DRG Impact | FY2027 Inpatient Revenue Impact

§ 01 / Pick a hospital

What the FY2027 MS-DRG rates do to Medicare inpatient revenue

These rates will be validated and potentially updated once the FY2027 Pricer is released. This analysis currently reflects the Final FY2027 Rate tables that were published by CMS on July 31, 2026. The full note is at the end of section 11.

This takes the Medicare cases a hospital actually treated in 2024 and prices them twice. Once at FY2026 rates, once at FY2027 rates. The case count is identical in both years, so every dollar of change shown here comes from what CMS did to the rates and the weights. Volume and coding are held still on purpose.

Hospital

Which payment are we counting?

§ 02 / Headline

Where this hospital lands in FY2027

Every figure below is defined in the glossary, with the formula used to calculate it.

§ 03 / Where the money moves

What is driving the change

From FY2026 revenue to FY2027 revenue

The two markers are total revenue in each year. The bars between them show what moved it. Watch the axis: it does not start at zero, because a 4% change on a large base is invisible if it does. That is why the year totals are drawn as markers rather than bars, so no bar height overstates the change.

Which parts of the payment moved

Medicare pays a hospital in pieces. This shows what each piece did between the two years. It always uses the all-in payment at 2024 volume, whichever button is selected above, so the whole payment sits in one place.

§ 04 / Winners and losers

Which MS-DRGs move the number

Ranked by dollars, so a small rate change on a high-volume DRG outranks a big rate change on a rare one.

Biggest gains

The ten MS-DRGs that add the most dollars in FY2027.

Biggest losses

The ten MS-DRGs that give up the most dollars in FY2027.

By service line

The same change, grouped into the major diagnostic categories CMS uses.

How concentrated is it

Each bar is one MS-DRG. The purple line adds them up from left to right, so it shows how many codes it takes to explain most of the change.

§ 05 / Scenarios

What would change the answer

These controls change every number on the page. A banner appears at the top whenever one of them is switched on.

Volume growth, applied to every DRG

+0.0%

-25%+25%

Policy and calibration assumptions

Assume Congress extends the hospital-specific rate into FY2027
Hold the Uncompensated Care Payment at its FY2026 amount

FY2026 Part A deductible FY2027 Part A deductible Sequestration %

Medicare does not send a hospital the full priced amount. The patient owes the Part A deductible, and 2% comes off the rest for sequestration. These two boxes turn the priced amount into what actually lands in the bank. The defaults are the published deductibles and the standard 2% withhold. Change them if a different assumption fits better. The FY2026 box holds the real calendar 2026 deductible of $1,736. The FY2027 box is an estimate, because CMS does not announce the calendar 2027 deductible until November 2026.

§ 06 / Market

How this hospital compares to

The peer set is the other hospitals CMS puts in the same wage area.

Every hospital in the market, by how much it changed

Each dot is one hospital. The selected one is the large mint dot. The shaded band holds the middle half of the market and the purple line marks the middle hospital. Dots that land on the same spot are stacked so they can still be counted.

The selected hospital A peer Middle of the market

Click a column heading to sort by it. Click a hospital name to switch the whole page to that hospital.

§ 07 / Uncompensated Care Payment

What CMS pays this market for uncompensated care

Straight from CMS, for every hospital in the same wage area that this model prices. Two figures here: the whole-year dollars, and the amount CMS lists per discharge. The stat tiles above the chart are the annual dollars.

The Uncompensated Care Payment across this market

FY2026 annual Uncompensated Care Payment, and what FY2027 does to it. One bar per hospital, ordered by the FY2026 amount, largest first, with the count noted below when the market is too big to draw in full. The solid bar is the FY2026 annual amount. A mint block on the end is money added in FY2027. A hatched block cut out of the end is money taken away. The figure beside each bar is the FY2027 total and the percent change. The selected hospital is marked in mint and labelled.

§ 08 / Coverage

What this model cannot price

Read this before comparing these case counts to a hospital's own records. Two different things are missing: MS-DRGs CMS withheld because too few patients went through them, and MS-DRGs this model could not price. The first is much the larger.

§ 09 / Detail

Every MS-DRG, line by line

Every MS-DRG CMS published for this hospital, exactly as published and not scaled. At most hospitals that is not the whole book, so these rows will not add up to the totals above. CMS withholds any MS-DRG with fewer than 11 discharges at a hospital; the totals are restored to CMS's own case count. Section 08 gives both figures for this hospital.

