981 8.3 11.1 $0412 No No 07 SURG CHOLECYSTECTOMY W C.D.E. W CC 2.3819 5.5 6.5 $0413 No No 07 SURG CHOLECYSTECTOMY W C.D.E. W/O CC/MCC 1.6862 3.5 4.3 $0414 Yes No 07 SURG CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC 3.5772 8.0 9.8 $0415 Yes No 07 SURG CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 2.0188 5.2 6.1 $0416 Yes No 07 SURG CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC 1.3931 3.2 3.8 $0417 No No 07 SURG LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 2.4234 5.4 6.7 $0418 No No 07 SURG LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 1.6642 3.7 4.4 $0419 No No 07 SURG LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 1.3042 2.5 2.9 $0420 No No 07 SURG HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC 3.5176 7.7 10.5 $0421 No No 07 SURG HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC 1.7791 4.1 5.4 $0422 No No 07 SURG HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC 1.5076 2.8 3.4 $0423 No No 07 SURG OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC 3.9460 8.6 12.3 $0424 No No 07 SURG OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC 2.1911 5.6 7.4 $0425 No No 07 SURG OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC 1.4929 3.4 4.1 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

432 No No 07 MED CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC 1.8260 4.7 6.4 $0433 No No 07 MED CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 1.0279 3.3 4.2 $0434 No No 07 MED CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC 0.6511 2.3 2.8 $0435 No No 07 MED MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC 1.6977 4.8 6.3 $0436 No No 07 MED MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC 1.1359 3.5 4.5 $0437 No No 07 MED MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC 0.8658 2.4 3.1 $0438 No No 07 MED DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 1.6382 4.6 6.3 $0439 No No 07 MED DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 0.8623 3.2 4.0 $0440 No No 07 MED DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 0.6213 2.5 2.9 $0441 Yes No 07 MED DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC 1.8572 4.7 6.5 $0442 Yes No 07 MED DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 0.9389 3.2 4.1 $0443 Yes No 07 MED DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC 0.6958 2.5 3.0 $0444 No No 07 MED DISORDERS OF THE BILIARY TRACT W MCC 1.6109 4.4 5.7 $0445 No No 07 MED DISORDERS OF THE BILIARY TRACT W CC 1.0676 3.2 3.9 $0446 No No 07 MED DISORDERS OF THE BILIARY TRACT W/O CC/MCC 0.7950 2.3 2.7 $0453 No No 08 SURG COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC 9.4969 7.6 9.7 $0454 No No 08 SURG COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 6.3368 4.0 4.7 $0455 No No 08 SURG COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC 5.0000 2.6 3.0 $0456 No No 08 SURG SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC 9.1252 9.5 11.6 $0457 No No 08 SURG SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC 6.5446 5.3 6.1 $0458 No No 08 SURG SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC 5.1212 3.2 3.6 $0459 Yes No 08 SURG SPINAL FUSION EXCEPT CERVICAL W MCC 6.3848 6.3 7.9 $0460 Yes No 08 SURG SPINAL FUSION EXCEPT CERVICAL W/O MCC 4.0375 2.9 3.4 $0461 No No 08 SURG BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC 4.4825 5.6 6.7 $0462 No No 08 SURG BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC 3.1941 2.9 3.2 $0463 Yes No 08 SURG WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC 5.1319 9.8 13.0 $0464 Yes No 08 SURG WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC 2.9440 5.5 7.0 $0465 Yes No 08 SURG WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC1.8374 2.7 3.5 $0466 Yes No 08 SURG REVISION OF HIP OR KNEE REPLACEMENT W MCC 5.1132 6.6 8.3 $0467 Yes No 08 SURG REVISION OF HIP OR KNEE REPLACEMENT W CC 3.4704 3.4 4.1 $0468 Yes No 08 SURG REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC 2.7914 2.2 2.5 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

