Inpatient Rehabilitation Facility PPS: Data Files

Beginning with FY 2015 and later, all IRF PPS Related data files are included with their appropriate Federal Regulation from the  IRF Rules and Related Files webpage:

• IRF Wage Index Final Rule - These files contain the final urban and rural Core-Based Statistical Area wage index tables.
• IRF Rate Setting Final Rule - This file contains data for each inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.
• Case-Mix Groups, Relative Weights, and Average Length of Stay - Values used in the final rule and the standard deviations from the average lengths of stay.
• Tier Comorbidities – ICD-10-CM - This file contains the list of diagnoses (ICD-10-CM codes) that are used to determine placement in tiers for IRF discharges effective at the start of the fiscal year.  It contains the ICD-10-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-10-CM codes are excluded from the tiers.
• Tier Comorbidities Changes - This file contains the list of diagnoses (ICD-10-CM codes) that have been added or removed from the tier comorbidities. This file also lists code label changes to diagnoses. (For ICD-10-CM coding updates, see 2024 files)
• Presumptive Compliance-3 (ICD-10-CM) - This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective for discharges beginning on or after the appropriate start of the fiscal year.
• Presumptive Compliance Changes - This file contains the list of diagnoses (ICD-10-CM codes) that have been added and/or removed from the list of diagnoses codes used for determining presumptive compliance with the IRF 60 percent rule. (For ICD-10-CM coding updates, see 2024 files).
• Impairment Group Codes That Meet Presumptive Compliance Criteria-3 (ICD-10-CM)  - This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective for discharges beginning on or after the start of the fiscal year.

Special Open Door Forum (ODF):  Tier Comorbidity Updates (ZIP)

Link to the Special ODF on Tier Comorbidity Updates transcript and audio file downloads.  This Special ODF, held July 16, 2016, was to allow inpatient rehabilitation facilities (IRFs) and other stakeholders to provide input and suggestions to CMS regarding the areas of most concern or interest for updating the tier comorbidity portion of IRF payments.  

Special Open Door Forum (ODF):  Tier Comorbidity Updates (PDF)

This file contains presentation slides for the Special ODF on Tier Comorbidity Updates. This Special ODF is to allow inpatient rehabilitation facilities (IRFs) and other stakeholders to provide input and suggestions to CMS regarding the areas of most concern or interest for updating the tier comorbidity portion of IRF payments. 

ICD-10-CM Data Files (ZIP)

Presumptive Compliance-1 (ICD-10-CM) This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective October 1, 2015 through the start of an IRF’s next compliance review period beginning on or after that date.

Presumptive Compliance-2 (ICD-10-CM) This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective for compliance review periods beginning on or after October 1, 2015.

Presumptive Compliance-3 (ICD-10-CM) This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective for discharges beginning on or after October 1, 2017.

Impairment Group Codes That Meet Presumptive Compliance Criteria-1 (ICD-10-CM) This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective October 1, 2015 through the start of an IRF’s next compliance review period beginning on or after that date.

Impairment Group Codes That Meet Presumptive Compliance Criteria-2 (ICD-10-CM) This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective for compliance review periods beginning on or after October 1, 2015.

Impairment Group Codes That Meet Presumptive Compliance Criteria-3 (ICD-10-CM) This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective for discharges beginning on or after October 1, 2017.

Legislative Changes to the IRF Prospective Payment Rates--Effective April 1, 2010 (PDF)

Section 3401(d)(2) of the Patient Protection and Affordable Care Act, as amended by section 10319(c) of such Act and further amended by Section 1105 of the Health Care and Education Reconciliation Act of 2010, amends Section 1886(b)(3)(B) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)) to apply a 0.25 percentage point reduction to the payment rates for inpatient rehabilitation facilities (IRFs) for part of fiscal year 2010. The new rates will become effective for discharges occurring on or after April 1, 2010, and will apply from April 1, 2010 through September 30, 2010. Payment rates for discharges occurring from October 1, 2009 through March 31, 2010 will continue to be based on the 2.5 percent market basket factor that was implemented in the FY 2010 IRF PPS final rule (74 FR 39762). 

Legislative Changes to the IRF Prospective Payment Rates--Effective April 1, 2008 (PDF)

Section 115 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 amended Section 1886(j)(3)(C) of the Social Security Act to apply a zero percent increase to payment rates for inpatient rehabilitation facilities (IRFs) for part of fiscal year (FY) 2008 and all of FY 2009. The new rates will become effective for discharges occurring on or after April 1, 2008, and will apply to the last two quarters of FY 2008 (from April 1, 2008 through September 30, 2008). Payment rates for the first two quarters of FY 2008 (from October 1, 2007 through March 31, 2008) will continue to be based on the 3.2 percent market basket increase that was implemented in the FY 2008 IRF PPS final rule (72 FR 44284).  

FY 2008 IRF PPS Final Rule Data Files(ZIP) (ZIP)

IRF Rate Setting Final Rule
This file contains data for each of the 1,220 inpatient rehabilitation facilities used to estimate the final update to the outlier threshold amount and to simulate the distributional impacts shown in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.

IRF Wage Index Final Rule
These files contain the urban and rural Core-Based Statistical Area final wage index tables.

Case-Mix Groups, Relative Weights, and Average Length Of Stay Used In The Final Rule

Appendix C—List of Comorbidities (Revised August 3, 2007)
This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2007. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2008 IRF PPS Proposed Rule Data Files

IRF Rate Setting Proposed Rule 
This file contains data for each of the 1,234 inpatient rehabilitation facilities used to estimate the proposed update to the outlier threshold amount and to simulate the distributional impacts shown in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.

IRF Wage Index Proposed Rule
These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.

FY 2007 IRF PPS Final Rule Data Files (ZIP)

IRF Rate Setting Final Rule
This file contains data for each of the 1,202 inpatient rehabilitation facilities used to estimate the final update to the outlier threshold amount and to simulate the distributional impacts shown in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.

IRF Wage Index Final Rule
These files contain the urban and rural Core-Based Statistical Area final wage index tables.

Case-Mix Groups, Relative Weights, and Average Length Of Stay Used In The Final Rule

Appendix C—List of Comorbidities (Revised August 1, 2006)
This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2006. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2007 IRF PPS Proposed Rule Data Files

IRF Rate Setting Proposed Rule revised 
This file contains data for each of the 1,202 inpatient rehabilitation facilities used to estimate the proposed update to the outlier threshold amount and to simulate the distributional impacts shown in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.

IRF Wage Index Proposed Rule 
These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.

Hypothetical FY 2007 IRF MSA-based wage index: This wage index file is posted in response to a request from the industry. Since this file was not used to determine the wage index in the FY 2007 IRF PPS proposed rule, this is a hypothetical wage index file under the MSA-based area designation scenario. This file is for public informational purposes only and was not used to determine the proposed FY 2007 CBSA wage index for IRFs.

Case-Mix Groups, Relative Weights, and Average Length Of Stay Used In The Proposed Rule