[Federal Register: August 30, 2002 (Volume 67, Number 169)] [Rules and Regulations] [Page 56053-56090] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr30au02-23] [[pp. 56053-56090]] Medicare Program; Prospective Payment System for Long-Term Care Hospitals: Implementation and FY 2003 Rates [[Continued from page 56052]] [[Page 56053]] The counting of the days begins on the day of discharge from the long- term care hospital and ends on the 27th day after the discharge. (3) For a discharge to a SNF, the applicable fixed day period is 45 days. The counting of the days begins on the day of discharge from the long-term care hospital and ends on the 45th day after the discharge. (b) Methods of determining payments. (1) For purposes of determining a Federal prospective payment, any stay in a long-term care hospital that involves an interruption of the stay will be paid as a single discharge from the long-term care hospital. The number of days that a beneficiary spends in an acute care hospital, an IRF, or a SNF during an interruption of stay at a long- term care hospital is not included in determining the length of stay of the patient at the long-term care hospital. CMS will make only one LTC- DRG payment for all portions of a long-term care stay that involves an interruption of a stay. In accordance with Sec. 412.513(b), payment will be based on the patient's LTC-DRG that would be determined by the principal diagnosis, which is the condition established after study to be chiefly responsible for occasioning the first admission of the patient to the hospital for care. (2) If the total number of days of a patient's length of stay in a long-term care hospital prior to and following an interruption of a stay is up to and including five-sixths of the geometric average length of stay of the LTC-DRG, CMS will make a Federal prospective payment for a short-stay outlier in accordance with Sec. 412.529(c). (3) If the total number of days of a patient's length of stay in a long-term care hospital prior to and following an interruption of a stay exceeds five-sixths of the geometric average length of stay for the LTC-DRG, CMS will make one full Federal LTC-DRG prospective payment for the case. An additional payment will be made if the patient's stay qualifies as a high-cost outlier, as set forth in Sec. 412.525(a). (4) Notwithstanding the provisions of paragraph (a) of this section, if a patient who has been discharged from a long-term care hospital to another facility and is readmitted to the long-term care hospital for additional treatment or services in the long-term care hospital following the stay at the other facility, the subsequent admission to the long-term care hospital is considered a new stay, even if the case is determined to fall into the same LTC-DRG, and the long- term care hospital will receive two separate Federal prospective payments if one of the following conditions are met: (i) The patient has a length of stay in the acute care hospital that exceeds 9 days from the day of discharge from the long-term care hospital; (ii) The patient has a length of stay in the IRF that exceeds 27 days from the day of discharge from the long-term care hospital; or (iii) The patient has a length of stay in the SNF that exceeds 45 days from the day of discharge from the long-term care hospital. (c) Payments to an acute care hospital, an IRF, or a SNF during an interruption of a stay. (1) Payment to the acute care hospital for the acute care hospital stay following discharge from the long-term care hospital will be paid in accordance with the acute care hospital inpatient prospective payment systems specified in Sec. 412.1(a)(1). (2) Payment to an IRF for the IRF stay following a discharge from the long-term care hospital will be paid in accordance with the IRF prospective payment system specified in Sec. 412.624 of Subpart P of this part. (3) Payment to a SNF for the SNF stay following a discharge from the long-term care hospital will be paid in accordance with the SNF prospective payment system specified in subpart J of Part 413 of this subchapter. Sec. 412.532 Special payment provisions for patients who are transferred to onsite providers and readmitted to a long-term care hospital. (a) The policies set forth in this section apply in the following situations: (1) A long-term care hospital (including a satellite facility) that is co-located within an onsite acute care hospital, an onsite IRF, or an onsite psychiatric facility or unit that meets the definition of a hospital-within-a-hospital under Sec. 412.22(e). (2) A satellite facility, as defined in Sec. 412.22(f), that is co- located with the long-term care hospital. (3) A SNF, as defined in section 1819(a) of the Act, that is co- located with the long-term care hospital. (b) As used in this section, ``co-located'' or ``onsite'' facility means a hospital or unit that occupies space in a building also used by another hospital or unit or in one or more buildings on the same campus, as defined in Sec. 413.65(a)(2) of this subchapter, as buildings used by another hospital or unit. (c) If, during a cost reporting period, a long-term care hospital (including a satellite facility) discharges patients to an acute care hospital co-located with the long-term care hospital, as described in paragraph (a) of this section, and subsequently directly readmits more than 5 percent (that is, in excess of 5.0 percent) of the total number of its Medicare inpatients discharged from that acute care hospital, all such discharges to the co-located acute care hospital and the readmissions to the long-term care hospital will be treated as one discharge for that cost reporting period and one LTC-DRG payment will be made on the basis of each patient's initial principal diagnosis. (d) If, during a cost reporting period, a long-term care hospital (including a satellite facility) discharges patients to an onsite IRF, an onsite psychiatric hospital or unit, or an onsite SNF, as described in paragraph (a) of this section, and subsequently directly readmits more than 5 percent (that is, in excess of 5.0 percent) of the total number of its Medicare inpatients discharged from the onsite IRF, the onsite psychiatric hospital or unit, or the onsite SNF, all such discharges to any of these providers and the readmissions to the LTCH will be treated as one discharge for that cost reporting period and one LTC-DRG payment will be made on the basis of the patient's initial principal diagnosis. (e) For purposes of calculating the payment per discharge, payment for the entire stay at the long-term care hospital will be paid as a full LTC-DRG payment under Sec. 412.523 or a short-stay outlier under Sec. 412.529, depending on the duration of the entire stay. (f) If the long-term care hospital does not meet the 5-percent thresholds specified under paragraph (c) or (d) of this section for discharges to the specified onsite providers and readmissions to the long-term care hospital during a cost reporting period, payment under the long-term care prospective payment system will be made, where applicable, under the policies on interruption of a stay as specified in Sec. 412.531. (g) Payment to the onsite acute care hospital, the onsite IRF, the onsite psychiatric hospital or unit, and the onsite SNF for a beneficiary's stay in the specified onsite providers is subject to the applicable payment policies, including outliers and transfers, under the acute care hospital inpatient prospective payment system, the IRF prospective payment system, the SNF prospective payment system, or the excluded psychiatric hospital or unit cost-based reimbursement payment system, as appropriate. (h) In determining whether a patient has previously been discharged and [[Page 56054]] then admitted, all prior discharges are considered, even if the discharge occurs late in one cost reporting period and the readmission occurs late in next cost reporting period. (i) A long-term care hospital or a satellite of a long-term care hospital that occupies space in a building used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital and that meets the criteria of paragraphs (h)(1) through (h)(4) of this section must notify its fiscal intermediary and CMS in writing of its co-location within 60 days following the effective date of these regulations and within 60 days of a change in this co-located status. Sec. 412.533 Transition payments. (a) Duration of transition periods. Except for a long-term care hospital that makes an election under paragraph (c) of this section or for a long-term care hospital that is defined as new under Sec. 412.23(e)(4), for cost reporting periods beginning on or after October 1, 2002, and before October 1, 2006, a long-term care hospital receives a payment comprised of a blend of the adjusted Federal prospective payment as determined under Sec. 412.523, and the payment determined under the cost-based reimbursement rules under Part 413 of this subchapter. (1) For cost reporting periods beginning on or after October 1, 2002 and before October 1, 2003, payment is based on 20 percent of the Federal prospective payment rate and 80 percent of the cost-based reimbursement rate. (2) For cost reporting periods beginning on or after October 1, 2003 and before October 1, 2004, payment is based on 40 percent of the Federal prospective payment rate and 60 percent of the cost-based reimbursement rate. (3) For cost reporting periods beginning on or after October 1, 2004 and before October 1, 2005, payment is based on 60 percent of the Federal prospective payment rate and 40 percent of the cost-based reimbursement rate. (4) For cost reporting periods beginning on or after October 1, 2005 and before October 1, 2006, payment is based on 80 percent of the Federal prospective payment rate and 20 percent of the cost-based reimbursement