469 Yes No 08 SURG MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTR 3.1742 4.9 6.2 $0470 Yes No 08 SURG MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTR 1.9898 2.2 2.5 $0471 No No 08 SURG CERVICAL SPINAL FUSION W MCC 5.0107 6.3 8.6 $0472 No No 08 SURG CERVICAL SPINAL FUSION W CC 2.9468 2.4 3.2 $0473 No No 08 SURG CERVICAL SPINAL FUSION W/O CC/MCC 2.3729 1.5 1.8 $0474 Yes No 08 SURG AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC 3.7951 8.9 11.1 $0475 Yes No 08 SURG AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC 2.1488 5.8 7.1 $0476 Yes No 08 SURG AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC 1.1507 3.1 4.0 $0477 Yes Yes 08 SURG BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 3.1384 8.2 10.2 $0478 Yes Yes 08 SURG BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 2.2792 5.3 6.6 $0479 Yes Yes 08 SURG BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 1.7980 3.4 4.2 $0480 Yes Yes 08 SURG HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC 3.0304 6.4 7.5 $0481 Yes Yes 08 SURG HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 2.0623 4.4 4.8 $0482 Yes Yes 08 SURG HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC 1.6645 3.5 3.7 $0483 No No 08 SURG MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES 2.3835 1.6 1.9 $0485 No No 08 SURG KNEE PROCEDURES W PDX OF INFECTION W MCC 3.3041 8.0 9.6 $0486 No No 08 SURG KNEE PROCEDURES W PDX OF INFECTION W CC 2.2184 5.3 6.3 $0487 No No 08 SURG KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC 1.6502 3.7 4.2 $0488 Yes No 08 SURG KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC 2.1125 3.8 5.0 $0489 Yes No 08 SURG KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC 1.2974 2.1 2.5 $0492 Yes Yes 08 SURG LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC 3.3905 6.1 7.7 $0493 Yes Yes 08 SURG LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC 2.2461 4.0 4.8 $0494 Yes Yes 08 SURG LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC 1.7539 2.7 3.2 $0495 Yes Yes 08 SURG LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC 3.4623 7.3 9.8 $0496 Yes Yes 08 SURG LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC 1.9609 3.5 4.5 $0497 Yes Yes 08 SURG LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC 1.4350 1.9 2.4 $0498 No No 08 SURG LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC 2.2780 5.1 6.8 $0499 No No 08 SURG LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC 1.1192 2.1 2.6 $0500 Yes Yes 08 SURG SOFT TISSUE PROCEDURES W MCC 3.0680 7.3 9.7 $0501 Yes Yes 08 SURG SOFT TISSUE PROCEDURES W CC 1.6874 4.2 5.2 $0502 Yes Yes 08 SURG SOFT TISSUE PROCEDURES W/O CC/MCC 1.2911 2.5 3.0 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

503 No No 08 SURG FOOT PROCEDURES W MCC 2.5622 6.8 8.5 $0504 No No 08 SURG FOOT PROCEDURES W CC 1.7295 4.8 5.8 $0505 No No 08 SURG FOOT PROCEDURES W/O CC/MCC 1.5798 2.8 3.4 $0506 No No 08 SURG MAJOR THUMB OR JOINT PROCEDURES 1.4103 3.8 4.8 $0507 No No 08 SURG MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC 1.9425 4.5 5.9 $0508 No No 08 SURG MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W/O CC/MCC 1.4474 2.1 2.6 $0509 No No 08 SURG ARTHROSCOPY 1.6703 4.4 5.6 $0510 Yes No 08 SURG SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC 2.7324 5.0 6.3 $0511 Yes No 08 SURG SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC 1.8473 3.4 4.0 $0512 Yes No 08 SURG SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC 1.5221 2.2 2.5 $0513 No No 08 SURG HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC 1.6396 4.1 5.3 $0514 No No 08 SURG HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC 0.9998 2.3 2.9 $0515 Yes Yes 08 SURG OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC 3.0820 6.4 8.3 $0516 Yes Yes 08 SURG OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 1.8854 3.8 4.7 $0517 Yes Yes 08 SURG OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC 1.3809 2.2 2.7 $0518 Yes Yes 08 SURG BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM 3.1002 3.4 5.4 $0519 Yes Yes 08 SURG BACK & NECK PROC EXC SPINAL FUSION W CC 1.8620 3.1 4.0 $0520 Yes Yes 08 SURG BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 1.3141 1.9 2.3 $0533 Yes No 08 MED FRACTURES OF FEMUR W MCC 1.5305 4.2 5.7 $0534 Yes No 08 MED FRACTURES OF FEMUR W/O MCC 0.7755 2.9 3.5 $0535 Yes No 08 MED FRACTURES OF HIP & PELVIS W MCC 1.2548 3.8 4.9 $0536 Yes No 08 MED FRACTURES OF HIP & PELVIS W/O MCC 0.7570 2.9 3.4 $0537 No No 08 MED SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC 0.9105 3.1 3.7 $0538 No No 08 MED SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC 0.7270 2.5 2.9 $0539 Yes No 08 MED OSTEOMYELITIS W MCC 2.0192 6.1 8.2 $0540 Yes No 08 MED OSTEOMYELITIS W CC 1.2969 4.5 5.7 $0541 Yes No 08 MED OSTEOMYELITIS W/O CC/MCC 0.8827 3.2 4.0 $0542 Yes No 08 MED PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC 1.8253 5.2 6.9 $0543 Yes No 08 MED PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC 1.0725 3.7 4.6 $0544 Yes No 08 MED PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC0.7984 2.8 3.3 $0545 Yes No 08 MED CONNECTIVE TISSUE DISORDERS W MCC 2.4791 5.6 8.0 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

