The CMS policy timeline this engine tracks — final rules, grouper versions, code sets, quarterly edit files — alongside product releases. Regulatory dates are CMS effective/issue dates; product dates are when the feature shipped here.
Screen an outpatient claim through the official CMS edit files: 1.4M NCCI procedure-to-procedure pairs with modifier bypass (59/X{EPSU}), facility medically-unlikely unit limits with MAI levels, add-on-code primary checks, and OPPS status-indicator packaging — each finding tied to its OCE edit number, disposition, and CARC where one clearly matches.
The Group tabs gained a form entry mode: search 74,719 ICD-10-CM diagnoses and 79,115 ICD-10-PCS procedures by code or description (each diagnosis shows its CC/MCC level inline), set POA per diagnosis, and get HAC screening flags, per-code validation against the official FY2026 files, MDC titles, and a raw API response toggle.
Group claims under any MS-DRG manual from FY2022 to FY2026, matching the discharge date's version — the same version-picker workflow big groupers offer, backed by version-keyed reference tables.
Price NY Medicaid FFS discharges from the state-published datasets: 1,272 APR-DRG × severity service-intensity weights (grouper v34) and per-hospital rate factors for the 1/1/2025 period — SIW × case-payment rate plus IME, capital, DME, and ALC per-diems. APR-DRG assignment itself stays 3M-licensed; you supply the DRG.
One tab prices a procedure in both outpatient settings from the July 2026 rate tables — wage-adjusted, with the site-of-service differential — and adds a Medicaid EAPG mode that computes payer-factor payments (base rate × weight × units, less consolidation discounting).
The Verify tab prices the same claim through this engine and CMS's own Inpatient PPS pricer live, side by side. Five reference cases reconcile within a rounding cent, and the 60-second product film shows the whole engine end to end.
The July OPPS Addendum B and ASC Addendum AA quarterly updates take effect — the tables this calculator prices outpatient claims with — alongside the Q3 2026 NCCI PTP, MUE, and add-on-code edit files.
CMS's April update adds 80 new procedure codes effective for discharges on or after April 1, 2026 — largely new-technology procedures — with grouper logic updated for their OR/non-OR assignments. This engine's default version.
The CY2026 outpatient conversion factors take effect — OPPS $91.415 and ASC $56.322 — with the annual status-indicator and APC reshuffles, plus the Q1 2026 NCCI quarterly files.
CMS finalizes calendar-2026 hospital outpatient and ambulatory surgical center payment policy: conversion-factor updates, APC weight recalibration, covered-procedures list changes, and the site-of-service differential this calculator's outpatient module computes.
Fiscal-2026 begins: the v43 grouper, the annual ICD-10-CM/PCS updates, refreshed CC/MCC severity designations, and new relative weights all apply to discharges on or after October 1, 2025.
The inpatient rule this engine runs on: FY2026 standardized amounts, wage indices for 3,253 hospitals, IME/DSH factors, uncompensated-care amounts, and the $40,397 outlier fixed-loss threshold — every rate this calculator prices with.
April ICD-10-PCS additions land in the grouper for discharges on or after April 1, 2025 — the mid-year cadence CMS adopted for new-technology procedure codes.
CY2025 OPPS/ASC rates take effect, and NY Medicaid opens its 1/1/2025 inpatient APR-DRG rate period — the per-hospital case-payment rates and v34 weight table this calculator's NY Medicaid tab prices from.
Calendar-2025 outpatient policy: a ~2.9% payment update, APC recalibration, and continued site-neutrality debate — the annual rhythm of the outpatient rules this module tracks.
FY2025 brings the v42 grouper and the annual code update — 252 new ICD-10-CM diagnosis codes — with the usual severity-designation and relative-weight refresh for discharges on or after October 1, 2024.
A ~2.9% operating payment update, wage-index policy refinements, and new-technology add-on payment changes for fiscal 2025 inpatient discharges.
New April ICD-10-PCS procedure codes enter the grouper for discharges on or after April 1, 2024, continuing the twice-yearly code cadence.
FY2024 begins with the v41 grouper and one of the larger annual updates — 395 new ICD-10-CM diagnosis codes — applying to discharges on or after October 1, 2023.
A 3.1% operating payment update for fiscal 2024, plus wage-index and DSH policy changes — the oldest rule year in this engine's multi-version grouper range.
Regulatory entries summarize public CMS rulemaking and file releases with their official effective/issue dates; consult the Federal Register text for authoritative detail. Product entries are dated when the feature shipped on this site. Independent publication — not affiliated with or endorsed by CMS. © 2026 PayerParity.