rate. (5) For cost reporting periods beginning on or after October 1, 2006, payment is based entirely on the adjusted Federal prospective payment rate. (b) Adjustments based on reconciliation of cost reports. The cost- based percentage of the provider's total Medicare payment under paragraphs (a)(1) through (a)(4) of this section are subject to adjustments based on reconciliation of cost reports. (c) Election not to be paid under the transition period methodology. A long-term care hospital may elect to be paid based on 100 percent of the Federal prospective rate at the start of any of its cost reporting periods during the 5-year transition periods specified in paragraph (a) of this section. Once a long-term care hospital elects to be paid based on 100 percent of the Federal prospective payment rate, it may not revert to the transition blend. (1) General requirement. A long-term care hospital must notify its fiscal intermediary of its intent to elect to be paid based on 100 percent of the Federal prospective rate at the start of any of its cost reporting periods during the 5-year transition period specified in paragraph (a) of this section. (2) Notification requirement to make election. (i) The request by the long-term care hospital to make the election under paragraph (c)(1) of this section must be made in writing to the Medicare fiscal intermediary. (ii) For cost reporting periods that begin on or after October 1, 2002 through November 30, 2002, the fiscal intermediary must receive the notification of the election before November 1, 2002. (iii) For cost reporting periods that begin on or after December 1, 2002 through September 30, 2006, the fiscal intermediary must receive the notification of the election on or before the 30th day before the applicable cost reporting period begins. (iv) The fiscal intermediary must receive the notification by the dates specified in paragraphs (c)(2)(ii) and (c)(2)(iii) of this section, regardless of any postmarks or anticipated delivery dates. Requests received, postmarked, or delivered by other means after the dates specified in paragraphs (c)(2)(ii) and (c)(2)(iii) of this section will not be accepted. If the date specified in paragraphs (c)(2)(ii) and (c)(2)(iii) of this section falls on a day that the postal service or other delivery sources are not open for business, the long-term care hospital is responsible for allowing sufficient time for the delivery of the notification before the deadline. (v) If a long-term care hospital's notification is not received by the dates specified in paragraphs (c)(2)(ii) and (c)(2)(iii) of this section, payment will be based on the transition period rates specified in paragraphs (a)(1) through (a)(5) of this section. (d) Payments to new long-term care hospitals. A new long-term care hospital, as defined in Sec. 412.23(e)(4), will be paid based on 100 percent of the standard Federal rate, as described in Sec. 412.523, with no transition payments, as described in Sec. 412.533(a)(1) through (a)(5). Sec. 412.535 Publication of the Federal prospective payment rates. CMS publishes information pertaining to the long-term care hospital prospective payment system effective for each fiscal year in the Federal Register. This information includes the unadjusted Federal payment rates, the LTC-DRG classification system and associated weighting factors, and a description of the methodology and data used to calculate the payment rates. This information is published on or before August 1 prior to the beginning of each fiscal year. Sec. 412.541 Method of payment under the long-term care hospital prospective payment system. (a) General rule. Subject to the exceptions in paragraphs (b) and (c) of this section, long-term care hospitals receive payment under this subpart for inpatient operating costs and capital-related costs for each discharge only following submission of a discharge bill. (b) Periodic interim payments. (1) Criteria for receiving periodic interim payments. (i) A long-term care hospital receiving payment under this subpart may receive periodic interim payments (PIP) for Part A services under the PIP method subject to the provisions of Sec. 413.64(h) of this subchapter. (ii) To be approved for PIP, the long-term care hospital must meet the qualifying requirements in Sec. 413.64(h)(3) of this subchapter. (iii) As provided in Sec. 413.64(h)(5) of this subchapter, intermediary approval is conditioned upon the intermediary's best judgment as to whether payment can be made under the PIP method without undue risk of the PIP resulting in an overpayment to the provider. (2) Frequency of payment. (i) For long-term care hospitals approved for PIP and paid solely under Federal prospective payment system rates under Sec. 412.533(b), the intermediary estimates the long-term care hospital's Federal prospective payments net after estimated beneficiary deductibles and coinsurance and makes biweekly payments equal to \1/26\ of the total estimated amount of payment for the year. [[Page 56055]] (ii) For long-term care hospitals approved for PIP and paid using the blended payment schedule specified in Sec. 412.533(a) for cost reporting periods beginning on or after October 1, 2002, and before October 1, 2006, the intermediary estimates the hospital's portion of the Federal prospective payments net and the hospital's portion of the reasonable cost-based reimbursement payments net, after beneficiary deductibles and coinsurance, in accordance with the blended transition percentages specified in Sec. 412.533(a), and makes biweekly payments equal to \1/26\ of the total estimated amount of both portions of payments for the year. (iii) If the long-term care hospital has payment experience under the long-term care hospital prospective payment system, the intermediary estimates PIP based on that payment experience, adjusted for projected changes supported by substantiated information for the current year. (iv) Each payment is made 2 weeks after the end of a biweekly period of service as described in Sec. 413.64(h)(6) of this subchapter. (v) The interim payments are reviewed at least twice during the reporting period and adjusted if necessary. Fewer reviews may be necessary if a hospital receives interim payments for less than a full reporting period. These payments are subject to final settlement. (3) Termination of PIP. (i) Request by the hospital. Subject to paragraph (b)(1)(iii) of this section, a long-term care hospital receiving PIP may convert to receiving prospective payments on a non- PIP basis at any time. (ii) Removal by the intermediary. An intermediary terminates PIP if the long-term care hospital no longer meets the requirements of Sec. 413.64(h) of this subchapter. (c) Interim payments for Medicare bad debts and for Part A costs not paid under the prospective payment system. For Medicare bad debts and for the costs of an approved education program, blood clotting factors, anesthesia services furnished by hospital-employed nonphysician anesthetists or obtained under arrangement, and photocopying and mailing medical records to a QIO, which are costs paid outside the prospective payment system, the intermediary determines the interim payments by estimating the reimbursable amount for the year based on the previous year's experience, adjusted for projected changes supported by substantiated information for the current year, and makes biweekly payments equal to \1/26\ of the total estimated amount. Each payment is made 2 weeks after the end of the biweekly period of service as described in Sec. 413.64(h)(6) of this subchapter. The interim payments are reviewed at least twice during the reporting period and adjusted if necessary. Fewer reviews may be necessary if a long-term care hospital receives interim payments for less than a full reporting period. These payments are subject to final cost settlement. (d) Special interim payment for unusually long lengths of stay. (1) First interim payment. A hospital that is not receiving periodic interim payments under paragraph (b) of this section may request an interim payment 60 days after a Medicare beneficiary has been admitted to the hospital. Payment for the interim bill is determined as if the bill were a final discharge bill. (2) Additional interim payments. A hospital may request additional interim payments at intervals of at least 60 days after the date of the first interim bill submitted under paragraph (d)(1) of this section. Payment for these additional interim bills, as well as the final bill, is determined as if the bill were the final bill with appropriate adjustments made to the payment amount to reflect any previous interim payment made under the provisions of this paragraph. (e) Outlier payments. Additional payments for outliers are not made on an interim basis. The outlier payments are made based on the submission of a discharge bill and represent final payment. (f) Accelerated payments. (1) General rule. Upon request, an accelerated payment may be made to a long-term care hospital that is receiving payment under this subpart and is not receiving PIP under paragraph (b) of this section if the hospital is experiencing financial difficulties because of the following: (i) There is a delay by the intermediary in making payment to the long-term care hospital. (ii) Due to an exceptional situation, there is a temporary delay in the hospital's preparation and submittal of bills to the intermediary beyond its normal billing cycle. (2) Approval of payment. A request by a long-term care hospital for an accelerated payment must be approved by the intermediary and by CMS. (3) Amount of payment. The amount of the accelerated payment is computed as a percentage of the net payment for unbilled or unpaid covered services. (4) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital bills are processed or by