546 Yes No 08 MED CONNECTIVE TISSUE DISORDERS W CC 1.2144 3.6 4.6 $0547 Yes No 08 MED CONNECTIVE TISSUE DISORDERS W/O CC/MCC 0.8576 2.7 3.3 $0548 No No 08 MED SEPTIC ARTHRITIS W MCC 2.0672 6.1 7.8 $0549 No No 08 MED SEPTIC ARTHRITIS W CC 1.2442 4.1 5.1 $0550 No No 08 MED SEPTIC ARTHRITIS W/O CC/MCC 0.9238 3.0 3.6 $0551 Yes No 08 MED MEDICAL BACK PROBLEMS W MCC 1.5916 4.4 5.7 $0552 Yes No 08 MED MEDICAL BACK PROBLEMS W/O MCC 0.9010 3.0 3.6 $0553 No No 08 MED BONE DISEASES & ARTHROPATHIES W MCC 1.2376 3.9 5.0 $0554 No No 08 MED BONE DISEASES & ARTHROPATHIES W/O MCC 0.7569 2.8 3.4 $0555 No No 08 MED SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC 1.2792 3.7 5.0 $0556 No No 08 MED SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC 0.7677 2.7 3.3 $0557 Yes No 08 MED TENDONITIS, MYOSITIS & BURSITIS W MCC 1.4324 4.6 5.7 $0558 Yes No 08 MED TENDONITIS, MYOSITIS & BURSITIS W/O MCC 0.8635 3.2 3.8 $0559 Yes No 08 MED AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 1.7987 4.8 6.6 $0560 Yes No 08 MED AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 1.0217 3.6 4.6 $0561 Yes No 08 MED AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 0.7561 2.7 3.5 $0562 Yes No 08 MED FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC 1.4081 4.1 5.2 $0563 Yes No 08 MED FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC 0.8381 3.0 3.4 $0564 No No 08 MED OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC 1.5722 4.7 6.1 $0565 No No 08 MED OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC 0.9758 3.4 4.1 $0566 No No 08 MED OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC0.7623 2.6 3.2 $0570 Yes No 09 SURG SKIN DEBRIDEMENT W MCC 3.0347 7.6 10.2 $0571 Yes No 09 SURG SKIN DEBRIDEMENT W CC 1.7029 5.2 6.5 $0572 Yes No 09 SURG SKIN DEBRIDEMENT W/O CC/MCC 1.1786 3.4 4.2 $0573 Yes No 09 SURG SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W MCC 5.2515 10.7 15.3 $0574 Yes No 09 SURG SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W CC 3.0459 7.5 10.4 $0575 Yes No 09 SURG SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W/O CC/MCC 1.7586 4.8 6.0 $0576 No No 09 SURG SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W MCC 4.8807 8.4 12.8 $0577 No No 09 SURG SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC 2.5092 4.7 6.9 $0578 No No 09 SURG SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC 1.5297 2.7 3.5 $0579 Yes No 09 SURG OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC 2.7978 6.5 8.8 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

580 Yes No 09 SURG OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 1.5898 4.1 5.3 $0581 Yes No 09 SURG OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC 1.2364 2.4 3.0 $0582 No No 09 SURG MASTECTOMY FOR MALIGNANCY W CC/MCC 1.5695 2.4 3.4 $0583 No No 09 SURG MASTECTOMY FOR MALIGNANCY W/O CC/MCC 1.3781 1.7 2.0 $0584 No No 09 SURG BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC 1.8714 3.6 4.7 $0585 No No 09 SURG BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC 1.5657 2.2 2.7 $0592 Yes No 09 MED SKIN ULCERS W MCC 1.7082 5.4 7.1 $0593 Yes No 09 MED SKIN ULCERS W CC 1.1294 4.2 5.3 $0594 Yes No 09 MED SKIN ULCERS W/O CC/MCC 0.8102 3.2 3.9 $0595 No No 09 MED MAJOR SKIN DISORDERS W MCC 1.9869 5.2 7.1 $0596 No No 09 MED MAJOR SKIN DISORDERS W/O MCC 1.0115 3.5 4.4 $0597 No No 09 MED MALIGNANT BREAST DISORDERS W MCC 1.7200 4.9 6.6 $0598 No No 09 MED MALIGNANT BREAST DISORDERS W CC 1.1623 3.5 4.7 $0599 No No 09 MED MALIGNANT BREAST DISORDERS W/O CC/MCC 0.7164 2.2 2.9 $0600 No No 09 MED NON-MALIGNANT BREAST DISORDERS W CC/MCC 0.9560 3.5 4.3 $0601 No No 09 MED NON-MALIGNANT BREAST DISORDERS W/O CC/MCC 0.6192 2.7 3.0 $0602 Yes No 09 MED CELLULITIS W MCC 1.4440 4.7 5.9 $0603 Yes No 09 MED CELLULITIS W/O MCC 0.8477 3.3 3.9 $0604 No No 09 MED TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC 1.4168 3.9 5.0 $0605 No No 09 MED TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC 0.8605 2.7 3.3 $0606 No No 09 MED MINOR SKIN DISORDERS W MCC 1.3808 4.2 5.8 $0607 No No 09 MED MINOR SKIN DISORDERS W/O MCC 0.8010 2.8 3.6 $0614 No No 10 SURG ADRENAL & PITUITARY PROCEDURES W CC/MCC 2.3636 3.5 4.8 $0615 No No 10 SURG ADRENAL & PITUITARY PROCEDURES W/O CC/MCC 1.4812 2.0 2.3 $0616 Yes No 10 SURG AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC 4.1352 10.1 12.7 $0617 Yes No 10 SURG AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC 2.0736 5.9 7.0 $0618 Yes No 10 SURG AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W/O CC/MCC 1.1593 3.5 4.3 $0619 No No 10 SURG O.R. PROCEDURES FOR OBESITY W MCC 2.9207 3.0 4.7 $0620 No No 10 SURG O.R. PROCEDURES FOR OBESITY W CC 1.8096 2.0 2.5 $0621 No No 10 SURG O.R. PROCEDURES FOR OBESITY W/O CC/MCC 1.5783 1.5 1.7 $0622 Yes No 10 SURG SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC 3.7980 8.7 12.0 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