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§ 10 / Glossary

What each number means and how it is calculated

Every metric on this page, in plain language, with the arithmetic behind it.

The three payment buttons

All-in payment: What it is. Everything the pricer pays for a discharge. Operating base, disproportionate share, teaching add-on, capital, the Uncompensated Care Payment, the hospital-specific rate, and the quality adjustments. How it is built. The pricer's Total Payment field, taken straight. Use it for the number that ties to a Medicare remittance.
Without the Uncompensated Care Payment: What it is. The all-in payment with the Uncompensated Care Payment taken out. How it is built. Total Payment minus the Uncompensated Care Payment for that discharge. Use it for a read on how the DRG business is doing. The Uncompensated Care Payment is driven by how much uncompensated care a hospital reports, and it swamps the DRG signal at safety-net hospitals. At one hospital in this file it is 90.9% of the Medicare payment.
Operating base DRG: What it is. Just the core MS-DRG payment. No disproportionate share, no teaching add-on, no capital, no Uncompensated Care Payment, no quality adjustments, and no hospital-specific rate. How it is built. The pricer's Operating Base DRG Payment field, which is the standardized amount times the relative weight, adjusted for the hospital's wage index. Use it for the cleanest read on rate and weight changes. One warning: at a Sole Community or Medicare-Dependent hospital, this button hides the hospital-specific rate, so it can look healthy while the real operating payment falls.

The headline numbers

FY2027 revenue: What it is. What the hospital's 2024 caseload would have been paid at FY2027 rates. How it is built. For each MS-DRG, the hospital's 2024 discharge count times the FY2027 payment for one discharge of that DRG at that hospital. Added up across every DRG.
Change vs FY2026: What it is. The same caseload priced at FY2027 rates minus the same caseload priced at FY2026 rates. How it is built. FY2027 revenue minus FY2026 revenue. Because the discharge counts are identical on both sides, volume cancels out and what remains is rate, weight and policy.
Payment per discharge: What it is. The average payment for one case. How it is built. Total revenue divided by total discharges. This moves when case mix moves as well as when rates move.
Case mix index drift: What it is. How much CMS reweighting alone changed the average complexity of the work the hospital already does. How it is built. Case mix index is discharges times each DRG's relative weight, divided by discharges. Calculate it twice on the same 2024 caseload, once with FY2026 weights and once with FY2027 weights, then take the percent change. The cases are identical on both sides, so the movement comes from CMS changing the weights. The patients are the same patients. For the 18 MS-DRGs CMS retired for FY2027, the FY2027 weight used here is the share-weighted blend of the codes that replace them. Section 11 explains that mapping.
Rank in the market: What it is. Where the hospital's percent change falls among the hospitals CMS puts in the same wage area. How it is built. Sort every hospital in the CBSA by percent change, best first, and find the position.
National rank: What it is. Where the hospital's percent change falls among every hospital in this file. How it is built. Same sort, run nationally. First place is the largest gain.
Modeled gross vs actually paid: What it is. A sanity check. How far the model's priced amount sits above what Medicare really paid the hospital in 2024. How it is built. Modeled FY2026 revenue divided by the actual Medicare payment reported in the 2024 utilization file. Nationally this comes out at 1.17. The gap is almost entirely the Part A deductible, which the reported figure leaves out by definition, plus the 2% sequestration withhold. Take one deductible off each discharge and apply sequestration and most of it closes. The absolute level runs high for the reasons above. The year-over-year change is not affected by that, because the same offset sits in both years.
Volume growth to hold FY2026 revenue: What it is. How many more cases it would take to end FY2027 with the same revenue as FY2026. How it is built. FY2026 revenue divided by FY2027 revenue, minus one. It assumes the extra cases arrive in the same mix as 2024. This holds revenue level. It does not know what the extra cases cost to treat, so it is not a cost break-even.
Net Medicare receipts: What it is. The priced amount converted into money that actually reaches the hospital. How it is built. Take the gross revenue, subtract one Part A deductible for every discharge, then take 2% off for sequestration. Both figures are editable in Scenarios. The FY2026 deductible is the published calendar 2026 figure. The FY2027 one is an estimate, because CMS does not announce it until November 2026.