direct payment by the long-term care hospital. PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT FOR SKILLED NURSING FACILITIES 1. The authority citation for Part 413 continues to read as follows: Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i) and (n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww). Subpart A--Introduction and General Rules 2. Section 413.1 is amended by: a. Revising paragraph (d)(2)(ii). b. Adding paragraphs (d)(2)(vi) and (d)(2)(vii). Sec. 413.1 Introduction. * * * * * (d) * * * (2) * * * (ii) Payment to children's and psychiatric hospitals (as well as separate psychiatric units (distinct parts) of short-term general hospitals) that are excluded from the prospective payment systems under subpart B of Part 412 of this subchapter and hospitals outside the 50 states and the District of Columbia is on a reasonable cost basis, subject to the provisions of Sec. 413.40. * * * * * (vi) For cost reporting periods beginning before October 1, 2002, payment to long-term care hospitals that are excluded under subpart B of Part 412 of this subchapter from the prospective payment systems is on a reasonable cost basis, subject to the provisions of Sec. 413.40. (vii) For cost reporting periods beginning on or after October 1, 2002, payment to the long-term hospitals that meet the condition for payment of Secs. 412.505 through 412.511 of this subchapter is based on prospectively determined rates under subpart O of Part 412 of this subchapter. * * * * * Subpart C--Limits on Cost Reimbursement 3. Section 413.40 is amended by: a. Republishing the introductory text of paragraph (a)(2)(i). b. Adding a new paragraph (a)(2)(i)(D). c. Amending paragraph (a)(2)(ii) by republishing the introductory text, removing ``and'' at the end of paragraph (a)(2)(ii)(A), removing the period and [[Page 56056]] adding ``; and'' at the end of paragraph (a)(2)(ii)(B), and adding a new paragraph (a)(2)(ii)(C). d. Adding a new paragraph (a)(2)(iv). Sec. 413.40 Ceiling on the rate of increase in hospital inpatient cost. (a) Introduction. * * * (2) Applicability. (i) This section is not applicable to-- * * * * * (D) Long-term care hospitals, as defined in section 1886(d)(1)(B)(iv) of the Act, that are paid based on 100 percent of the Federal prospective payment rate for inpatient hospital services in accordance with section 123 of Public Law 106-113 and section 307 of Public Law 106-554 and Sec. 412.533(b) and (c) of subpart O of Part 412 of this subchapter for cost reporting periods beginning on or after October 1, 2002. (ii) For cost reporting periods beginning on or after October 1, 1983, this section applies to-- * * * * * (C) Long-term care hospitals excluded from the prospective payment systems described in Sec. 412.1(a)(1) of this subchapter and in accordance with Sec. 412.23 of this subchapter, except as limited by paragraph (a)(2)(iv) of this section with respect to long-term care hospitals specified in Sec. 412.23(e) of this subchapter. * * * * * (iv) For cost reporting periods beginning on or after October 1, 1983 and before October 1, 2002, this section applies to long-term care hospitals that are excluded from the prospective payment systems described in Sec. 412.1(a)(1) of this subchapter. For cost reporting periods beginning on or after October 1, 2002, and before October 1, 2006, this section also applies to long-term care hospitals, subject to paragraph (a)(2)(i)(D) of this section. * * * * * Subpart E--Payments to Providers 4. Section Sec. 413.64 is amended as follows: a. The introductory text of paragraph (h)(2) is republished. b. Paragraph (h)(2)(i) and the introductory text of paragraph (h)(3) are revised. Sec. 413.64 Payment to providers: Specific rules. * * * * * (h) Periodic interim payment method of reimbursement-- * * * (2) Covered services furnished on or after July 1, 1987. Effective with claims received on or after July 1, 1987, the periodic interim payment (PIP) method is available for the following: (i) Part A inpatient services furnished in hospitals that are excluded from the prospective payment systems described in Sec. 412.1(a)(1) of this chapter, under subpart B of Part 412 of this subchapter or are paid under the prospective payment systems described in subparts O and P of Part 412 of this subchapter. * * * * * (3) Any participating provider furnishing the services described in paragraphs (h)(1) and (h)(2) of this section that establishes to the satisfaction of the intermediary that it meets the following requirements may elect to be reimbursed under the PIP method, beginning with the first month after its request that the intermediary finds administratively feasible: * * * * * PART 476--UTILIZATION AND QUALITY CONTROL REVIEW 1. The authority citation for Part 476 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 2. Section 476.71 is amended by revising paragraph (c)(2) to read as follows: Sec. 476.71 QIO review requirements. * * * * * (c) Other duties and functions. * * * (2) As directed by CMS, the QIO must review changes in DRG and LTC- DRG assignments made by the intermediary under the provisions of Secs. 412.60(d) and 412.513(c) of this chapter that result in the assignment of a higher-weighted DRG or a different LTC-DRG. The QIO's review must verify that the diagnostic and procedural information supplied by the hospital is substantiated by the information in the medical record. * * * * * (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare--Hospital Insurance) Dated: August 21, 2002. Thomas A. Scully, Administrator, Centers for Medicare & Medicaid Services. Dated: August 21, 2002. Tommy G. Thompson, Secretary. [[Page 56057]] [[Page 56057]] Addendum This addendum contains the tables referred to throughout the preamble to this final rule. The tables presented below are as follows: Table 1.--Long-Term Care Hospital Wage Index for Urban Areas Table 2.--Long-Term Care Hospital Wage Index for Rural Areas Table 3.--LTC-DRG Relative Weights and Arithmetic Mean Length of Stay Table 1.--Long-Term Care Hospital Wage Index for Urban Areas ------------------------------------------------------------------------ Urban area MSA (constituent Full wage index \1/5\ wage index counties) \1\ \2\ ------------------------------------------------------------------------ 0040 Abilene, TX.......... 0.7965 0.9593 Taylor, TX 0060 Aguadilla, PR........ 0.4683 0.8937 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH............ 0.9739 0.9948 Portage, OH Summit, OH 0120 Albany, GA........... 1.0606 1.0121 Dougherty, GA Lee, GA 0160 Albany-Schenectady- 0.8452 0.9690 Troy, NY............ Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM...... 0.9723 0.9945 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA....... 0.8015 0.9603 Rapides, LA 0240 Allentown-Bethlehem- 1.0014 1.0003 Easton, PA.......... Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA.......... 0.9100 0.9820 Blair, PA 0320 Amarillo, TX......... 0.8671 0.9734 Potter, TX Randall, TX 0380 Anchorage, AK........ 1.2569 1.0514 Anchorage, AK 0440 Ann Arbor, MI........ 1.0959 1.0192 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL......... 0.8276 0.9655 Calhoun, AL 0460 Appleton-Oshkosh- 0.9241 0.9848 Neenah, WI.......... Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR.......... 0.4630 0.8926 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC........ 0.9174 0.9835 Buncombe, NC Madison, NC 0500 Athens, GA........... 0.9842 0.9968 Clarke, GA Madison, GA Oconee, GA 0520 Atlanta, GA.......... 1.0043 1.0009 Barrow, GA Bartow, GA Carroll, GA Cherokee, GA Clayton, GA Cobb, GA [[Page 56058]] Coweta, GA DeKalb, GA Douglas, GA Fayette, GA Forsyth, GA Fulton, GA Gwinnett, GA Henry, GA Newton, GA Paulding, GA Pickens, GA Rockdale, GA Spalding, GA Walton, GA 0560 Atlantic-Cape May, NJ 1.1297 1.0259 Atlantic, NJ Cape May, NJ 0580 Auburn-Opelika, AL... 0.8230 0.9646 Lee, AL 0600 Augusta-Aiken, GA-SC. 0.9975 0.9995 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 Austin-San Marcos, TX 0.9597 0.9919 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA...... 0.9406 0.9881 Kern, CA 0720 Baltimore, MD........ 0.9805 0.9961 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME........... 0.9580 0.9916 Penobscot, ME 0743 Barnstable-Yarmouth, 1.3626 1.0725 MA.................. Barnstable, MA 0760 Baton Rouge, LA...... 0.8136 0.9627 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, 0.8428 0.9686 TX.................. Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA....... 1.1826 1.0365 Whatcom, WA 0870 Benton Harbor, MI.... 0.8810 0.9762 Berrien, MI 0875 Bergen-Passaic, NJ... 1.1681 1.0336 Bergen, NJ Passaic, NJ 0880 Billings, MT......... 0.9365 0.9873 Yellowstone, MT 0920 Biloxi-Gulfport- 0.8440 0.9688 Pascagoula, MS...... Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY....... 0.8404 0.9681 Broome, NY Tioga, NY 1000 Birmingham, AL....... 0.8775 0.9755 Blount, AL [[Page 56059]] Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND......... 0.7984 0.9597 Burleigh, ND Morton, ND 1020 Bloomington, IN...... 0.8842 0.9768 Monroe, IN 1040 Bloomington-Normal, 0.9038 0.9808 IL.................. McLean, IL 1080 Boise City, ID....... 0.9051 0.9810 Ada, ID Canyon, ID 1123 Boston-Worcester- 1.1349 1.0270 Lawrence-Lowell- Brockton, MA-NH (NH Hospitals).......... Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH 1125 Boulder-Longmont, CO. 0.9798 0.9960 Boulder, CO 1145 Brazoria, TX......... 0.8209 0.9642 Brazoria, TX 1150 Bremerton, WA........ 1.0758 1.0152 Kitsap, WA 1240 Brownsville-Harlingen- 0.9004 0.9801 San Benito, TX...... Cameron, TX 1260 Bryan-College 0.9328 0.9866 Station, TX......... Brazos, TX 1280 Buffalo-Niagara 0.9392 0.9878 Falls, NY........... Erie, NY Niagara, NY 1303 Burlington, VT....... 0.9914 0.9983 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR........... 0.4705 0.8941 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH. 0.8904 0.9781 Carroll, OH Stark, OH 1350 Casper, WY........... 0.9496 0.9899 Natrona, WY 1360 Cedar Rapids, IA..... 0.8699 0.9740 Linn, IA 1400 Champaign-Urbana, IL. 0.9295 0.9859 Champaign, IL 1440 Charleston-North 0.9204 0.9841 Charleston, SC...... Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV....... 0.9264 0.9853 Kanawha, WV Putnam, WV 1520 Charlotte-Gastonia- 0.9312 0.9862 Rock Hill, NC-SC.... Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC [[Page 56060]] York, SC 1540 Charlottesville, VA.. 1.0501 1.0100 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA... 0.9333 0.9867 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 Cheyenne, WY......... 0.8288 0.9658 Laramie, WY 1600 Chicago, IL.......... 1.1008 1.0202 Cook, IL DeKalb, IL DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA... 0.9856 0.9971 Butte, CA 1640 Cincinnati, OH-KY-IN. 0.9444 0.9889 Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH 1660 Clarksville- 0.8306 0.9661 Hopkinsville, TN-KY. Christian, KY Montgomery, TN 1680 Cleveland-Lorain- 0.9429 0.9886 Elyria, OH.......... Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO. 0.9745 0.9949 El Paso, CO 1740 Columbia, MO......... 0.8674 0.9735 Boone, MO 1760 Columbia, SC......... 0.9474 0.9895 Lexington, SC Richland, SC 1800 Columbus, GA-AL...... 0.8382 0.9676 Russell, AL Chattahoochee, GA Harris, GA Muscogee, GA 1840 Columbus, OH......... 0.9543 0.9909 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX... 0.8337 0.9667 Nueces, TX San Patricio, TX 1890 Corvallis, OR........ 1.1646 1.0329 [[Page 56061]] Benton, OR 1900 Cumberland, MD-WV (WV 0.8321 0.9664 Hospital)........... Allegany, MD Mineral, WV 1920 Dallas, TX........... 0.9855 0.9971 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA......... 0.8613 0.9723 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock 0.8638 0.9728 Island, IA-IL....... Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, 0.9151 0.9830 OH.................. Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL.... 0.8952 0.9790 Flagler, FL Volusia, FL 2030 Decatur, AL.......... 0.8775 0.9755 Lawrence, AL Morgan, AL 2040 Decatur, IL.......... 0.7974 0.9595 Macon, IL 2080 Denver, CO........... 1.0280 1.0056 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA....... 0.8735 0.9747 Dallas, IA Polk, IA Warren, IA 2160 Detroit, MI.......... 1.0413 1.0083 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL........... 0.7948 0.9590 Dale, AL Houston, AL 2190 Dover, DE............ 1.0296 1.0059 Kent, DE 2200 Dubuque, IA.......... 0.8519 0.9704 Dubuque, IA 2240 Duluth-Superior, MN- 1.0284 1.0057 WI.................. St. Louis, MN Douglas, WI 2281 Dutchess County, NY.. 1.0514 1.0103 Dutchess, NY 2290 Eau Claire, WI....... 0.8814 0.9763 Chippewa, WI Eau Claire, WI 2320 El Paso, TX.......... 0.9207 0.9841 El Paso, TX 2330 Elkhart-Goshen, IN... 0.9638 0.9928 Elkhart, IN 2335 Elmira, NY........... 0.8415 0.9683 Chemung, NY 2340 Enid, OK............. 0.8357 0.9671 [[Page 56062]] Garfield, OK 2360 Erie, PA............. 0.8633 0.9727 Erie, PA 2400 Eugene-Springfield, 1.1471 1.0294 OR.................. Lane, OR 2440 Evansville-Henderson, 0.8489 0.9698 IN-KY (IN Hospitals) Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN 0.9268 0.9854 Clay, MN Cass, ND 2560 Fayetteville, NC..... 0.9027 0.9805 Cumberland, NC 2580 Fayetteville- 0.8445 0.9689 Springdale-Rogers, AR.................. Benton, AR Washington, AR 2620 Flagstaff, AZ-UT..... 1.0553 1.0111 Coconino, AZ Kane, UT 2640 Flint, MI............ 1.0844 1.0169 Genesee, MI 2650 Florence, AL......... 0.7845 0.9569 Colbert, AL Lauderdale, AL 2655 Florence, SC......... 0.8693 0.9739 Florence, SC 2670 Fort Collins- 1.0018 1.0004 Loveland, CO........ Larimer, CO 2680 Ft. Lauderdale, FL... 1.0293 1.0059 Broward, FL 2700 Fort Myers-Cape 0.9374 0.9875 Coral, FL........... Lee, FL 2710 Fort Pierce-Port St. 1.0214 1.0043 Lucie, FL........... Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK.... 0.8052 0.9610 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL 0.9002 0.9800 Okaloosa, FL 2760 Fort Wayne, IN....... 0.9197 0.9839 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 Forth Worth- 0.9357 0.9871 Arlington, TX....... Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA........... 0.9856 0.9971 Fresno, CA Madera, CA 2880 Gadsden, AL.......... 0.8792 0.9758 Etowah, AL 2900 Gainesville, FL...... 0.9255 0.9851 Alachua, FL 2920 Galveston-Texas City, 1.0262 1.0052 TX.................. Galveston, TX 2960 Gary, IN............. 0.9529 0.9906 Lake, IN Porter, IN 2975 Glens Falls, NY...... 0.8336 0.9667 Warren, NY Washington, NY 2980 Goldsboro, NC........ 0.8709 0.9742 Wayne, NC [[Page 56063]] 2985 Grand Forks, ND-MN... 0.9069 0.9814 Polk, MN Grand Forks, ND 2995 Grand Junction, CO... 0.9529 0.9906 Mesa, CO 3000 Grand Rapids-Muskegon- 0.9933 0.9987 Holland, MI......... Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT...... 0.8870 0.9774 Cascade, MT 3060 Greeley, CO.......... 0.9254 0.9851 Weld, CO 3080 Green Bay, WI........ 0.9208 0.9842 Brown, WI 3120 Greensboro-Winston- 0.9537 0.9907 Salem-High Point, NC Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC....... 0.9153 0.9831 Pitt, NC 3160 Greenville- 0.9151 0.9830 Spartanburg- Anderson, SC........ Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD....... 0.8365 0.9673 Washington, MD 3200 Hamilton-Middletown, 0.9287 0.9857 OH.................. Butler, OH 3240 Harrisburg-Lebanon- 0.9285 0.9857 Carlisle, PA........ Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 Hartford, CT......... 1.1504 1.0301 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 Hattiesburg, MS \2\.. 0.7476 0.9495 Forrest, MS Lamar, MS 3290 Hickory-Morganton- 0.9367 0.9873 Lenoir, NC.......... Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI......... 1.1538 1.0308 Honolulu, HI 3350 Houma, LA............ 0.7949 0.9590 Lafourche, LA Terrebonne, LA 3360 Houston, TX.......... 0.9623 0.9925 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, 0.9613 0.9923 WV-KY-OH............ Boyd, KY Carter, KY Greenup, KY Lawrence, OH [[Page 56064]] Cabell, WV Wayne, WV 3440 Huntsville, AL....... 0.8883 0.9777 Limestone, AL Madison, AL 3480 Indianapolis, IN..... 0.9676 0.9935 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA........ 0.9824 0.9965 Johnson, IA 3520 Jackson, MI.......... 0.9257 0.9851 Jackson, MI 3560 Jackson, MS.......... 0.8435 0.9687 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN.......... 0.9013 0.9803 Madison, TN Chester, TN 3600 Jacksonville, FL..... 0.9213 0.9843 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC..... 0.7622 0.9524 Onslow, NC 3610 Jamestown, NY........ 0.8050 0.9610 Chautauqua, NY 3620 Janesville-Beloit, WI 0.9739 0.9948 Rock, WI 3640 Jersey City, NJ...... 1.1162 1.0232 Hudson, NJ 3660 Johnson City- 0.8617 0.9723 Kingsport-Bristol, TN-VA............... Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA........ 0.8668 0.9734 Cambria, PA Somerset, PA 3700 Jonesboro, AR........ 0.8439 0.9688 Craighead, AR 3710 Joplin, MO........... 0.8729 0.9746 Jasper, MO Newton, MO 3720 Kalamazoo- 1.0639 1.0128 Battlecreek, MI..... Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL......... 0.9889 0.9978 Kankakee, IL 3760 Kansas City, KS-MO... 0.9501 0.9900 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO [[Page 56065]] Platte, MO Ray, MO 3800 Kenosha, WI.......... 0.9568 0.9914 Kenosha, WI 3810 Killeen-Temple, TX... 0.8513 0.9703 Bell, TX Coryell, TX 3840 Knoxville, TN........ 0.8873 0.9775 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN........... 0.9126 0.9825 Howard, IN Tipton, IN 3870 La Crosse, WI-MN..... 0.9244 0.9849 Houston, MN La Crosse, WI 3880 Lafayette, LA........ 0.8499 0.9700 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN........ 0.9121 0.9824 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA..... 0.7766 0.9553 Calcasieu, LA 3980 Lakeland-Winter 0.9067 0.9813 Haven, FL........... Polk, FL 4000 Lancaster, PA........ 0.9286 0.9857 Lancaster, PA 4040 Lansing-East Lansing, 0.9639 0.9928 MI.................. Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX........... 0.7849 0.9570 Webb, TX 4100 Las Cruces, NM....... 0.8619 0.9724 Dona Ana, NM 4120 Las Vegas, NV-AZ..... 1.1179 1.0236 Mohave, AZ Clark, NV Nye, NV 4150 Lawrence, KS......... 0.8656 0.9731 Douglas, KS 4200 Lawton, OK........... 0.8682 0.9736 Comanche, OK 4243 Lewiston-Auburn, ME.. 0.9267 0.9853 Androscoggin, ME 4280 Lexington, KY........ 0.8743 0.9749 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH............. 0.9470 0.9894 Allen, OH Auglaize, OH 4360 Lincoln, NE.......... 1.0168 1.0034 Lancaster, NE 4400 Little Rock-North 0.8957 0.9791 Little Rock, AR..... Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX 0.8571 0.9714 Gregg, TX [[Page 56066]] Harrison, TX Upshur, TX 4480 Los Angeles-Long 1.1946 1.0389 Beach, CA........... Los Angeles, CA 4520 Louisville, KY-IN \1\ 0.9457 0.9891 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX.......... 0.8432 0.9686 Lubbock, TX 4640 Lynchburg, VA........ 0.9104 0.9821 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA............ 0.8839 0.9768 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI.......... 1.0360 1.0072 Dane, WI 4800 Mansfield, OH........ 0.8708 0.9742 Crawford, OH Richland, OH 4840 Mayaguez, PR......... 0.4853 0.8971 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg- 0.8378 0.9676 Mission, TX......... Hidalgo, TX 4890 Medford-Ashland, OR.. 1.0314 1.0063 Jackson, OR 4900 Melbourne-Titusville- 0.9913 0.9983 Palm Bay, FL........ Brevard, FL 4920 Memphis, TN-AR-MS.... 0.8962 0.9792 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA........... 0.9721 0.9944 Merced, CA 5000 Miami, FL............ 0.9967 0.9993 Dade, FL 5015 Middlesex-Somerset- 1.1407 1.0281 Hunterdon, NJ....... Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 Milwaukee-Waukesha, 0.9894 0.9979 WI.................. Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 Minneapolis-St. Paul, 1.0909 1.0182 MN-WI............... Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN [[Page 56067]] Sherburne, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT......... 0.9364 0.9873 Missoula, MT 5160 Mobile, AL........... 0.8027 0.9605 Baldwin, AL Mobile, AL 5170 Modesto, CA.......... 1.0820 1.0164 Stanislaus, CA 5190 Monmouth-Ocean, NJ... 1.0863 1.0173 Monmouth, NJ Ocean, NJ 5200 Monroe, LA........... 0.8149 0.9630 Ouachita, LA 5240 Montgomery, AL....... 0.7349 0.9470 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN........... 0.9760 0.9952 Delaware, IN 5330 Myrtle Beach, SC..... 0.8759 0.9752 Horry, SC 5345 Naples, FL........... 0.9699 0.9940 Collier, FL 5360 Nashville, TN........ 0.9690 0.9938 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 Nassau-Suffolk, NY... 1.3461 1.0692 Nassau, NY Suffolk, NY 5483 New Haven-Bridgeport- 1.2178 1.0436 Stamford-Waterbury- Danbury, CT......... Fairfield, CT New Haven, CT 5523 New London-Norwich, 1.1525 1.0305 CT.................. New London, CT 5560 New Orleans, LA...... 0.8995 0.9799 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 New York, NY......... 1.4305 1.0861 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 Newark, NJ........... 1.1618 1.0324 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA...... 1.1113 1.0223 Orange, NY Pike, PA 5720 Norfolk-Virginia 0.8538 0.9708 Beach-Newport News, VA-NC............... [[Page 56068]] Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA Isle of Wight, VA James City, VA Mathews, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City VA Williamsburg City, VA York, VA 5775 Oakland, CA.......... 1.5332 1.1066 Alameda, CA Contra Costa, CA 5790 Ocala, FL............ 0.9556 0.9911 Marion, FL 5800 Odessa-Midland, TX... 1.0105 1.0021 Ector, TX Midland, TX 5880 Oklahoma City, OK.... 0.8655 0.9731 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA.......... 1.1362 1.0272 Thurston, WA 5920 Omaha, NE-IA......... 0.9677 0.9935 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 Orange County, CA.... 1.1108 1.0222 Orange, CA 5960 Orlando, FL.......... 0.9603 0.9921 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY........ 0.8333 0.9667 Daviess, KY 6015 Panama City, FL...... 0.9061 0.9812 Bay, FL 6020 Parkersburg-Marietta, 0.8128 0.9626 WV-OH............... Washington, OH Wood, WV 6080 Pensacola, FL........ 0.8331 0.9666 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL..... 0.8635 0.9727 Peoria, IL Tazewell, IL Woodford, IL 6160 Philadelphia, PA-NJ.. 1.0829 1.0166 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 Phoenix-Mesa, AZ..... 0.9610 0.9922 Maricopa, AZ Pinal, AZ [[Page 56069]] 6240 Pine Bluff, AR....... 0.7925 0.9585 Jefferson, AR 6280 Pittsburgh, PA....... 0.9464 0.9893 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 Pittsfield, MA....... 1.0171 1.0034 Berkshire, MA 6340 Pocatello, ID........ 0.9448 0.9890 Bannock, ID 6360 Ponce, PR............ 0.5218 0.9044 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME......... 0.9367 0.9873 Cumberland, ME Sagadahoc, ME York, ME 6440 Portland-Vancouver, 1.1107 1.0221 OR-WA............... Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 Providence-Warwick- 1.0768 1.0154 Pawtucket, RI....... Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT....... 0.9836 0.9967 Utah, UT 6560 Pueblo, CO........... 0.8582 0.9716 Pueblo, CO 6580 Punta Gorda, FL...... 0.9014 0.9803 Charlotte, FL 6600 Racine, WI........... 0.9323 0.9865 Racine, WI 6640 Raleigh-Durham-Chapel 0.9774 0.9955 Hill, NC............ Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD....... 0.8843 0.9769 Pennington, SD 6680 Reading, PA.......... 0.9564 0.9913 Berks, PA 6690 Redding, CA.......... 1.1136 1.0227 Shasta, CA 6720 Reno, NV............. 1.0369 1.0074 Washoe, NV 6740 Richland-Kennewick- 1.0960 1.0192 Pasco, WA........... Benton, WA Franklin, WA 6760 Richmond-Petersburg, 0.9624 0.9925 VA.................. Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Hopewell City, VA [[Page 56070]] New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, VA 6780 Riverside-San 1.1104 1.0221 Bernardino, CA...... Riverside, CA San Bernardino, CA 6800 Roanoke, VA.......... 0.8286 0.9657 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN........ 1.1474 1.0295 Olmsted, MN 6840 Rochester, NY........ 0.9200 0.9840 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL......... 0.9189 0.9838 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC...... 0.9109 0.9822 Edgecombe, NC Nash, NC 6920 Sacramento, CA....... 1.1769 1.0354 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City- 0.9526 0.9905 Midland, MI......... Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN........ 0.9844 0.9969 Benton, MN Stearns, MN 7000 St. Joseph, MO....... 0.9009 0.9802 Andrew, MO Buchanan, MO 7040 St. Louis, MO-IL..... 0.8882 0.9776 Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO 7080 Salem, OR............ 1.0011 1.0002 Marion, OR Polk, OR 7120 Salinas, CA.......... 1.4674 1.0935 Monterey, CA 7160 Salt Lake City-Ogden, 0.9861 0.9972 UT.................. Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX....... 0.8193 0.9639 Tom Green, TX 7240 San Antonio, TX...... 0.8547 0.9709 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX [[Page 56071]] 7320 San Diego, CA........ 1.1283 1.0257 San Diego, CA 7360 San Francisco, CA.... 1.4170 1.0834 Marin, CA San Francisco, CA San Mateo, CA 7400 San Jose, CA......... 1.4222 1.0844 Santa Clara, CA 7440 San Juan-Bayamon, PR. 0.4748 0.8950 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, PR Luguillo, PR Manati, PR Morovis, PR Naguabo, PR Naranjito, PR Rio Grande, PR San Juan, PR Toa Alta, PR Toa Baja, PR Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo- 1.0990 1.0198 Atascadero-Paso Robles, CA.......... San Luis Obispo, CA 7480 Santa Barbara-Santa 1.0794 1.0159 Maria-Lompoc, CA.... Santa Barbara, CA 7485 Santa Cruz- 1.3970 1.0794 Watsonville, CA..... Santa Cruz, CA 7490 Santa Fe, NM......... 1.0196 1.0039 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA....... 1.3004 1.0601 Sonoma, CA 7510 Sarasota-Bradenton, 1.0090 1.0018 FL.................. Manatee, FL Sarasota, FL 7520 Savannah, GA......... 0.9974 0.9995 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton--Wilkes- 0.8682 0.9736 Barre--Hazleton, PA. Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 Seattle-Bellevue- 1.1324 1.0265 Everett, WA......... Island, WA King, WA Snohomish, WA 7610 Sharon, PA........... 0.7924 0.9585 Mercer, PA 7620 Sheboygan, WI........ 0.8427 0.9685 Sheboygan, WI 7640 Sherman-Denison, TX.. 0.9373 0.9875 Grayson, TX [[Page 56072]] 7680 Shreveport-Bossier 0.9014 0.9803 City, LA............ Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE.... 0.8735 0.9747 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD...... 0.9095 0.9819 Lincoln, SD Minnehaha, SD 7800 South Bend, IN....... 0.9929 0.9986 St. Joseph, IN 7840 Spokane, WA.......... 1.0653 1.0131 Spokane, WA 7880 Springfield, IL...... 0.8654 0.9731 Menard, IL Sangamon, IL 7920 Springfield, MO...... 0.8555 0.9711 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA...... 1.0806 1.0161 Hampden, MA Hampshire, MA 8050 State College, PA.... 0.9122 0.9824 Centre, PA 8080 Steubenville-Weirton, 0.8637 0.9727 OH-WV (WV Hospitals) Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA.... 1.0785 1.0157 San Joaquin, CA 8140 Sumter, SC........... 0.7794 0.9559 Sumter, SC 8160 Syracuse, NY......... 0.9491 0.9898 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA........... 1.1611 1.0322 Pierce, WA 8240 Tallahassee, FL...... 0.8483 0.9697 Gadsden, FL Leon, FL 8280 Tampa-St. Petersburg- 0.8908 0.9782 Clearwater, FL...... Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 Terre Haute, IN...... 0.8498 0.9700 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR- 0.8319 0.9664 Texarkana, TX....... Miller, AR Bowie, TX 8400 Toledo, OH........... 0.9738 0.9948 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS........... 0.8914 0.9783 Shawnee, KS 8480 Trenton, NJ.......... 1.0383 1.0077 Mercer, NJ 8520 Tucson, AZ........... 0.8967 0.9793 Pima, AZ 8560 Tulsa, OK............ 0.8924 0.9785 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK [[Page 56073]] 8600 Tuscaloosa, AL....... 0.8171 0.9634 Tuscaloosa, AL 8640 Tyler, TX............ 0.9609 0.9922 Smith, TX 8680 Utica-Rome, NY....... 0.8311 0.9662 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield- 1.3563 1.0713 Napa, CA............ Napa, CA Solano, CA 8735 Ventura, CA.......... 1.0996 1.0199 Ventura, CA 8750 Victoria, TX......... 0.8328 0.9666 Victoria, TX 8760 Vineland-Millville- 1.0441 1.0088 Bridgeton, NJ....... Cumberland, NJ 8780 Visalia-Tulare- 0.9610 0.9922 Porterville, CA..... Tulare, CA 8800 Waco, TX............. 0.8110 0.9622 McLennan, TX 8840 Washington, DC-MD-VA- 1.0962 1.0192 WV.................. District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpeper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920 Waterloo-Cedar Falls, 0.7980 0.9596 IA.................. Black Hawk, IA 8940 Wausau, WI........... 0.9702 0.9940 Marathon, WI 8960 West Palm Beach-Boca 0.9778 0.9956 Raton, FL........... Palm Beach, FL 9000 Wheeling, WV-OH...... 0.7940 0.9588 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS.......... 0.9545 0.9909 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX.... 0.7867 0.9573 Archer, TX Wichita, TX 9140 Williamsport, PA..... 0.8497 0.9699 Lycoming, PA 9160 Wilmington-Newark, DE- 1.0804 1.0161 MD.................. New Castle, DE Cecil, MD 9200 Wilmington, NC....... 0.9408 0.9882 New Hanover, NC Brunswick, NC 9260 Yakima, WA........... 1.0575 1.0115 [[Page 56074]] Yakima, WA 9270 Yolo, CA............. 0.9696 0.9939 Yolo, CA 9280 York, PA............. 0.9372 0.9874 York, PA 9320 Youngstown-Warren, OH 0.9549 0.9910 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA........ 1.0359 1.0072 Sutter, CA Yuba, CA 9360 Yuma, AZ............. 0.8989 0.9798 Yuma, AZ ------------------------------------------------------------------------ \1\ Pre-reclassification wage index from FY 2002 based on fiscal year 1998 audited inpatient acute-care hospital wage data that excludes wages for services provided by teaching physicians, interns and residents, and non-physician anesthetists under Part B of the Medicare program. \2\ One-fifth of the full wage index value. For example, for a LTCH located in Chicago, Illinois (MSA 1600) in FY 2003, the \1/5\ of the wage index is computed as 5.1008/5 = 1.0202. For further details, see section X.J.1. of this final rule. [[Page 56075]] Table 2.