623 Yes No 10 SURG SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC 1.9232 5.5 6.6 $0624 Yes No 10 SURG SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W/O CC/MCC 1.2960 3.3 4.0 $0625 No No 10 SURG THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC 2.7833 4.8 7.0 $0626 No No 10 SURG THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC 1.6106 2.5 3.6 $0627 No No 10 SURG THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC 1.0850 1.4 1.7 $0628 Yes No 10 SURG OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC 3.6750 7.3 10.0 $0629 Yes No 10 SURG OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC 2.3387 6.0 7.2 $0630 Yes No 10 SURG OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC 1.5345 2.9 3.6 $0637 Yes No 10 MED DIABETES W MCC 1.3813 3.9 5.1 $0638 Yes No 10 MED DIABETES W CC 0.8722 2.9 3.6 $0639 Yes No 10 MED DIABETES W/O CC/MCC 0.6319 2.1 2.6 $0640 Yes No 10 MED MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC 1.1902 3.3 4.5 $0641 Yes No 10 MED MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC 0.7519 2.6 3.3 $0642 No No 10 MED INBORN AND OTHER DISORDERS OF METABOLISM 1.2635 3.2 4.3 $0643 Yes No 10 MED ENDOCRINE DISORDERS W MCC 1.6341 5.0 6.3 $0644 Yes No 10 MED ENDOCRINE DISORDERS W CC 1.0125 3.5 4.3 $0645 Yes No 10 MED ENDOCRINE DISORDERS W/O CC/MCC 0.7429 2.7 3.2 $0652 No No 11 SURG KIDNEY TRANSPLANT 3.3146 5.3 6.1 $65,000653 Yes No 11 SURG MAJOR BLADDER PROCEDURES W MCC 5.4890 10.5 13.5 $0654 Yes No 11 SURG MAJOR BLADDER PROCEDURES W CC 2.8733 6.2 7.3 $0655 Yes No 11 SURG MAJOR BLADDER PROCEDURES W/O CC/MCC 2.0772 3.7 4.4 $0656 No No 11 SURG KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC 3.3276 6.0 7.9 $0657 No No 11 SURG KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC 1.9474 3.6 4.3 $0658 No No 11 SURG KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC 1.5664 2.3 2.6 $0659 Yes No 11 SURG KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC 2.7271 6.1 8.2 $0660 Yes No 11 SURG KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC 1.4476 3.2 4.2 $0661 Yes No 11 SURG KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC 1.0728 2.0 2.3 $0662 No No 11 SURG MINOR BLADDER PROCEDURES W MCC 3.1787 7.3 10.3 $0663 No No 11 SURG MINOR BLADDER PROCEDURES W CC 1.6403 3.9 5.2 $0664 No No 11 SURG MINOR BLADDER PROCEDURES W/O CC/MCC 1.1857 2.0 2.4 $0665 No No 11 SURG PROSTATECTOMY W MCC 3.1788 8.2 10.5 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