The revenue bridge

DRG weight recalibration: What it is. The share of the change caused by CMS moving the relative weights on the DRGs the hospital bills. How it is built. For each DRG, discharges times the change in relative weight, times the FY2026 payment per unit of weight. This is measured at last year's rates, so it isolates the weight move on its own. It is gross of the budget neutrality factor CMS applies to keep total spending flat, and that factor sits inside the standardized amount, so it lands in the rate bar instead.
Rate, wage index and policy: What it is. Everything else. The standardized amount update, the wage index move, policy changes, and the interaction between rate and weight. How it is built. For each DRG, discharges times FY2027 weight times the change in payment per unit of weight. Wage index moves are unusually large this year. The median hospital gains 1.34%, the 95th percentile gains 8.36%, and 20 hospitals gain more than 10%. When the rate bar is large, check the wage index before looking anywhere else.
Hospital-specific rate: What it is. The Sole Community and Medicare-Dependent hospital payment, shown on its own because it does not scale with DRG weight. How it is built. Discharges times the change in the hospital-specific portion.
Uncompensated Care Payment: What it is. The uncompensated care money, shown on its own for the same reason. How it is built. Discharges times the change in the per-discharge amount. It is a flat dollar figure per case, identical across every DRG at one hospital. Section 07 shows the annual dollars CMS publishes for the whole market, which is a different figure built a different way.

The market Uncompensated Care Payment charts

Uncompensated Care Payment per discharge: What it is. The flat amount CMS lists per inpatient claim for a hospital. CMS calls it the estimated per-claim amount in the Medicare DSH Supplemental Data File and the interim per-discharge Uncompensated Care Payment in the rule text. How it is built. Both years taken from that file as published, to the cent. It is one number per hospital per year, the same on every MS-DRG. CMS sets the annual amount first, then divides it by the discharges it projects to get this rate, and settles up later against the claims the hospital actually bills. The annual amount is fixed for the year. This one is a rate, so a hospital can gain on one and lose on the other. Where it differs from section 03. Section 03 prices from the amount each rate file carries, because that is what the pricer used. The FY2027 file carries the published amount at every hospital in this model. The FY2026 file differs at 43 of them, at most by $180, so at those hospitals the chart and section 03 will not tie out to the cent. The note under the chart names the hospital when it is the one on screen. SCH. CMS's code for a Sole Community Hospital it projects will be paid its hospital-specific rate rather than the federal rate. CMS projects those hospitals will not be paid Medicare DSH and treats them as ineligible for the uncompensated care payment, publishes no annual figure for them, and lists a per-discharge amount because the hospital is paid the higher of the two rates claim by claim. CMS codes it a year at a time, and 30 hospitals here carry the code in one of the two years but not the other, so the chart tags a bare SCH when it applies to both years and puts the year on the tag when it applies to one.
Annual Uncompensated Care Payment: What it is. The whole-year dollar amount CMS projects for a hospital, published in the Medicare DSH Supplemental Data File. How it is built. We take it as published and add the Total Supplemental Payment column, which is how Indian Health Service and Puerto Rico hospitals receive theirs. Both years come from the final rule file: FY2026 from CMS-1833-F and FY2027 from CMS-1849-F.
Why it does not match the bar in section 03: Section 03 shows the pricer's per-discharge add-on multiplied by the hospital's 2024 caseload. Section 07 shows CMS's own annual total. The first moves with the volume the hospital ran in 2024, the second does not move with volume at all. At a single hospital they can move in opposite directions, and often do. The annual figure is the one to read for what CMS says a hospital gets.
A hospital at zero: A hospital shown at $0 is one CMS does not project a Medicare DSH Uncompensated Care Payment for in that year. It is not missing data. Eligibility flips both ways every year, and a flip is the single biggest cause of an extreme percent change on this page.

The MS-DRG table

Weight FY26 and Weight FY27: The national relative weight CMS assigns each MS-DRG. It is the same number for every hospital in the country. A weight of 2.0 means that DRG pays roughly twice the average case. The FY2027 weights here are the final rule weights from CMS-1849-F Table 5, after the 10% cap CMS applies to any one year's weight change.
Per case: What one discharge of that DRG pays at the selected hospital, on the payment basis selected at the top of the page. This differs between hospitals because of wage index, teaching status and disproportionate share percentage. The per case figures are not columns on the table, they are not in the CSV download and they do not print. Every revenue number on the page is still built from them, and the section 04 hover card still shows them for the MS-DRGs it draws.
Revenue: The hospital's 2024 discharges for that DRG times the per case amount.
% of gross change: How much of the total movement this one DRG accounts for. It uses absolute values, so a gain of $1M and a loss of $1M each count as $1M of movement. That is deliberate. A million dollar gain in cardiology and a million dollar loss in orthopedics net to zero on the page, and each one still needs an answer. It will not sum to the net change.