--Long-Term Care Hospital Wage Index for Rural Areas ------------------------------------------------------------------------ Full wage \1/5\ wage Nonurban area index \1\ index \2\ ------------------------------------------------------------------------ Alabama......................................... 0.7332 0.9466 Alaska.......................................... 1.1853 1.0371 Arizona......................................... 0.8675 0.9735 Arkansas........................................ 0.7488 0.9498 California...................................... 0.9772 0.9954 Colorado........................................ 0.8807 0.9761 Connecticut..................................... 1.2077 1.0415 Delaware........................................ 0.9581 0.9916 Florida......................................... 0.8812 0.9762 Georgia......................................... 0.8288 0.9658 Hawaii.......................................... 1.1110 1.0222 Idaho........................................... 0.8702 0.9740 Illinois........................................ 0.8049 0.9610 Indiana......................................... 0.8720 0.9744 Iowa............................................ 0.8124 0.9625 Kansas.......................................... 0.7754 0.9551 Kentucky........................................ 0.7958 0.9592 Louisiana....................................... 0.7596 0.9519 Maine........................................... 0.8716 0.9743 Maryland........................................ 0.8859 0.9772 Massachusetts................................... 1.1454 1.0291 Michigan........................................ 0.9004 0.9801 Minnesota....................................... 0.9017 0.9803 Mississippi..................................... 0.7522 0.9504 Missouri........................................ 0.7772 0.9554 Montana......................................... 0.8649 0.9730 Nebraska........................................ 0.8111 0.9622 Nevada.......................................... 0.9671 0.9934 New Hampshire................................... 0.9736 0.9947 New Jersey \3\.................................. .......... .......... New Mexico...................................... 0.8673 0.9735 New York........................................ 0.8515 0.9703 North Carolina.................................. 0.8536 0.9707 North Dakota.................................... 0.7856 0.9571 Ohio............................................ 0.8664 0.9733 Oklahoma........................................ 0.7565 0.9513 Oregon.......................................... 1.0014 1.0003 Pennsylvania.................................... 0.8587 0.9717 Puerto Rico..................................... 0.4797 0.8959 Rhode Island \3\................................ .......... .......... South Carolina.................................. 0.8510 0.9702 South Dakota.................................... 0.7845 0.9569 Tennessee....................................... 0.7928 0.9586 Texas........................................... 0.7705 0.9541 Utah............................................ 0.9041 0.9808 Vermont......................................... 0.9462 0.9892 Virginia........................................ 0.8236 0.9647 Washington...................................... 1.0200 1.0040 West Virginia................................... 0.8047 0.9609 Wisconsin....................................... 0.9069 0.9814 Wyoming......................................... 0.8736 0.9747 ------------------------------------------------------------------------ \1\ Pre-reclassification wage index from FY 2002 based on fiscal year 1998 audited inpatient acute-care hospital wage data that excludes wages for services provided by teaching physicians, interns and residents, and non-physician anesthetists under Part B of the Medicare program. \2\ One-fifth of the full wage index value. For example, for a LTCH located in rural Arizona in FY 2003, the \1/5\ of the wage index is computed as 4.8675/5 = 0.9735. For further details, see section X.J.1 of this final rule. \3\ All counties within the State are classified as urban. [[Page 56076]] Table 3.--LTC-DRG Relative Weights and Arithmetic Mean Length of Stay ---------------------------------------------------------------------------------------------------------------- Geo-metric LTC-DRG Description Relative mean length of FY 2001 LTCH weight stay cases ---------------------------------------------------------------------------------------------------------------- 1............................. CRANIOTOMY AGE17 W 1.8783 46.3 8 CC \5\. 2............................. CRANIOTOMY AGE 17 W/O 1.8783 46.3 1 CC \5\. 3............................. CRANIOTOMY AGE 0-17 *........... 1.8783 46.3 0 4............................. SPINAL PROCEDURES \4\........... 1.2493 31.3 16 5............................. EXTRACRANIAL VASCULAR PROCEDURES 1.2493 31.3 5 \4\. 6............................. CARPAL TUNNEL RELEASE *......... 0.4055 16.8 0 7............................. PERIPH & CRANIAL NERVE & OTHER 1.7829 43.8 97 NERV SYST PROC W CC. 8............................. PERIPH & CRANIAL NERVE & OTHER 1.2493 31.3 5 NERV SYST PROC W/O CC \4\. 9............................. SPINAL DISORDERS & INJURIES..... 1.4118 34.6 130 10............................ NERVOUS SYSTEM NEOPLASMS W CC 0.8537 24.5 102 \7\. 11............................ NERVOUS SYSTEM NEOPLASMS W/O CC 0.8537 24.5 26 \7\. 12............................ DEGENERATIVE NERVOUS SYSTEM 0.7773 27.1 1,577 DISORDERS. 13............................ MULTIPLE SCLEROSIS & CEREBELLAR 0.7207 25.6 89 ATAXIA. 14............................ INTERCRANIAL HEMORRHAGE & STROKE 0.8816 26.6 1,198 W INFARCT. 15............................ NONSPECIFIC CVA & PRECEREBRAL 0.9053 29.4 1,627 OCCULUSION W/O INFARCT. 16............................ NONSPECIFIC CEREBROVASCULAR 0.8864 27.0 120 DISORDERS W CC. 17............................ NONSPECIFIC CEREBROVASCULAR 0.6655 21.9 21 DISORDERS W/O CC \2\. 18............................ CRANIAL & PERIPHERAL NERVE 0.7770 24.9 133 DISORDERS W CC. 19............................ CRANIAL & PERIPHERAL NERVE 0.5486 22.0 43 DISORDERS W/O CC. 20............................ NERVOUS SYSTEM INFECTION EXCEPT 1.2331 29.3 163 VIRAL MENINGITIS. 21............................ VIRAL MENINGITIS \1\............ 0.4055 16.8 7 22............................ HYPERTENSIVE ENCEPHALOPATHY \2\. 0.6655 21.9 4 23............................ NONTRAUMATIC STUPOR & COMA...... 0.9623 27.2 85 24............................ SEIZURE & HEADACHE AGE 17 W CC. 25............................ SEIZURE & HEADACHE AGE 17 W/O CC. 26............................ SEIZURE & HEADACHE AGE 0-17 *... 0.4055 16.8 0 27............................ TRAUMATIC STUPOR & COMA, COMA 1.1126 31.6 31 1 HR. 28............................ TRAUMATIC STUPOR & COMA, COMA <1 1.1507 29.0 134 HR AGE 17 W CC. 29............................ TRAUMATIC STUPOR & COMA, COMA <1 0.9268 27.2 65 HR AGE 17 W/O CC. 30............................ TRAUMATIC STUPOR & COMA, COMA <1 0.8284 23.3 0 HR AGE 0-17 *. 31............................ CONCUSSION AGE 17 W 0.6655 21.9 4 CC \2\. 32............................ CONCUSSION AGE 17 W/O 0.4055 16.8 0 CC *. 33............................ CONCUSSION AGE 0-17 *........... 0.4055 16.8 0 34............................ OTHER DISORDERS OF NERVOUS 0.8385 25.1 394 SYSTEM W CC. 35............................ OTHER DISORDERS OF NERVOUS 0.6561 25.3 189 SYSTEM W/O CC. 36............................ RETINAL PROCEDURES *............ 0.4055 16.8 0 37............................ ORBITAL PROCEDURES *............ 0.4055 16.8 0 38............................ PRIMARY IRIS PROCEDURES *....... 0.4055 16.8 0 39............................ LENS PROCEDURES WITH OR WITHOUT 0.4055 16.8 0 VITRECTOMY *. 40............................ EXTRAOCULAR PROCEDURES EXCEPT 0.4055 16.8 0 ORBIT AGE 17 *. 41............................ EXTRAOCULAR PROCEDURES EXCEPT 0.4055 16.8 0 ORBIT AGE 0-17 *. 42............................ INTRAOCULAR PROCEDURES EXCEPT 0.4055 16.8 0 RETINA, IRIS & LENS *. 43............................ HYPHEMA \3\..................... 0.8284 23.3 2 44............................ ACUTE MAJOR EYE INFECTIONS \2\.. 0.6655 21.9 5 45............................ NEUROLOGICAL EYE DISORDERS \1\.. 0.4055 16.8 2 46............................ OTHER DISORDERS OF THE EYE AGE 0.6655 21.9 14 17 W CC \2\. 47............................ OTHER DISORDERS OF THE EYE AGE 0.4055 16.8 3 17 W/O CC \1\. 48............................ OTHER DISORDERS OF THE EYE AGE 0- 0.4055 16.8 0 17 *. 49............................ MAJOR HEAD & NECK PROCEDURES *.. 1.8783 46.3 0 50............................ SIALOADENECTOMY *............... 0.6655 21.9 0 51............................ *............................... 0.6655 21.9 0 52............................ CLEFT LIP & PALATE REPAIR *..... 0.6655 21.9 0 53............................ SINUS & MASTOID PROCEDURES AGE 0.6655 21.9 0 17 *. 54............................ SINUS & MASTOID PROCEDURES AGE 0- 0.6655 21.9 0 17 *. 55............................ MISCELLANEOUS EAR, NOSE, MOUTH & 0.6655 21.9 1 THROAT PROCEDURES \2\. 56............................ RHINOPLASTY *................... 0.6655 21.9 0 57............................ T&A PROC, EXCEPT TONSILLECTOMY &/ 0.6655 21.9 0 OR ADENOIDECTOMY ONLY, AGE 17 *. 58............................ T&A PROC, EXCEPT TONSILLECTOMY &/ 0.6655 21.9 0 OR ADENOIDECTOMY ONLY, AGE 0-17 *. 59............................ TONSILLECTOMY &/OR ADENOIDECTOMY 0.6655 21.9 0 ONLY, AGE 17 *. 60............................ TONSILLECTOMY &/OR ADENOIDECTOMY 0.6655 21.9 0 ONLY, AGE 0-17 *. 61............................ MYRINGOTOMY W TUBE INSERTION AGE 1.8783 46.3 1 17 \5\. 62............................ MYRINGOTOMY W TUBE INSERTION AGE 0.6655 21.9 0 0-17 *. 63............................ OTHER EAR, NOSE, MOUTH & THROAT 1.8783 46.3 1 O.R. PROCEDURES \5\. 64............................ EAR, NOSE, MOUTH & THROAT 1.0447 25.5 111 MALIGNANCY. 65............................ DYSEQUILIBRIUM.................. 0.5056 19.8 25 66............................ EPISTAXIS \1\................... 0.4055 16.8 3 67............................ EPIGLOTTITIS \1\................ 0.4055 16.8 1 68............................ OTITIS MEDIA & URI AGE >17 W 0.8284 23.3 14 CC \3\. [[Page 56077]] 69............................ OTITIS MEDIA & URI AGE >17 W/ 0.8284 23.3 8 O CC \3\. 70............................ OTITIS MEDIA & URI AGE 0-17 *... 0.4055 16.8 0 71............................ LARYNGOTRACHEITIS *............. 0.4055 16.8 0 72............................ NASAL TRAUMA & DEFORMITY \1\.... 0.4055 16.8 2 73............................ OTHER EAR, NOSE, MOUTH & THROAT 0.8097 23.7 29 DIAGNOSES AGE 17. 74............................ OTHER EAR, NOSE, MOUTH & THROAT 0.4055 16.8 0 DIAGNOSES AGE 0-17 *. 75............................ MAJOR CHEST PROCEDURES \5\...... 1.8783 46.3 13 76............................ OTHER RESP SYSTEM O.R. 2.7674 50.6 522 PROCEDURES W CC. 77............................ OTHER RESP SYSTEM O.R. 1.8783 46.3 14 PROCEDURES W/O CC \5\. 78............................ PULMONARY EMBOLISM.............. 0.6348 20.5 96 79............................ RESPIRATORY INFECTIONS & 0.8916 22.2 1,134 INFLAMMATIONS AGE 17 W CC. 80............................ RESPIRATORY INFECTIONS & 0.7947 22.8 123 INFLAMMATIONS AGE 17 W/O CC. 81............................ RESPIRATORY INFECTIONS & 0.4055 16.8 0 INFLAMMATIONS AGE 0-17 *. 82............................ RESPIRATORY NEOPLASMS........... 0.7976 20.9 402 83............................ MAJOR CHEST TRAUMA W CC......... 0.7384 24.8 25 84............................ MAJOR CHEST TRAUMA W/O CC \1\... 0.4055 16.8 6 85............................ PLEURAL EFFUSION W CC........... 0.8207 23.6 163 86............................ PLEURAL EFFUSION W/O CC......... 0.6194 21.1 23 87............................ PULMONARY EDEMA & RESPIRATORY 1.6597 32.3 3,875 FAILURE. 88............................ CHRONIC OBSTRUCTIVE PULMONARY 0.7532 20.9 3,412 DISEASE. 89............................ SIMPLE PNEUMONIA & PLEURISY AGE 0.8533 23.6 2,654 17 W CC. 90............................ SIMPLE PNEUMONIA & PLEURISY AGE 0.7921 23.0 318 17 W/O CC. 91............................ SIMPLE PNEUMONIA & PLEURISY AGE 0.8284 23.3 0 0-17 *. 92............................ INTERSTITIAL LUNG DISEASE W CC.. 0.7251 19.1 135 93............................ INTERSTITIAL LUNG DISEASE W/O CC 0.5573 18.5 29 94............................ PNEUMOTHORAX W CC............... 0.7885 22.7 41 95............................ PNEUMOTHORAX W/O CC \1\......... 0.4055 16.8 7 96............................ BRONCHITIS & ASTHMA AGE 17 W CC. 97............................ BRONCHITIS & ASTHMA AGE 17 W/O CC. 98............................ BRONCHITIS & ASTHMA AGE 0-17 *.. 0.4055 16.8 0 99............................ RESPIRATORY SIGNS & SYMPTOMS W 1.1164 27.3 705 CC. 100........................... RESPIRATORY SIGNS & SYMPTOMS W/O 1.0015 25.4 77 CC. 101........................... OTHER RESPIRATORY SYSTEM 0.9763 23.4 177 DIAGNOSES W CC. 102........................... OTHER RESPIRATORY SYSTEM 0.9313 24.5 28 DIAGNOSES W/O CC. 103........................... HEART TRANSPLANT \6\............ 0.0000 0.0 0 104........................... CARDIAC VALVE & OTHER MAJOR 1.8783 46.3 0 CARDIOTHORACIC PROC W CARDIAC CATH *. 105........................... CARDIAC VALVE & OTHER MAJOR 1.8783 46.3 0 CARDIOTHORACIC PROC W/O CARDIAC CATH *. 106........................... CORONARY BYPASS W PTCA *........ 1.8783 46.3 0 107........................... CORONARY BYPASS W CARDIAC CATH * 1.8783 46.3 0 108........................... OTHER CARDIOTHORACIC PROCEDURES 0.6655 21.9 1 \2\. 109........................... CORONARY BYPASS W/O PTCA OR 1.8783 46.3 0 CARDIAC CATH *. 110........................... MAJOR CARDIOVASCULAR PROCEDURES 1.8783 46.3 5 W CC \5\. 111........................... MAJOR CARDIOVASCULAR PROCEDURES 1.8783 46.3 1 W/O CC \5\. 113........................... AMPUTATION FOR CIRC SYSTEM 1.4103 36.9 92 DISORDERS EXCEPT UPPER LIMB & TOE. 114........................... UPPER LIMB & TOE AMPUTATION FOR 1.3377 40.2 32 CIRC SYSTEM DISORDERS. 115........................... PRM CARD PACEM IMPL W AMI,HRT 1.8783 46.3 3 FAIL OR SHK,OR AICD LEAD OR GNRTR P \5\. 116........................... OTH PERM CARD PACEMAK IMPL OR 0.8284 23.3 4 PTCA W CORONARY ARTERY STENT IMPLNT \3\. 117........................... CARDIAC PACEMAKER REVISION 0.4055 16.8 0 EXCEPT DEVICE REPLACEMENT *. 118........................... CARDIAC PACEMAKER DEVICE 0.4055 16.8 2 REPLACEMENT \1\. 119........................... VEIN LIGATION & STRIPPING *..... 0.6655 21.9 0 120........................... OTHER CIRCULATORY SYSTEM O.R. 1.4091 36.4 174 PROCEDURES. 121........................... CIRCULATORY DISORDERS W AMI & 0.7167 21.6 196 MAJOR COMP, DISCHARGED ALIVE. 122........................... CIRCULATORY DISORDERS W AMI W/O 0.5144 19.0 51 MAJOR COMP, DISCHARGED ALIVE. 123........................... CIRCULATORY DISORDERS W AMI, 0.9412 20.9 36 EXPIRED. 124........................... CIRCULATORY DISORDERS EXCEPT 0.8284 23.3 5 AMI, W CARD CATH & COMPLEX DIAG \3\. 125........................... CIRCULATORY DISORDERS EXCEPT 1.8783 46.3 3 AMI, W CARD CATH W/O COMPLEX DIAG \5\. 126........................... ACUTE & SUBACUTE ENDOCARDITIS... 0.7689 24.8 148 127........................... HEART FAILURE & SHOCK........... 0.7616 22.4 2,324 128........................... DEEP VEIN THROMBOPHLEBITIS...... 0.6042 20.8 29 129........................... CARDIAC ARREST, UNEXPLAINED..... 1.0534 20.9 22 130........................... PERIPHERAL VASCULAR DISORDERS W 0.7914 24.8 1,061 CC. 131........................... PERIPHERAL VASCULAR DISORDERS W/ 0.7081 23.7 178 O CC. [[Page 56078]] 132........................... ATHEROSCLEROSIS W CC............ 0.8183 21.8 645 133........................... ATHEROSCLEROSIS W/O CC.......... 0.5484 18.5 126 134........................... HYPERTENSION.................... 0.6985 24.0 123 135........................... CARDIAC CONGENITAL & VALVULAR 0.7331 20.3 169 DISORDERS AGE 17 W CC. 136........................... CARDIAC CONGENITAL & VALVULAR 0.7075 21.0 24 DISORDERS AGE 17 W/O CC. 137........................... CARDIAC CONGENITAL & VALVULAR 0.6655 21.9 0 DISORDERS AGE 0-17 *. 138........................... CARDIAC ARRHYTHMIA & CONDUCTION 0.7187 23.4 295 DISORDERS W CC. 139........................... CARDIAC ARRHYTHMIA & CONDUCTION 0.6482 20.4 54 DISORDERS W/O CC. 140........................... ANGINA PECTORIS................. 0.7690 20.1 52 141........................... SYNCOPE & COLLAPSE W CC......... 0.6252 23.2 101 142........................... SYNCOPE & COLLAPSE W/O CC....... 0.5452 21.5 41 143........................... CHEST PAIN...................... 0.7316 22.7 41 144........................... OTHER CIRCULATORY SYSTEM 0.7870 21.9 551 DIAGNOSES W CC. 145........................... OTHER CIRCULATORY SYSTEM 0.7637 25.0 66 DIAGNOSES W/O CC. 146........................... RECTAL RESECTION W CC \4\....... 1.2493 31.3 1 147........................... RECTAL RESECTION W/O CC *....... 1.2493 31.3 0 148........................... MAJOR SMALL & LARGE BOWEL 2.8488 47.6 20 PROCEDURES W CC. 149........................... MAJOR SMALL & LARGE BOWEL 0.6655 21.9 3 PROCEDURES W/O CC \2\. 150........................... PERITONEAL ADHESIOLYSIS W CC \1\ 0.4055 16.8 1 151........................... PERITONEAL ADHESIOLYSIS W/O CC * 0.4055 16.8 0 152........................... MINOR SMALL & LARGE BOWEL 1.2493 31.3 1 PROCEDURES W CC \4\. 153........................... MINOR SMALL & LARGE BOWEL 0.8284 23.3 0 PROCEDURES W/O CC *. 154........................... STOMACH, ESOPHAGEAL & DUODENAL 1.2493 31.3 7 PROCEDURES AGE 17 W CC \4\. 155........................... STOMACH, ESOPHAGEAL & DUODENAL 0.8284 23.3 0 PROCEDURES AGE 17 W/ O CC *. 156........................... STOMACH, ESOPHAGEAL & DUODENAL 0.8284 23.3 0 PROCEDURES AGE 0-17 *. 157........................... ANAL & STOMAL PROCEDURES W CC 0.4055 16.8 1 \1\. 158........................... ANAL & STOMAL PROCEDURES W/O CC 0.4055 16.8 0 *. 159........................... HERNIA PROCEDURES EXCEPT 1.2493 31.3 2 INGUINAL & FEMORAL AGE 17 W CC \4\. 160........................... HERNIA PROCEDURES EXCEPT 0.6655 21.9 0 INGUINAL & FEMORAL AGE 17 W/O CC *. 161........................... INGUINAL & FEMORAL HERNIA 0.6655 21.9 0 PROCEDURES AGE 17 W CC *. 162........................... INGUINAL & FEMORAL HERNIA 0.6655 21.9 0 PROCEDURES AGE 17 W/ O CC *. 163........................... HERNIA PROCEDURES AGE 0-17 *.... 0.6655 21.9 0 164........................... APPENDECTOMY W COMPLICATED 0.8284 23.3 0 PRINCIPAL DIAG W CC *. 165........................... APPENDECTOMY W COMPLICATED 0.8284 23.3 0 PRINCIPAL DIAG W/O CC *. 