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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, using Medicare's PC Pricer program.

PC Pricer download

2019/2020

For hospital discharge dates from Oct. 1, 2019, through Sept. 30, 2020:  The FY 2019.0 PC Pricer, updated April 8, 2018, 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, 2019.)

2018/2019

For hospital discharge dates from Oct. 1, 2018, through Sept. 30, 2019:  The FY 2018.0 PC Pricer, updated April 10, 2018, 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, 2018.)

2017/2018

For hospital discharge dates Oct. 1, 2017, through Sept. 30, 2018:  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.)

Instructions for using the 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 Nov. 1 to 10, 2019, should be entered in the Pricer as Nov. 1 to 10, 2018, and 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

Hospital catastrophic injury threshold amounts

  • Discharges from Oct. 1, 2019, through Sept. 30, 2020:  $209,336

  • Discharges from Oct. 1, 2018, through Sept. 30, 2019:  $204,350*

  • Discharges from Oct. 1, 2017, through Sept. 30, 2018:  $193,605*

  • Discharges from Jan. 1, 2017, through Sept. 30, 2017:  $181,703*

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

*The previously listed threshold amounts of $183,523 on Jan. 1, 2017, $196,021 on Oct. 1, 2017, and $206,822 on Oct. 1, 2018, were incorrect. If you have any questions, contact the Department of Labor and Industry’s medical policy staff at 651-284-5052 or medical.policy.dli@state.mn.us