666 No No 11 SURG PROSTATECTOMY W CC 1.7791 4.2 5.8 $0667 No No 11 SURG PROSTATECTOMY W/O CC/MCC 1.0804 2.2 2.8 $0668 No No 11 SURG TRANSURETHRAL PROCEDURES W MCC 2.8146 7.1 9.2 $0669 No No 11 SURG TRANSURETHRAL PROCEDURES W CC 1.5825 4.0 5.2 $0670 No No 11 SURG TRANSURETHRAL PROCEDURES W/O CC/MCC 0.9635 2.1 2.6 $0671 No No 11 SURG URETHRAL PROCEDURES W CC/MCC 1.6835 3.9 5.3 $0672 No No 11 SURG URETHRAL PROCEDURES W/O CC/MCC 1.0569 1.9 2.3 $0673 No No 11 SURG OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC 3.5773 7.9 10.9 $0674 No No 11 SURG OTHER KIDNEY & URINARY TRACT PROCEDURES W CC 2.3121 5.3 7.0 $0675 No No 11 SURG OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC 1.6253 2.8 3.6 $0682 Yes No 11 MED RENAL FAILURE W MCC 1.5320 4.5 5.9 $0683 Yes No 11 MED RENAL FAILURE W CC 0.9190 3.2 4.0 $0684 Yes No 11 MED RENAL FAILURE W/O CC/MCC 0.6198 2.3 2.7 $0686 No No 11 MED KIDNEY & URINARY TRACT NEOPLASMS W MCC 1.7176 5.1 6.8 $0687 No No 11 MED KIDNEY & URINARY TRACT NEOPLASMS W CC 1.0537 3.3 4.3 $0688 No No 11 MED KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC 0.7909 2.0 2.4 $0689 Yes No 11 MED KIDNEY & URINARY TRACT INFECTIONS W MCC 1.1116 3.9 4.8 $0690 Yes No 11 MED KIDNEY & URINARY TRACT INFECTIONS W/O MCC 0.7941 3.0 3.6 $0691 No No 11 MED URINARY STONES W ESW LITHOTRIPSY W CC/MCC 1.6242 3.0 3.9 $0692 No No 11 MED URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC 1.1306 2.0 2.4 $0693 No No 11 MED URINARY STONES W/O ESW LITHOTRIPSY W MCC 1.3236 3.8 5.1 $0694 No No 11 MED URINARY STONES W/O ESW LITHOTRIPSY W/O MCC 0.7021 2.1 2.6 $0695 No No 11 MED KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC 1.1487 3.6 4.7 $0696 No No 11 MED KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC 0.6886 2.4 3.0 $0697 No No 11 MED URETHRAL STRICTURE 0.9600 2.5 3.6 $0698 Yes No 11 MED OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC 1.6151 4.9 6.2 $0699 Yes No 11 MED OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC 1.0279 3.4 4.2 $0700 Yes No 11 MED OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC 0.7597 2.5 3.1 $0707 No No 12 SURG MAJOR MALE PELVIC PROCEDURES W CC/MCC 1.7914 2.3 3.2 $0708 No No 12 SURG MAJOR MALE PELVIC PROCEDURES W/O CC/MCC 1.4065 1.3 1.4 $0709 No No 12 SURG PENIS PROCEDURES W CC/MCC 2.0318 3.6 5.8 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

710 No No 12 SURG PENIS PROCEDURES W/O CC/MCC 1.6695 1.7 2.2 $0711 No No 12 SURG TESTES PROCEDURES W CC/MCC 2.0835 5.2 7.2 $0712 No No 12 SURG TESTES PROCEDURES W/O CC/MCC 1.0768 2.4 2.9 $0713 No No 12 SURG TRANSURETHRAL PROSTATECTOMY W CC/MCC 1.4634 2.9 4.2 $0714 No No 12 SURG TRANSURETHRAL PROSTATECTOMY W/O CC/MCC 0.9105 1.7 2.1 $0715 No No 12 SURG OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W CC/MCC 2.2099 5.4 7.6 $0716 No No 12 SURG OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC1.4630 1.5 1.8 $0717 No No 12 SURG OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC 1.9543 4.2 5.8 $0718 No No 12 SURG OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC1.2326 2.5 3.0 $0722 No No 12 MED MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC 1.6597 5.1 7.0 $0723 No No 12 MED MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC 1.1015 3.5 4.5 $0724 No No 12 MED MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC 0.6892 1.9 2.5 $0725 No No 12 MED BENIGN PROSTATIC HYPERTROPHY W MCC 1.2143 4.0 5.1 $0726 No No 12 MED BENIGN PROSTATIC HYPERTROPHY W/O MCC 0.7645 2.6 3.3 $0727 No No 12 MED INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC 1.4380 4.7 6.0 $0728 No No 12 MED INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC 0.7914 3.0 3.6 $0729 No No 12 MED OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC 1.0820 3.3 4.5 $0730 No No 12 MED OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC 0.5684 1.9 2.3 $0734 No No 13 SURG PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/MCC 2.3059 3.7 5.2 $0735 No No 13 SURG PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC 1.3650 1.8 2.1 $0736 No No 13 SURG UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC 4.0306 8.9 11.6 $0737 No No 13 SURG UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC 2.0314 4.6 5.4 $0738 No No 13 SURG UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC 1.3923 2.8 3.1 $0739 No No 13 SURG UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W MCC 3.5977 6.6 9.4 $0740 No No 13 SURG UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC 1.7429 3.0 4.0 $0741 No No 13 SURG UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC 1.3278 1.7 2.0 $0742 No No 13 SURG UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC 1.7140 3.0 3.9 $0743 No No 13 SURG UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC 1.1156 1.8 2.0 $0744 No No 13 SURG D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC 1.6903 4.1 5.6 $0745 No No 13 SURG D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC 1.0694 2.1 2.6 $0746 No No 13 SURG VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC 1.6777 3.5 5.1 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