166........................... APPENDECTOMY W/O COMPLICATED 0.6655 21.9 0 PRINCIPAL DIAG W CC *. 167........................... APPENDECTOMY W/O COMPLICATED 0.6655 21.9 0 PRINCIPAL DIAG W/O CC *. 168........................... MOUTH PROCEDURES W CC \3\....... 0.8284 23.3 1 169........................... MOUTH PROCEDURES W/O CC *....... 0.6655 21.9 0 170........................... OTHER DIGESTIVE SYSTEM O.R. 1.5543 35.0 40 PROCEDURES W CC. 171........................... OTHER DIGESTIVE SYSTEM O.R. 0.8284 23.3 1 PROCEDURES W/O CC \3\. 172........................... DIGESTIVE MALIGNANCY W CC....... 0.8553 24.2 335 173........................... DIGESTIVE MALIGNANCY W/O CC..... 0.5513 18.9 55 174........................... G.I. HEMORRHAGE W CC............ 0.8741 23.6 258 175........................... G.I. HEMORRHAGE W/O CC.......... 0.8359 25.6 35 176........................... COMPLICATED PEPTIC ULCER........ 0.7661 24.4 37 177........................... UNCOMPLICATED PEPTIC ULCER W CC 0.8284 23.3 14 \3\. 178........................... UNCOMPLICATED PEPTIC ULCER W/O 0.6655 21.9 6 CC \2\. 179........................... INFLAMMATORY BOWEL DISEASE...... 1.0975 23.4 45 180........................... G.I. OBSTRUCTION W CC........... 0.8457 22.8 193 181........................... G.I. OBSTRUCTION W/O CC......... 0.5638 19.5 20 182........................... ESOPHAGITIS, GASTROENT & MISC 0.8829 25.9 436 DIGEST DISORDERS AGE 17 W CC. 183........................... ESOPHAGITIS, GASTROENT & MISC 0.6913 21.5 66 DIGEST DISORDERS AGE 17 W/O CC. 184........................... ESOPHAGITIS, GASTROENT & MISC 0.6655 21.9 0 DIGEST DISORDERS AGE 0-17 *. 185........................... DENTAL & ORAL DIS EXCEPT 0.8284 23.3 20 EXTRACTIONS & RESTORATIONS, AGE 17 \3\. 186........................... DENTAL & ORAL DIS EXCEPT 0.8284 23.3 0 EXTRACTIONS & RESTORATIONS, AGE 0-17 *. 187........................... DENTAL EXTRACTIONS & 0.8284 23.3 0 RESTORATIONS *. 188........................... OTHER DIGESTIVE SYSTEM DIAGNOSES 1.0490 24.2 481 AGE 17 W CC. 189........................... OTHER DIGESTIVE SYSTEM DIAGNOSES 0.5852 17.4 48 AGE 17 W/O CC. 190........................... OTHER DIGESTIVE SYSTEM DIAGNOSES 0.6655 21.9 0 AGE 0-17 *. 191........................... PANCREAS, LIVER & SHUNT 1.8783 46.3 5 PROCEDURES W CC \5\. 192........................... PANCREAS, LIVER & SHUNT 1.2493 31.3 0 PROCEDURES W/O CC *. 193........................... BILIARY TRACT PROC EXCEPT ONLY 1.2493 31.3 1 CHOLECYST W OR W/O C.D.E. W CC \4\. 194........................... BILIARY TRACT PROC EXCEPT ONLY 0.8284 23.3 0 CHOLECYST W OR W/O C.D.E. W/O CC *. [[Page 56079]] 195........................... CHOLECYSTECTOMY W C.D.E. W CC *. 0.8284 23.3 0 196........................... CHOLECYSTECTOMY W C.D.E. W/O CC 0.8284 23.3 0 *. 197........................... CHOLECYSTECTOMY EXCEPT BY 1.8783 46.3 2 LAPAROSCOPE W/O C.D.E. W CC \5\. 198........................... CHOLECYSTECTOMY EXCEPT BY 1.8783 46.3 2 LAPAROSCOPE W/O C.D.E. W/O CC \5\. 199........................... HEPATOBILIARY DIAGNOSTIC 0.8284 23.3 1 PROCEDURE FOR MALIGNANCY \3\. 200........................... HEPATOBILIARY DIAGNOSTIC 1.2493 31.3 3 PROCEDURE FOR NON-MALIGNANCY \4\. 201........................... OTHER HEPATOBILIARY OR PANCREAS 1.8783 46.3 5 O.R. PROCEDURES \5\. 202........................... CIRRHOSIS & ALCOHOLIC HEPATITIS. 0.5736 18.4 64 203........................... MALIGNANCY OF HEPATOBILIARY 0.5897 18.2 88 SYSTEM OR PANCREAS. 204........................... DISORDERS OF PANCREAS EXCEPT 0.9444 22.1 169 MALIGNANCY. 205........................... DISORDERS OF LIVER EXCEPT 0.6825 21.5 85 MALIG,CIRR,ALC HEPA W CC. 206........................... DISORDERS OF LIVER EXCEPT 0.6655 21.9 13 MALIG,CIRR,ALC HEPA W/O CC \2\. 207........................... DISORDERS OF THE BILIARY TRACT W 0.6979 21.5 78 CC. 208........................... DISORDERS OF THE BILIARY TRACT W/ 0.4055 16.8 20 O CC \1\. 209........................... MAJOR JOINT & LIMB REATTACHMENT 1.8783 46.3 4 PROCEDURES OF LOWER EXTREMITY \5\. 210........................... HIP & FEMUR PROCEDURES EXCEPT 1.2493 31.3 12 MAJOR JOINT AGE 17 W CC \4\. 211........................... HIP & FEMUR PROCEDURES EXCEPT 0.8284 23.3 0 MAJOR JOINT AGE 17 W/ O CC *. 212........................... HIP & FEMUR PROCEDURES EXCEPT 0.8284 23.3 0 MAJOR JOINT AGE 0-17 *. 213........................... AMPUTATION FOR MUSCULOSKELETAL 1.2591 33.0 32 SYSTEM & CONN TISSUE DISORDERS. 216........................... BIOPSIES OF MUSCULOSKELETAL 1.2493 31.3 8 SYSTEM & CONNECTIVE TISSUE \4\. 217........................... WND DEBRID & SKN GRFT EXCEPT 1.3602 38.8 203 HAND,FOR MUSCSKELET & CONN TISS DIS. 218........................... LOWER EXTREM & HUMER PROC EXCEPT 0.8284 23.3 4 HIP,FOOT,FEMUR AGE 17 W CC \3\. 219........................... LOWER EXTREM & HUMER PROC EXCEPT 0.8284 23.3 0 HIP,FOOT,FEMUR AGE 17 W/O CC *. 220........................... LOWER EXTREM & HUMER PROC EXCEPT 0.8284 23.3 0 HIP,FOOT,FEMUR AGE 0-17 *. 223........................... MAJOR SHOULDER/ELBOW PROC, OR 1.2493 31.3 1 OTHER UPPER EXTREMITY PROC W CC \4\. 224........................... SHOULDER,ELBOW OR FOREARM 0.4055 16.8 1 PROC,EXC MAJOR JOINT PROC, W/O CC \1\. 225........................... FOOT PROCEDURES \4\............. 1.2493 31.3 23 226........................... SOFT TISSUE PROCEDURES W CC \4\. 1.2493 31.3 8 227........................... SOFT TISSUE PROCEDURES W/O CC 0.8284 23.3 2 \3\. 228........................... MAJOR THUMB OR JOINT PROC,OR OTH 0.6655 21.9 0 HAND OR WRIST PROC W CC *. 229........................... HAND OR WRIST PROC, EXCEPT MAJOR 0.6655 21.9 1 JOINT PROC, W/O CC \2\. 230........................... LOCAL EXCISION & REMOVAL OF INT 0.4055 16.8 1 FIX DEVICES OF HIP & FEMUR \1\. 231........................... LOCAL EXCISION & REMOVAL OF INT 1.8783 46.3 9 FIX DEVICES EXCEPT HIP & FEMUR \5\. 232........................... ARTHROSCOPY *................... 0.4055 16.8 0 233........................... OTHER MUSCULOSKELET SYS & CONN 1.2493 31.3 23 TISS O.R. PROC W CC \4\. 234........................... OTHER MUSCULOSKELET SYS & CONN 0.4055 16.8 2 TISS O.R. PROC W/O CC \1\. 235........................... FRACTURES OF FEMUR.............. 0.7540 28.5 167 236........................... FRACTURES OF HIP & PELVIS....... 0.7381 27.2 1,451 237........................... SPRAINS, STRAINS, & DISLOCATIONS 0.6655 21.9 15 OF HIP, PELVIS & THIGH \2\. 238........................... OSTEOMYELITIS................... 0.8275 27.5 947 239........................... PATHOLOGICAL FRACTURES & 0.6689 21.9 199 MUSCULOSKELETAL & CONN TISS MALIGNANCY. 240........................... CONNECTIVE TISSUE DISORDERS W CC 0.9260 26.0 100 241........................... CONNECTIVE TISSUE DISORDERS W/O 0.5805 22.7 40 CC. 242........................... SEPTIC ARTHRITIS................ 0.7725 26.3 174 243........................... MEDICAL BACK PROBLEMS........... 0.6596 23.4 765 244........................... BONE DISEASES & SPECIFIC 0.5756 20.6 337 ARTHROPATHIES W CC. 245........................... BONE DISEASES & SPECIFIC 0.4426 17.5 376 ARTHROPATHIES W/O CC. 246........................... NON-SPECIFIC ARTHROPATHIES...... 0.6053 21.4 45 247........................... SIGNS & SYMPTOMS OF 0.5590 20.4 324 MUSCULOSKELETAL SYSTEM & CONN TISSUE. 248........................... TENDONITIS, MYOSITIS & BURSITIS. 0.7288 23.9 277 249........................... AFTERCARE, MUSCULOSKELETAL 0.8005 27.1 348 SYSTEM & CONNECTIVE TISSUE. 250........................... FX, SPRN, STRN & DISL OF 0.8373 31.8 120 FOREARM, HAND, FOOT AGE 17 W CC. 251........................... FX, SPRN, STRN & DISL OF 0.6904 26.0 55 FOREARM, HAND, FOOT AGE 17 W/O CC. 252........................... FX, SPRN, STRN & DISL OF 0.4055 16.8 0 FOREARM, HAND, FOOT AGE 0-17 *. 253........................... FX, SPRN, STRN & DISL OF 0.8054 28.0 225 UPARM,LOWLEG EX FOOT AGE 17 W CC. 254........................... FX, SPRN, STRN & DISL OF 0.6999 26.4 118 UPARM,LOWLEG EX FOOT AGE 17 W/O CC. 255........................... FX, SPRN, STRN & DISL OF 0.4055 16.8 0 UPARM,LOWLEG EX FOOT AGE 0-17 *. 256........................... OTHER MUSCULOSKELETAL SYSTEM & 0.8002 25.1 240 CONNECTIVE TISSUE DIAGNOSES. 257........................... TOTAL MASTECTOMY FOR MALIGNANCY 0.6655 21.9 3 W CC \2\. 258........................... TOTAL MASTECTOMY FOR MALIGNANCY 0.6655 21.9 0 W/O CC *. [[Page 56080]] 259........................... SUBTOTAL MASTECTOMY FOR 0.6655 21.9 0 MALIGNANCY W CC *. 260........................... SUBTOTAL MASTECTOMY FOR 0.6655 21.9 0 MALIGNANCY W/O CC *. 261........................... BREAST PROC FOR NON-MALIGNANCY 0.4055 16.8 0 EXCEPT BIOPSY & LOCAL EXCISION *. 262........................... BREAST BIOPSY & LOCAL EXCISION 0.4055 16.8 1 FOR NON-MALIGNANCY \1\. 263........................... SKIN GRAFT &/OR DEBRID FOR SKN 1.5388 45.0 1,093 ULCER OR CELLULITIS W CC. 264........................... SKIN GRAFT &/OR DEBRID FOR SKN 1.1645 38.8 115 ULCER OR CELLULITIS W/O CC. 265........................... SKIN GRAFT &/OR DEBRID EXCEPT 1.6569 45.6 29 FOR SKIN ULCER OR CELLULITIS W CC. 266........................... SKIN GRAFT &/OR DEBRID EXCEPT 0.8284 23.3 5 FOR SKIN ULCER OR CELLULITIS W/ O CC \3\. 267........................... PERIANAL & PILONIDAL PROCEDURES 0.4055 16.8 0 *. 268........................... SKIN, SUBCUTANEOUS TISSUE & 1.2493 31.3 5 BREAST PLASTIC PROCEDURES \4\. 269........................... OTHER SKIN, SUBCUT TISS & BREAST 1.3915 41.7 209 PROC W CC. 270........................... OTHER SKIN, SUBCUT TISS & BREAST 1.3879 41.6 22 PROC W/O CC. 271........................... SKIN ULCERS..................... 0.9714 31.1 4,059 272........................... MAJOR SKIN DISORDERS W CC....... 0.6846 21.0 33 273........................... MAJOR SKIN DISORDERS W/O CC \2\. 0.665