Coverage

Discharges repriced: Cases that exist in all three source files and therefore have a price in both years.
Discharges that cannot be repriced: Cases in the 2024 file whose MS-DRG has no price in one or both years. The main cause is a code CMS retired before FY2026, so it has no price in either of these two years. The five spinal fusion MS-DRGs CMS retired effective FY2025 (453, 454, 455, 459 and 460) are most of it. The 18 MS-DRGs CMS retired for FY2027 are not in this bucket. Those keep their 2024 volume and get an FY2027 price through the mapping described in section 11.

Terms

CBSA: Core Based Statistical Area. The geography CMS uses to set a hospital's wage index, and what this page treats as its market.
CC and MCC: Complication or Comorbidity, and Major Complication or Comorbidity. The severity tiers that split most DRG families into two or three payment levels.
CMI: Case Mix Index. The average relative weight of a hospital's cases.
CMS-1833-F: The FY2026 IPPS final rule. It sets the FY2026 rates, weights and Uncompensated Care Payment amounts used on this page.
CMS-1849-P: The FY2027 IPPS proposed rule, CMS display date April 10, 2026, published in the Federal Register on April 14, 2026 at 91 FR 19312. Nothing on this page comes from it. It is listed only because CMS moved several figures between the proposed rule and the final rule, so a number sourced from the proposed rule will not match this page.
CMS-1849-F: The FY2027 IPPS final rule. CMS puts a display date of July 31, 2026 on it, which is the date this page uses, and the Federal Register published it on August 4, 2026 at 91 FR 49570. It sets every FY2027 rate, relative weight, Uncompensated Care Payment amount, MS-DRG title, service line and surgical flag on this page. What it does not include is the pricer software, which CMS releases separately, so the FY2027 payments here are calculated by the Bright Spot Insights IPPS calculation engine off the final rule files. This tool will be reconciled against the CMS pricer once CMS releases it.
DSH: Disproportionate Share Hospital. Extra payment for treating a high share of low-income patients. Since the Affordable Care Act, hospitals receive 25% of the formerly calculated amount this way, and the other 75% flows through the uncompensated care pool. The bars in section 03 show the two separately.
DSH Supplemental Data File: The file CMS publishes with each IPPS rule giving every hospital's projected annual Medicare DSH and Uncompensated Care Payment. It is the source for section 07.
IME: Indirect Medical Education. Extra payment to teaching hospitals.
IPPS: Inpatient Prospective Payment System. How Medicare pays for inpatient stays.
MDC: Major Diagnostic Category. The body-system groupings CMS sorts MS-DRGs into, used here as the service line view. Transplant, ECMO and tracheostomy DRGs sit outside the MDCs and are grouped separately.
MDH: Medicare-Dependent Hospital. A small rural designation, at least 60% Medicare admissions, that can be paid off a hospital-specific rate. The program has to be renewed by Congress. Section 6202 of the Consolidated Appropriations Act, 2026 extended it only through December 31, 2026. CMS states in CMS-1849-F that beginning January 1, 2027, absent action from Congress, every hospital holding MDH status loses it and is paid the Federal rate. That splits FY2027 in two. Neither rate file models a mid-year change, so this page prices all twelve months of FY2027 on one basis.
MS-DRG: Medicare Severity Diagnosis-Related Group. The code that determines what a stay pays.
PUF: Public Use File. The CMS dataset that reports 2024 discharges by hospital and DRG.
Relative weight: The multiplier CMS assigns each MS-DRG to set its payment relative to an average case. A weight of 2.0 pays roughly twice the average case.
SCH: Sole Community Hospital. A rural designation that can be paid off a hospital-specific rate. The classification has no expiry date, though CMS can withdraw it if a hospital stops meeting the criteria. Unlike the Medicare-Dependent program, it does not need renewing by Congress, and the January 1, 2027 expiration does not touch it.
Sequestration: A 2% reduction to what Medicare pays on a claim, taken after the deductible and coinsurance come out. It does not change what the patient owes.
Standardized amount: The base dollar figure most DRG payments start from. It splits into a labor share and a non-labor share, and only the labor share is adjusted by the wage index. Hospitals that fail the quality programs are paid from a reduced amount, and Sole Community and Medicare-Dependent discharges may be paid off a hospital-specific rate instead.
UCP: Uncompensated Care Payment. A hospital's share of a fixed national pool, sized by the uncompensated care it reports, which is charity care plus non-Medicare bad debt. CMS pays it as a flat interim amount per discharge, but the annual total is fixed and does not move with volume.
Wage index: The factor that adjusts payment for local wage levels. It applies only to the labor-related share, roughly two thirds of the operating base, so a 0.90 wage index does not cut payment by 10%.