747 No No 13 SURG VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC 0.9582 1.6 2.0 $0748 No No 13 SURG FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 1.2940 1.6 2.0 $0749 No No 13 SURG OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC 2.6020 5.7 7.8 $0750 No No 13 SURG OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 1.2239 2.4 2.9 $0754 No No 13 MED MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC 1.8414 5.2 7.1 $0755 No No 13 MED MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC 1.0699 3.3 4.4 $0756 No No 13 MED MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 0.7801 2.2 2.6 $0757 No No 13 MED INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC 1.4409 4.9 6.3 $0758 No No 13 MED INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC 1.0204 3.7 4.6 $0759 No No 13 MED INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 0.7107 2.6 3.2 $0760 No No 13 MED MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC 0.8717 2.6 3.3 $0761 No No 13 MED MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC0.5494 1.8 2.1 $0768 No No 14 SURG VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C 1.1314 2.7 4.2 $0769 No No 14 SURG POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 1.4579 3.2 4.3 $0770 No No 14 SURG ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY 1.0679 1.8 2.6 $0776 No No 14 MED POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE 0.6590 2.5 3.1 $0779 No No 14 MED ABORTION W/O D&C 0.7543 1.7 2.7 $0783 No No 14 SURG CESAREAN SECTION W STERILIZATION W MCC 1.7455 4.6 6.3 $0784 No No 14 SURG CESAREAN SECTION W STERILIZATION W CC 1.1021 3.4 4.1 $0785 No No 14 SURG CESAREAN SECTION W STERILIZATION W/O CC/MCC 0.8455 2.7 3.0 $0786 No No 14 SURG CESAREAN SECTION W/O STERILIZATION W MCC 1.5548 4.4 5.9 $0787 No No 14 SURG CESAREAN SECTION W/O STERILIZATION W CC 1.0811 3.5 4.2 $0788 No No 14 SURG CESAREAN SECTION W/O STERILIZATION W/O CC/MCC 0.9007 3.0 3.2 $0789 No No 15 MED NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 1.6637 1.8 1.8 $0790 No No 15 MED EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 5.4863 17.9 17.9 $0791 No No 15 MED PREMATURITY W MAJOR PROBLEMS 3.7470 13.3 13.3 $0792 No No 15 MED PREMATURITY W/O MAJOR PROBLEMS 2.2608 8.6 8.6 $0793 No No 15 MED FULL TERM NEONATE W MAJOR PROBLEMS 3.8489 4.7 4.7 $0794 No No 15 MED NEONATE W OTHER SIGNIFICANT PROBLEMS 1.3623 3.4 3.4 $0795 No No 15 MED NORMAL NEWBORN 0.1844 3.1 3.1 $0796 No No 14 SURG VAGINAL DELIVERY W STERILIZATION/D&C W MCC 1.4682 3.4 5.0 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

797 No No 14 SURG VAGINAL DELIVERY W STERILIZATION/D&C W CC 0.8469 2.2 2.4 $0798 No No 14 SURG VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC 0.8469 2.2 2.4 $0799 No No 16 SURG SPLENECTOMY W MCC 4.7016 8.3 11.0 $0800 No No 16 SURG SPLENECTOMY W CC 2.6268 4.7 6.1 $0801 No No 16 SURG SPLENECTOMY W/O CC/MCC 1.5563 2.5 2.8 $0802 No No 16 SURG OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC 3.3472 7.4 10.0 $0803 No No 16 SURG OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC 1.7221 4.1 5.2 $0804 No No 16 SURG OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC 1.2305 2.1 2.6 $0805 No No 14 MED VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC 1.0232 3.0 4.1 $0806 No No 14 MED VAGINAL DELIVERY W/O STERILIZATION/D&C W CC 0.7074 2.4 2.7 $0807 No No 14 MED VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC 0.6140 2.1 2.2 $0808 No No 16 MED MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC 2.1492 5.5 7.5 $0809 No No 16 MED MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC 1.2045 3.6 4.5 $0810 No No 16 MED MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC 0.9220 2.6 3.2 $0811 No No 16 MED RED BLOOD CELL DISORDERS W MCC 1.3560 3.7 4.9 $0812 No No 16 MED RED BLOOD CELL DISORDERS W/O MCC 0.8832 2.7 3.5 $0813 No No 16 MED COAGULATION DISORDERS 1.6115 3.7 4.9 $0814 No No 16 MED RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC 1.6630 4.5 6.3 $0815 No No 16 MED RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 0.9777 3.1 3.9 $0816 No No 16 MED RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC 0.7216 2.2 2.7 $0817 No No 14 SURG OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC 2.5317 3.8 6.5 $0818 No No 14 SURG OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC 1.3585 2.8 4.1 $0819 No No 14 SURG OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC 0.8390 1.6 2.1 $0820 No No 17 SURG LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W MCC 5.4437 10.9 15.2 $0821 No No 17 SURG LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC 2.3943 4.3 6.1 $0822 No No 17 SURG LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC 1.2098 1.9 2.4 $0823 No No 17 SURG LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W MCC 4.5246 10.4 13.8 $0824 No No 17 SURG LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W CC 2.1944 5.3 7.1 $0825 No No 17 SURG LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W/O CC/MCC 1.3590 2.5 3.5 $0826 No No 17 SURG MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W MCC 4.9479 9.9 12.7 $0827 No No 17 SURG MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC 2.2517 4.7 6.1 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

