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Minnesota Department of Labor and Industry

Workers' compensation -- PC Pricer tool for inpatient hospital bills

In 2015, Minnesota Statutes § 176.1362 was enacted to provide that the maximum pyament for most workers' compensation inpatient hospital services is 200 percent of the amount calculated under the Medicare diagnosis-related group (DRG) system, using Medicare's PC Pricer program.

Effective May 31, 2017, Minn. Stat. § 176.1362 was amended to identify the applicable PC Pricer program to be used to calculate payment for inpatient hospital services.

For hospital discharge dates from May 31 through Sept. 30, 2017:  The FY 2016.1 PC Pricer, updated Jan. 19, 2016, must be used to calculate the amount payable.

For hospital discharge dates on or after Oct. 1, 2017:  The FY 2017.0 PC Pricer, updated April 24, 2017, must be used to calculate the amount payable. (This is the PC Pricer program most recently available on the Medicare website as of July 1, 2017.)

No later than Oct. 1 of each subsequent year, the Department of Labor and Industry (DLI) must post on its website the version of the PC Pricer program that is most recently available on Medicare's website as of the preceding July 1. DLI will publish notice of the applicable program in the State Register no later than Oct. 1 of each year. If Medicare does not update the PC Pricer program, the version most recently posted on DLI's website remains in effect.

Additional information about inpatient hospital payments for Minnesota workers' compensation

Hospital catastophic injury threshold amounts

  • Statute:  Minnesota Statutes section 176.1362, subd. 2

  • Discharges from Jan. 1, 2016, through Dec. 31, 2016:  $175,000

  • Discharges from Jan. 1, 2017, through Sept. 30, 2017:  $183,523

  • Discharges from Oct. 1, 2017, through Sept. 30, 2018:  $196,021


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