§ 11 / Methodology

How this was built, and what it does not cover

Where the numbers come from

The caseload. CMS Medicare Inpatient Hospitals by Provider and Service, 2024. Discharges by hospital and MS-DRG. This is the most recent year CMS has published, and it is held constant across both rate years on purpose. CMS withholds any hospital-and-MS-DRG combination with fewer than 11 discharges in it, so this file is not a complete record of any hospital. Read the caveat on suppressed volume below; it is the largest single limitation on this page.
The full case count and case mix. The FY2027 IPPS final rule impact file, CMS-1849-F, columns Bills, CASETA43, CMIV43, CASETA44 and CMIV44. CMS publishes these for the whole hospital with no small-cell suppression, and they are what the revenue totals on this page are built on.
Puerto Rico. CMS publishes no MS-DRG caseload for Puerto Rico hospitals, so their totals rest entirely on the impact file volume above, and their FY2026 wage index comes from the FY2026 IPPS final rule impact file, CMS-1833-F, column FY 2026 Wage Index. The Puerto Rico note under "What to be careful about" says why that was needed.
The FY2026 rates. The IPPS base DRG payment file for FY2026, one priced claim per hospital per MS-DRG, produced by the official CMS FY2026 pricer under the FY2026 IPPS final rule, CMS-1833-F.
The FY2027 rates. Priced by the Bright Spot Insights IPPS calculation engine off the FY2027 IPPS final rule, CMS-1849-F, display date July 31, 2026, published in the Federal Register on August 4, 2026 at 91 FR 49570. Table 5 supplies the relative weights, Tables 1A through 1E supply the standardized amounts and the capital rate, and the final rule Medicare DSH Supplemental Data File supplies the uncompensated care amounts. There is no official CMS pricer for FY2027, so there was nothing else to run those parameters through. Read the caveat below before using any FY2027 dollar figure.
DRG titles, service lines and surgical flags. CMS IPPS Table 5 from the FY2027 final rule, CMS-1849-F, with the FY2026 final rule Table 5 as the fallback for the codes CMS retired.
Annual Uncompensated Care Payment dollars in section 07. The CMS Medicare DSH Supplemental Data Files, final rule version in both years. FY2026 from the CMS-1833-F file and FY2027 from the CMS-1849-F file.

How the files were joined

Matched on 6-digit CCN and MS-DRG. A record has to appear in the caseload file and in both rate files to be counted.
Puerto Rico hospitals cannot meet that test, because CMS publishes no caseload rows for them. They enter on CMS's impact file volume instead, with no MS-DRG rows. The Puerto Rico note below has the detail.
Some hospitals file under extended CCNs for separate campuses, such as 07001001 or 140010A. The caseload file reports only the 6-digit number, so those campus records are collapsed into the parent and the main hospital record sets the rate. Where the campuses sit in different wage areas, all of the volume gets priced at the main campus rate.

What to be careful about

The MS-DRG detail does not add up to the hospital totals, and it is not meant to. CMS suppresses every hospital-and-MS-DRG combination with fewer than 11 discharges in it before publishing the caseload file. That is a privacy rule about small cells, applied uniformly, and it is not a judgement about any hospital. Its effect here is very uneven. A hospital with a large Medicare book has most of its MS-DRGs above the threshold and loses little. A hospital with a small Medicare book spread across many MS-DRGs can lose almost all of it, which is why the loss is heaviest at safety-net hospitals whose patients are mostly not on Medicare.

Two consequences follow, and both are visible on the page.

First, the totals are restored and are estimates. Summing only the published MS-DRGs would understate most hospitals and would badly understate some. Every revenue total, change, per-discharge figure and payment component on this page is therefore scaled to CMS's own case-mix-weighted volume for that hospital, taken from the impact file, and priced at the rate that hospital is actually paid. The arithmetic is deliberately simple and is stated on the hospital's own page in section 08: CMS's published annual Uncompensated Care Payment, plus CMS's case count times its case-mix index times the hospital's payment per unit of relative weight. That last figure is a constant at a given hospital, so it can be read straight off the MS-DRGs CMS did publish. Any hospital whose total this moves by more than 5% is marked EST beside the figure, with the published share alongside it.

