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New Technology Add-On Payment Calculation

In an effort to recognize the rising costs of new technology, CMS has proposed that the existing new technology add-on payment calculation (currently at a 50% limit) be increased to equal the lesser of:65% of the cost of the new medical device or technology; OR 65% of the amount by which the cost of the case exceeds the standard DRG paymentNote: Unless the discharge qualifies for an outlier payment, the additional Medicare payment would be limited to the full MS-DRG payment plus 65% of the estimated costs of the new technology or device. As a result of this increase, the maximum payment for CAR-T Cell Therapies (KYMRIAHTM and YESCARTATM) would increase from $186,500 to $242,450, which may help to increase the use of this new technology.
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MS-DRG v 37 Changes

As expected, CMS is proposing to recalibrate the MS-DRG weights for FFY2020. Heart transplants and extensive burn DRGs appear to be getting a boost, while external heart assist devices and pancreas transplants are seeing significant reductions in weighting. DRG 319 and 320 are new in FFY2020. Below is a listing of the largest changes in weighting between v36 and v37 of the MS-DRGs:
Click here for a table of the MS-DRG v36 to v37 comparison.
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