828 No No 17 SURG MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W/O CC/MCC 1.6354 3.0 3.7 $0829 No No 17 SURG MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W 3.1097 6.4 9.6 $0830 No No 17 SURG MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W 1.4188 2.6 3.2 $0831 No No 14 MED OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC 1.0281 3.2 4.5 $0832 No No 14 MED OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC 0.7188 2.5 3.6 $0833 No No 14 MED OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC 0.4803 1.9 2.5 $0834 No No 17 MED ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC 5.5078 10.0 16.5 $0835 No No 17 MED ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC 2.1360 4.5 7.1 $0836 No No 17 MED ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC 1.2126 2.6 3.9 $0837 No No 17 MED CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC 5.3741 12.8 18.3 $0838 No No 17 MED CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT 2.3526 5.8 7.8 $0839 No No 17 MED CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC 1.2559 4.5 4.9 $0840 Yes No 17 MED LYMPHOMA & NON-ACUTE LEUKEMIA W MCC 3.2929 7.0 10.0 $0841 Yes No 17 MED LYMPHOMA & NON-ACUTE LEUKEMIA W CC 1.6348 4.2 5.7 $0842 Yes No 17 MED LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC 1.1211 2.9 3.8 $0843 No No 17 MED OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC 1.8460 5.3 7.3 $0844 No No 17 MED OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 1.1788 3.7 4.9 $0845 No No 17 MED OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC 0.8662 2.6 3.4 $0846 No No 17 MED CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC 2.8179 6.2 8.7 $0847 No No 17 MED CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC 1.3265 3.6 4.1 $0848 No No 17 MED CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC 0.9326 2.9 3.3 $0849 No No 17 MED RADIOTHERAPY 1.9702 5.0 7.0 $0853 Yes No 18 SURG INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC 5.0571 9.9 12.8 $0854 Yes No 18 SURG INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC 2.2028 5.7 7.1 $0855 Yes No 18 SURG INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC 1.5600 3.6 4.5 $0856 Yes No 18 SURG POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC 4.4883 8.9 12.0 $0857 Yes No 18 SURG POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC 2.0567 5.4 6.7 $0858 Yes No 18 SURG POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC 1.3801 3.7 4.5 $0862 Yes No 18 MED POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC 1.8277 5.0 6.6 $0863 Yes No 18 MED POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC 0.9848 3.5 4.3 $0864 No No 18 MED FEVER AND INFLAMMATORY CONDITIONS 0.8643 2.8 3.4 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

865 No No 18 MED VIRAL ILLNESS W MCC 1.3822 3.9 5.3 $0866 No No 18 MED VIRAL ILLNESS W/O MCC 0.8204 2.7 3.4 $0867 Yes No 18 MED OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC 2.1329 5.6 7.6 $0868 Yes No 18 MED OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC 1.0769 3.6 4.6 $0869 Yes No 18 MED OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC 0.7679 2.7 3.3 $0870 Yes No 18 MED SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS OR PERIPHERAL EXTRACORPO 6.2953 12.4 14.4 $0871 Yes No 18 MED SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 1.8564 4.8 6.3 $0872 Yes No 18 MED SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC 1.0529 3.7 4.4 $0876 No No 19 SURG O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 3.3014 7.2 14.8 $0880 No No 19 MED ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 0.8111 2.6 3.6 $0881 No No 19 MED DEPRESSIVE NEUROSES 0.7585 3.8 5.0 $0882 No No 19 MED NEUROSES EXCEPT DEPRESSIVE 0.7750 3.2 4.4 $0883 No No 19 MED DISORDERS OF PERSONALITY & IMPULSE CONTROL 1.3199 4.8 8.0 $0884 Yes No 19 MED ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY 1.3479 4.3 6.7 $0885 No No 19 MED PSYCHOSES 1.1961 5.8 8.2 $0886 No No 19 MED BEHAVIORAL & DEVELOPMENTAL DISORDERS 0.9887 3.7 6.3 $0887 No No 19 MED OTHER MENTAL DISORDER DIAGNOSES 1.0645 3.0 4.7 $0894 No No 20 MED ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA 0.5169 2.1 2.9 $0895 No No 20 MED ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY 1.4328 8.6 11.5 $0896 Yes No 20 MED ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC 1.7468 4.9 6.9 $0897 Yes No 20 MED ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MC0.8208 3.4 4.3 $0901 No No 21 SURG WOUND DEBRIDEMENTS FOR INJURIES W MCC 4.4649 9.2 13.7 $0902 No No 21 SURG WOUND DEBRIDEMENTS FOR INJURIES W CC 1.9204 4.9 6.6 $0903 No No 21 SURG WOUND DEBRIDEMENTS FOR INJURIES W/O CC/MCC 1.1639 2.9 3.7 $0904 No No 21 SURG SKIN GRAFTS FOR INJURIES W CC/MCC 3.2260 6.7 9.8 $0905 No No 21 SURG SKIN GRAFTS FOR INJURIES W/O CC/MCC 1.7692 3.5 4.8 $0906 No No 21 SURG HAND PROCEDURES FOR INJURIES 1.8432 2.8 4.7 $0907 Yes No 21 SURG OTHER O.R. PROCEDURES FOR INJURIES W MCC 4.2161 7.2 10.2 $0908 Yes No 21 SURG OTHER O.R. PROCEDURES FOR INJURIES W CC 1.9928 4.0 5.2 $0909 Yes No 21 SURG OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC 1.3254 2.5 3.1 $0913 No No 21 MED TRAUMATIC INJURY W MCC 1.4719 3.6 5.2 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