Second, the MS-DRG table in section 09 is left exactly as CMS published it. It is not scaled, spread or filled in, because the rows CMS withheld are not knowable one code at a time, and inventing them would put numbers on the page that CMS never published. So section 09 will not sum to the totals in sections 01 through 07 at most hospitals. The difference between them is the suppressed volume, and section 08 prints both numbers for the hospital you are looking at.

The scale factor is never below 1: suppression can only ever have removed volume. At a small number of hospitals the 2024 caseload file carries more volume than CMS's rate-setting extract does, because the two have different vintages; those totals are left alone rather than cut. One factor is used for both years, so the year-over-year percent change on every hospital is unaffected by any of this. The correction moves the levels, not the rate effect, and the national figure is the same either way.

What this means in practice. Treat a hospital's percent change, its rank and its MS-DRG mix as the reliable output of this page. Treat the absolute dollar totals as good estimates whose quality is stated on each hospital's page, and check the published share in section 08 before quoting one. Where the published share is low, the total rests on CMS's aggregate figures for the hospital rather than on the MS-DRG rows, and should be read that way.

Small case counts are missing from the caseload file. CMS hides any hospital and DRG combination with fewer than 11 discharges. The 11-discharge bucket is the biggest one in the file, which says a lot of volume sits just under the line. What is shown here is the reportable part of a hospital's Medicare book. Expect these counts to run below a hospital's own, and expect the hidden cases to lean toward low-volume, high-weight work.

FY2027 rates start on October 1, 2026. A hospital whose budget year is not the federal fiscal year gets a blend. A calendar-year hospital sees nine months of FY2027 rates in 2027 and three months of FY2026 rates. Weight this figure accordingly before it goes into a budget.

Traditional Medicare only. No Medicare Advantage, no Medicaid, no commercial. Nationally, Medicare Advantage now covers more than half of Medicare beneficiaries, though the share of inpatient volume varies a lot by market. None of it is here, though MA contracts often reference these same MS-DRG amounts.

How the retired MS-DRGs were mapped

Cardiac pacemaker revision and device replacement. CMS deleted MS-DRGs 258, 259, 260, 261 and 262 and replaced all five with MS-DRG 210 (with MCC) and MS-DRG 211 (without MCC). The old with-MCC tiers, 258 and 260, go to 210. The old with-CC and without-CC/MCC tiers, 259, 261 and 262, go to 211. No case had to be split, so this carries no estimate.

Uterine and adnexa procedures. CMS deleted MS-DRGs 736, 737 and 738 and MS-DRGs 739, 740 and 741 and merged both branches into MS-DRGs 731, 732 and 733. The severity tiers line up one for one, so 736 and 739 go to 731, 737 and 740 go to 732, and 738 and 741 go to 733. All 689 procedure codes carried over and the new weights fall between the two old branches at every tier, which is what a clean merge should produce.

Hip and knee revision, and joint infection. This is the one place we are estimating. CMS deleted MS-DRGs 466, 467 and 468 and MS-DRGs 485, 486 and 487, and created MS-DRG 449, MS-DRG 400, and MS-DRGs 403 and 404. It also rewrote the grouping logic. It removed a procedure code cluster restriction that used to force cases coded with both a removal code and a replacement code into the revision MS-DRGs, so those cases now group to MS-DRGs 463, 464 and 465 instead. And it pulled two knee prosthesis infection diagnosis codes out of the knee infection logic so those cases group to the new periprosthetic joint infection codes. CMS says directly that no case with a principal diagnosis of periprosthetic joint infection remains in 466, 467 or 468, but it has not published counts for where the rest went, and the redistribution report it promises is for a future proposed rule. So we split each deleted code by hand and we are calling these estimates. The infection shares track published rates of infection as an indication for revision arthroplasty, which run about 15% to 25%.

