Work comp: PC Pricer tool for inpatient hospital bills

Minnesota Statutes § 176.1362 provides that the maximum payment for most workers' compensation inpatient hospital services is 200% of the amount calculated under the Medicare diagnosis-related group (DRG) system.

For discharges on or after Oct. 1, 2021, payment for inpatient services, articles and supplies must be calculated using the inpatient PPS Web Pricer available on Medicare's website. Instructions for using the inpatient PPS Web Pricer are available below.

For discharges prior to Oct. 1, 2021, payment must be calculated using the applicable PC Pricer program. Links to download the PC Pricer program and instructions about how to use the downloadable PC Pricer program are available below.

Medicare's inpatient PPS Web Pricer

• Instructions for using Medicare's inpatient PPS Web Pricer

PC Pricer download

2020/2021

For hospital discharge dates from Oct. 1, 2020, through Sept. 30, 2021:  The INPC20C PC Pricer, effective May 20, 2020, 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, 2020.)

• Download INPC20C PC Pricer (.zip file; 27MB)

• Step-by-step instructions for downloading INPC20C PC Pricer

Instructions for using the downloadable PC Pricer Program 

The law directs payers to calculate the amount payable for inpatient hospital services using the PC Pricer program posted on the department’s website. However, because Medicare's payment year is from Oct. 1 through Sept. 30, the date of service must be adjusted to calculate payment using the applicable PC Pricer.

To calculate the amount payable using the PC Pricer program, make sure you are using the correct Pricer effective for the dates of service. When inputting the date of service, always enter the discharge as occurring one year prior to the date of service, with the same month and day portions of the dates of service. 

For example, an inpatient bill with dates of service from Feb. 3 to 7, 2020, should be entered in the Pricer as Feb. 3 to 7, 2019. The PC Pricer will then calculate the amount that would be paid by Medicare.

Additional information about inpatient hospital payments for Minnesota workers' compensation

• Spreadsheet:  Hospital provider identification numbers

• Statute:  Minnesota Statutes section 176.1362, Inpatient hospital payment

• Training:  PC Pricer program

Hospital catastrophic injury threshold amounts

• Discharges from Oct. 1, 2022, through Sept. 30, 2023:  $268,774

• Discharges from Oct. 1, 2021, through Sept. 30, 2022:  $253,752

• Discharges from Oct. 1, 2020, through Sept. 30, 2021:  $226,888