DRG MS-DRG Calculator · FY2026 · v43.1
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Inpatient Prospective Payment System · Real FY2026 rates

It agrees with CMS. To the dollar.

Group any inpatient claim, price it under the IPPS, and verify it live against the official CMS pricer — the authoritative source. Here is one real claim, priced three ways.

CMS pricer
$0.00
live · official Inpatient PPS
=
Third-party pricer
$0.00
independent Medicare DRG
This tool
$0.00
self-contained engine
Reconciled — Δ $0.54 · 0.006%
DRG 291 · Heart failure & shock w/ MCC Weight 1.2838 Saint Luke's South · CCN 170185
The proof

Every case tracks the authoritative pricer.

These are real claims run through our engine and cross-checked against CMS and a third-party pricer. Same DRG, same relative weight, totals within a rounding cent.

DRGCaseThis toolCMS / 3rd-partyMatch
291 Heart failure & shock with MCC · weight 1.2838 $8,616.85 $8,617.39 −$0.54
189 Pulmonary edema & respiratory failure cost outlier · weight 1.2354 $21,380.28 $21,380.45 −$0.17
208 Respiratory system dx w/ ventilator <96h cost outlier · $392,290 charges $23,394.34 $23,394.67 −$0.33
871 Septicemia / severe sepsis with MCC · weight 1.9425 $13,038.04 $13,038.86 −$0.82
195 Simple pneumonia & pleurisy without CC/MCC · weight 0.6285 $4,218.49 $4,218.75 −$0.26

The residual cents are input precision, not formula — CMS carries the provider's HRRP/VBP factors to more decimals than the published PSF. The operating base matches to the penny.

The pipeline

Group. Price. Verify.

Three moves take a coded claim to a payment you can defend — the last one is a live call to CMS, so you are never guessing.

01 · GROUP

ICD-10 → MS-DRG

A self-contained grouper on the CMS v43.1 tables — MDC, CC/MCC severity, surgical hierarchy.

A41.9 · sepsisprincipal
R65.21 · septic shockMCC
→ DRG 871w/ MCC
02 · PRICE

Full IPPS build

Operating + capital, wage index, IME & DSH, uncompensated care, and high-cost outliers.

Operating base$8,012.20
+ Capital / IME / DSH$623.10
+ Outlier (if any)$0.00
03 · VERIFY

Live vs CMS

One click prices the same claim through the official CMS pricer, side by side.

Our estimate$8,616.85
CMS pricer$8,617.39
VerdictMatches CMS ✓
The full toolkit

Every tab, one engine.

Eight ways into the same FY2026 pricing core — from a quick single-DRG estimate to a coded claim grouped, priced, and checked against the official pricer, live.

TAB 01

DRG Calculator

Pick an MS-DRG and a hospital: the full IPPS build — wage index, IME & DSH (each toggleable), capital, uncompensated care, outliers, transfer per-diems — plus the CC/MCC severity family so documentation gaps are visible.

Open →
TAB 02

Enhanced Search

Find any of 3,200+ IPPS hospitals by name, city, state, or CCN — or look up a provider by NPI, full or partial. Profiles benchmark the wage index against state and national averages.

Open →
TAB 03

Claim pricer

Paste a claim as JSON — our format or a structured export — and get the priced breakdown back, with a payment worksheet you can download as PDF or Excel.

Open →
TAB 04

Group only

ICD-10 diagnoses and procedures in, MS-DRG out — with the MDC, the medical/surgical path, and the exact CC or MCC that drove the severity flagged on every code.

Open →
TAB 05

Group & price

The whole pipeline in one shot: a coded claim is grouped to its MS-DRG and priced at the billing hospital in a single run.

Open →
LIVE
TAB 06

Verify vs CMS

The one nobody else has: any claim, priced by our engine and by CMS's own pricer in the same view — live, side by side, with a match verdict. $23,394.65 vs $23,394.67 on the sample case.

Compare a claim →
LIVE
TAB 07

Grouping Sandbox

The grouper as a glass box: toggle a diagnosis on or off and watch the real decision path re-run — MDC, medical vs surgical, CC/MCC screening — with the DRG and payment moving live. Includes a self-playing demo of two examples.

Play with it →
TAB 08

Integrations

Twelve connectors for core admin, contract modeling, and clearinghouse platforms — each with a working sandbox that groups and prices for real until credentials go live.

See connectors →
Why the DRG lands where it does

You can see what drives the severity.

Add a secondary diagnosis or an OR procedure and the grouper shows exactly which code moved the DRG — the CC/MCC that carries the weight is marked, with the base DRG range it selects within.

DRG 871 Severe sepsis · w/ MCC
base range 870–872
A41.9 — Sepsis, unspecified organismprincipal
R65.21 — Severe sepsis w/ septic shock ★MCC · driver
E11.9 — Type 2 diabetesno CC/MCC

Drop the MCC and the same claim falls to DRG 872 — a different weight, a different payment. This card is read-only; the live sandbox re-runs the real decision path — and the real dollars — as you toggle each code.

Integration-ready

The pricing engine, wired to the systems that consume it.

Twelve connectors for the platforms that price and adjudicate DRG claims — core admin, contract modeling, and clearinghouses. Each goes live on its own credentials; until then it runs a real sandbox that still groups and prices for real.

Core claim administration
Cognizant TriZetto
Facets
DRG pricingAdjudication
Cognizant TriZetto
QNXT
DRG pricingAdjudication
HealthEdge
HealthRules Payer
DRG pricingModeling
PLEXIS
Payer Platforms
DRG pricing
Epic
Tapestry
DRG pricingAdjudication
Oracle
Oracle Health (Cerner)
DRG pricingAdjudication
Contract pricing & modeling
Cognizant TriZetto
NetworX Pricer
DRG pricingModeling
Cognizant TriZetto
NetworX Modeler
Modeling
Optum
Claims Edit System
DRG pricing
Clearinghouses
Availity
Availity Essentials
EligibilityRemittance
Optum Insight
Change Healthcare
EligibilityRemittance
Waystar
Waystar
EligibilityRemittance
A live round-trip

Send a claim to NetworX, get both prices back.

Reference — our engine
DRG871 · w/ MCC
IPPS allowed$23,056.52
Grouperv43.1
Vendor — NetworX Pricer
ContractMOCK-IP-2026
Allowed amount$21,903.69
MethodologyDRG · 95% of IPPS

Bearer-authed POST over the connector framework; the vendor's reply is normalized alongside our reference. Point the URL at your tenant and it goes live — no code change.

Honest by design

Within 0.01% of CMS — and it tells you where it isn't.

The whole point is trust, so nothing is guessed. Where a case needs logic we haven't modeled yet, the tool flags it rather than inventing a number.

Known gap: the self-contained grouper doesn't yet read ventilator hours, so code-driven grouping tops out at DRG 189 instead of 207/208 — though pricing of 208 already matches CMS to $0.33 via DRG-in. Everything flagged, nothing faked.

Independent estimator built on real FY2026 IPPS reference data (CMS-1833-F) and the CMS MS-DRG v43.1 tables. Not affiliated with or endorsed by CMS or any payer/vendor; product names shown for integration reference only. Estimates are verified against CMS but are not a substitute for official adjudication.