Extensive and complex spinal fusion, and what this model gets wrong. CMS created MS-DRGs 523, 524 and 525 by pulling extensive and complex fusion cases out of ten MS-DRGs that all still exist in FY2027: 426, 427, 428, 447, 448, 450, 451, 456, 457 and 458. No MS-DRG was deleted to make room, so no retired code maps to them, and the 2024 caseload file has no volume under codes that did not exist. We leave the ten source MS-DRGs whole and assign nothing to 523, 524 or 525. Those three carry much higher relative weights (13.7383, 9.8322 and 7.2950 against 3.2596 to 9.9191 for the source codes), so at a hospital with a lot of extensive fusion work the FY2027 figure on this page understates what CMS would pay. There is no way to size that without running the Version 44 grouper against that hospital's own claims.

The bridge arithmetic

For each hospital and DRG, with d discharges, weights w₆ and w₇, and the weight-driven part of the payment y₆ and y₇:

Weight effect = d × (w₇ - w₆) × y₆/w₆
Rate effect = d × w₇ × (y₇/w₇ - y₆/w₆)
The Uncompensated Care Payment and the hospital-specific rate are carried separately, because neither one scales with DRG weight.

The four pieces add up to the total change exactly, with nothing left over. The weight effect is measured at FY2026 rates and the rate effect at FY2027 weights, which puts the interaction between them into the rate bar.

The FY2027 pricer, and what these rates are priced from

There is no CMS pricer for FY2027 yet. CMS issued the FY2027 IPPS final rule (CMS-1849-F) with a display date of July 31, 2026, and the Federal Register published it on August 4, 2026 at 91 FR 49570. Every FY2027 figure on this page is priced from it. The relative weights are the final rule Table 5 weights, the standardized amounts are the final rule Table 1A and 1B amounts, the capital rate is the final rule Table 1D rate, and the Uncompensated Care Payment comes from the final rule Medicare DSH Supplemental Data File. What is missing is the pricer. CMS has not released the FY2027 IPPS pricer, so the Bright Spot Insights IPPS calculation engine did the pricing instead. Once CMS releases the FY2027 pricer, the rates in this tool will be compared against it and updated so they line up for every hospital and every MS-DRG. That comparison could move some of the figures on this page. One input needs a caveat before you reconcile a single hospital: the FY2027 wage index on this page does not match CMS's published impact file at every hospital, and a small number of hospitals fall back to a labor market area index instead. The counts are above, and the hospitals affected are named there.

§ 12 / Terms of use

Important legal notices

These are estimates, and they are not advice

DRG Impact is an analytical estimate produced from public CMS data. It is not accounting, tax, legal, actuarial, reimbursement, billing or investment advice, and it is not a substitute for your own analysis or for professional counsel. Nothing here creates a client relationship of any kind. Do not use these figures as the sole basis for any budget, forecast, filing, contract, appeal, financial statement, disclosure or business decision.

Verify everything independently

All data, calculations, groupings and observations shown here must be separately verified against the primary sources and against the hospital's own records before anyone relies on them. The authoritative sources are the CMS Inpatient Prospective Payment System final rule and its published tables, the CMS pricer, and the hospital's own claims, remittance and general ledger data. Where this tool and an official CMS publication disagree, the CMS publication governs.

Known limits

These figures are modeled gross payments holding the 2024 case mix constant. They exclude outlier and transfer payments, short-stay adjustments, the low-volume adjustment, new technology add-ons and pass-through amounts. They cover traditional Medicare fee-for-service only and exclude Medicare Advantage, Medicaid and commercial payers. Some MS-DRGs and some hospitals cannot be priced at all and are absent. Source files may contain errors, may be revised or corrected by CMS, and may not reflect subsequent rulemaking, correction notices, litigation or legislation. Section 11 sets out the methodology and its limits in full, and you should read it before relying on any figure here.

Not a guarantee of payment

Nothing here is a guarantee, warranty or prediction of any payment any hospital will receive. What Medicare actually pays is determined by CMS, by the hospital's Medicare Administrative Contractor, and by the law in force on the date of service, and it will differ from these estimates.

Data currency

Built from CMS files as published, in August 2026. The FY2026 side reflects the FY2026 IPPS final rule, CMS-1833-F, priced by the official CMS FY2026 pricer, except at the Puerto Rico hospitals, where the FY2026 side is priced by the Bright Spot Insights IPPS calculation engine on the wage index CMS published, for the reason given in the Puerto Rico note above. The FY2027 side reflects the FY2027 IPPS final rule, CMS-1849-F, display date July 31, 2026, published in the Federal Register on August 4, 2026 at 91 FR 49570, priced by the Bright Spot Insights IPPS calculation engine because CMS has not released the FY2027 pricer. Once CMS releases the FY2027 pricer, the rates in this tool will be compared against it and updated so they line up for every hospital and every MS-DRG. Nothing here reflects later legislation, correction notices or litigation. Figures may be superseded without notice.