914 No No 21 MED TRAUMATIC INJURY W/O MCC 0.8378 2.5 3.2 $0915 No No 21 MED ALLERGIC REACTIONS W MCC 1.6769 3.7 4.9 $0916 No No 21 MED ALLERGIC REACTIONS W/O MCC 0.6353 1.8 2.2 $0917 Yes No 21 MED POISONING & TOXIC EFFECTS OF DRUGS W MCC 1.4737 3.5 4.8 $0918 Yes No 21 MED POISONING & TOXIC EFFECTS OF DRUGS W/O MCC 0.7787 2.3 3.1 $0919 No No 21 MED COMPLICATIONS OF TREATMENT W MCC 1.8243 4.3 6.0 $0920 No No 21 MED COMPLICATIONS OF TREATMENT W CC 1.0031 2.9 3.8 $0921 No No 21 MED COMPLICATIONS OF TREATMENT W/O CC/MCC 0.7066 2.2 2.7 $0922 No No 21 MED OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC 1.5584 3.8 5.6 $0923 No No 21 MED OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC 0.8698 2.7 3.9 $0927 No No 22 SURG EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W SKIN GRAFT 18.3845 22.2 29.0 $0928 No No 22 SURG FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC 5.8756 10.7 15.0 $0929 No No 22 SURG FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W/O CC/MCC 2.9722 5.8 7.9 $0933 No No 22 MED EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W/O SKIN GRAFT 2.8603 2.6 4.5 $0934 No No 22 MED FULL THICKNESS BURN W/O SKIN GRAFT OR INHAL INJ 1.8335 4.2 6.0 $0935 No No 22 MED NON-EXTENSIVE BURNS 1.8217 3.4 5.3 $0939 No No 23 SURG O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC 3.2787 6.5 9.4 $0940 No No 23 SURG O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC 2.1745 3.7 5.0 $0941 No No 23 SURG O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC1.8514 2.3 3.0 $0945 Yes No 23 MED REHABILITATION W CC/MCC 1.3649 9.4 11.6 $0946 Yes No 23 MED REHABILITATION W/O CC/MCC 1.0427 7.1 7.9 $0947 Yes No 23 MED SIGNS & SYMPTOMS W MCC 1.2056 3.5 4.8 $0948 Yes No 23 MED SIGNS & SYMPTOMS W/O MCC 0.7802 2.6 3.3 $0949 No No 23 MED AFTERCARE W CC/MCC 1.1462 4.5 6.4 $0950 No No 23 MED AFTERCARE W/O CC/MCC 0.7449 3.4 4.8 $0951 No No 23 MED OTHER FACTORS INFLUENCING HEALTH STATUS 0.7984 2.5 3.4 $0955 No No 24 SURG CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 6.0969 7.4 10.8 $0956 Yes No 24 SURG LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA 3.7838 6.1 7.5 $0957 No No 24 SURG OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC 7.5985 9.7 13.6 $0958 No No 24 SURG OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC 4.1798 7.0 8.7 $0959 No No 24 SURG OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC 2.4507 3.8 4.7 $0

Kentucky MedicaidInpatient Hospital - DRG Pricing VariablesDRG-Specific Variables - Correction NoticeFederal Fiscal Year 2019 - CMS V36

MS-DRG

FY 2019 FINAL Post-Acute DRG

FY 2019 FINAL

Special Pay DRG MDC TYPE MS-DRG Title Weights

Geometric mean LOS

Arithmetic mean LOS

Acquisition Fee Add-on

963 No No 24 MED OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC 2.7950 5.3 8.0 $0964 No No 24 MED OTHER MULTIPLE SIGNIFICANT TRAUMA W CC 1.4749 4.0 4.9 $0965 No No 24 MED OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC 0.9743 2.7 3.2 $0969 No No 25 SURG HIV W EXTENSIVE O.R. PROCEDURE W MCC 5.5987 11.7 15.9 $0970 No No 25 SURG HIV W EXTENSIVE O.R. PROCEDURE W/O MCC 2.7877 6.5 8.7 $0974 No No 25 MED HIV W MAJOR RELATED CONDITION W MCC 2.7230 6.4 9.0 $0975 No No 25 MED HIV W MAJOR RELATED CONDITION W CC 1.2899 4.1 5.3 $0976 No No 25 MED HIV W MAJOR RELATED CONDITION W/O CC/MCC 0.9386 3.1 3.9 $0977 No No 25 MED HIV W OR W/O OTHER RELATED CONDITION 1.1699 3.4 4.6 $0981 Yes No SURG EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 4.3705 8.4 11.4 $0

DRG-Specific