This runs in your browser

The calculations run on your own machine. The scenarios you set and the files you export are built locally and are not sent anywhere. Showing you a hospital is the exception: your browser has to ask our server for that hospital's figures, so the hospital you choose does reach us. Nothing else you do on this page leaves your browser.

What we record

We keep a plain usage log so we can see that the tool is being used and which hospitals people are looking at. It records the date and time, the hospital opened and the text typed to find it, the site or link that sent you here, and the country, state and city your connection resolves to. A random identifier is stored in your browser so that a second visit is not counted as a second person. It is tied to nothing you type, and clearing your browser data removes it.

We do not store your IP address, we do not use third-party analytics or advertising trackers, and we do not sell or share any of this with anyone.

Visitors outside the United States are asked first, and nothing at all is recorded unless they choose to allow it. That answer is remembered so the question is only asked once; to change it, clear this site's data in your browser and you will be asked again. Wherever you are, if you would rather we held no record of your visit, tell us through brightspotinsights.com/contact and we will delete it.

No warranty

This tool and its contents are provided on an "as is" and "as available" basis, without warranty of any kind, whether express, implied or statutory. Bright Spot Insights expressly disclaims all warranties, including any implied warranty of merchantability, fitness for a particular purpose, title, non-infringement, accuracy, completeness, currency or uninterrupted availability.

Limitation of liability and hold harmless

To the fullest extent permitted by law, Bright Spot Insights and Brian Cotter shall not be liable for any direct, indirect, incidental, special, consequential, exemplary or punitive damages, or for any lost profits, lost revenue, lost savings, cost of substitute services, business interruption, or loss of data or goodwill, arising out of or relating to your access to or use of this tool or reliance on anything in it, whether based in contract, tort, negligence, strict liability, warranty or any other theory, and whether or not Bright Spot Insights was advised of the possibility of such damages. If that exclusion is held unenforceable in whole or in part, the total aggregate liability of Bright Spot Insights and Brian Cotter arising from or relating to this tool shall not exceed one hundred United States dollars ($100).

By using this tool you agree to indemnify, defend and hold harmless Bright Spot Insights and Brian Cotter from and against any claim, loss, liability, cost or expense, including reasonable attorneys' fees, brought by any third party and arising from your use of this tool, your reliance on its output, or your distribution of its output to any other party.

No third-party reliance

These notices are for the benefit of Bright Spot Insights and Brian Cotter only. No third party has any right to enforce them, and no person or entity other than the user accessing this tool may rely on its output for any purpose. If you provide any output to a third party, including a board, a lender, an auditor or counsel, you do so on your own account and you remain solely responsible for it.

Attribution and reuse

You are welcome to use this tool for internal analysis. The presentation, the code, the methodology text and the compilation are the property of Bright Spot Insights; the underlying CMS data is public and is not claimed. You may not copy the tool itself, republish it, or present its output as your own work. If you circulate any output, including exported files and printed pages, keep the attribution to Bright Spot Insights intact and carry these notices with it, so that whoever reads it downstream sees the same limits you did.

Governing law and severability

These notices are governed by the laws of the State of Rhode Island, without regard to its conflict of laws rules, and any dispute arising from them shall be brought exclusively in the state or federal courts located in Providence County, Rhode Island. If any provision is held unenforceable, it shall be enforced to the maximum extent permitted and the remaining provisions shall remain in full force and effect.

Availability and changes

This is a preview built on a specific vintage of public CMS files. It may be updated, corrected, moved or withdrawn at any time without notice, and figures may change as CMS issues corrections or as later rulemaking takes effect. Nothing here is a commitment to maintain, support or continue to publish it.

No affiliation, and third-party content

Bright Spot Insights is not affiliated with, endorsed by, or acting on behalf of the Centers for Medicare & Medicaid Services or any other government agency. CMS data is used under its public use terms. Hospital names, CMS Certification Numbers and MS-DRG descriptions are the property of their respective owners and appear here for identification only.

Bright Spot Insights. Analysis prepared by Brian Cotter. Source data published by the Centers for Medicare & Medicaid Services. Questions about methodology are welcome at brightspotinsights.com.