> ## Documentation Index
> Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Calculate MS-DRG IPPS payment

> FY2026 IPPS payment for an already-grouped MS-DRG.

Looks up the CCN in the CMS Impact File and the MS-DRG in Table 5, then
runs the same FISS-pricer math as the website Payment Calculator. Does not
group diagnoses or procedures into an MS-DRG.



## OpenAPI

````yaml /docs/openapi.client.json post /v1/drg/payment
openapi: 3.1.0
info:
  description: >-
    Client API for RCIntel. Admin ingest, catalog sync, and internal audit
    routes are omitted. See Guides → Which API to use.
  summary: Multi-tenant knowledge API for healthcare revenue cycle management.
  title: Healthcare Knowledge Layer
  version: 0.1.0
servers: []
security: []
tags:
  - description: >-
      Geographic payer policy lookup (national NCD vs MAC LCD vs state). Query
      payer, code, state, plan_type. Each row includes geo_scope and
      document_version.
    name: policies
  - description: >-
      Payer network directory — search payers, check prior auth requirements,
      view filing rules, denial patterns, and appeal levels.
    name: payers
  - description: >-
      Resolve healthcare billing knowledge across the L1-L6 layer stack.
      Includes payment calculation, billing guidance, and per-layer queries.
    name: knowledge
  - description: >-
      CMS Fee Schedule lookups — OPPS (Addendum B / APC), DMEPOS (state-level
      pricing), and Clinical Lab Fee Schedule (CLFS).
    name: fee-schedules
  - description: >-
      NCCI (National Correct Coding Initiative) — dedicated MUE limits, PTP
      bundling edits, add-on code edits, and code pair validation.
    name: ncci
  - description: >-
      Service code intelligence — CPT/HCPCS lookup, RVU data, NCCI edits,
      payment calculation, implant/GUDID search, and service group
      classification.
    name: codes
  - description: >-
      Submit asynchronous AI agent jobs for code research, medical necessity,
      and denial resolution. Poll for results and retrieve reasoning traces.
    name: agents
  - description: >-
      Register and manage healthcare facilities by CCN (Medicare Provider
      Number). Each facility is the root entity for knowledge resolution.
    name: facilities
  - description: >-
      NPI Registry — live search against CMS NPPES API for provider and
      organization National Provider Identifiers.
    name: npi
  - description: >-
      OpenFDA drug product lookup by NDC. Includes product-level fields with
      normalized ingredient and package detail.
    name: drugs
  - description: Health checks, service metadata, and Prometheus metrics.
    name: system
paths:
  /v1/drg/payment:
    post:
      tags:
        - knowledge
      summary: Calculate MS-DRG IPPS payment
      description: >-
        FY2026 IPPS payment for an already-grouped MS-DRG.


        Looks up the CCN in the CMS Impact File and the MS-DRG in Table 5, then

        runs the same FISS-pricer math as the website Payment Calculator. Does
        not

        group diagnoses or procedures into an MS-DRG.
      operationId: calculate_ipps_payment_v1_drg_payment_post
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/IppsPaymentRequest'
        required: true
      responses:
        '200':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/IppsPaymentResponse'
          description: FY2026 acute IPPS estimate for a known MS-DRG at a CCN
        '422':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
          description: Validation Error
      security:
        - APIKeyHeader: []
components:
  schemas:
    IppsPaymentRequest:
      description: Calculate FY2026 acute IPPS payment for a known MS-DRG at a CCN.
      examples:
        - ccn: '180017'
          covered_charges: 47024.59
          length_of_stay: 6
          ms_drg: '486'
      properties:
        ccn:
          examples:
            - '180017'
          pattern: ^\d{6}$
          title: Ccn
          type: string
        covered_charges:
          anyOf:
            - minimum: 0
              type: number
            - type: 'null'
          description: Covered charges; enables cost-outlier and NTAP
          title: Covered Charges
        discharge_date:
          anyOf:
            - type: string
            - type: 'null'
          title: Discharge Date
        discharge_status:
          anyOf:
            - type: string
            - type: 'null'
          description: Patient discharge status code (e.g. 01, 02, 03)
          title: Discharge Status
        length_of_stay:
          anyOf:
            - minimum: 0
              type: number
            - type: 'null'
          description: Covered days / LOS; enables transfer per-diem
          title: Length Of Stay
        ms_drg:
          description: MS-DRG code (1-3 digits or zero-padded)
          examples:
            - '486'
          title: Ms Drg
          type: string
        new_technologies:
          description: NTAP technology names from the FY2026 Table 1G list
          items:
            type: string
          title: New Technologies
          type: array
      required:
        - ccn
        - ms_drg
      title: IppsPaymentRequest
      type: object
    IppsPaymentResponse:
      properties:
        adjustments:
          $ref: '#/components/schemas/IppsAdjustmentsOut'
        capital:
          $ref: '#/components/schemas/IppsCapitalOut'
        caveats:
          items:
            type: string
          title: Caveats
          type: array
        ccn:
          title: Ccn
          type: string
        discharge_date:
          anyOf:
            - type: string
            - type: 'null'
          title: Discharge Date
        drg:
          $ref: '#/components/schemas/IppsDrgOut'
        fiscal_year:
          title: Fiscal Year
          type: integer
        ms_drg:
          title: Ms Drg
          type: string
        operating:
          $ref: '#/components/schemas/IppsOperatingOut'
        provider:
          $ref: '#/components/schemas/IppsProviderOut'
        reliability:
          $ref: '#/components/schemas/ReliabilityMetadata'
        total_base_payment:
          title: Total Base Payment
          type: number
        total_payment:
          title: Total Payment
          type: number
      required:
        - ccn
        - ms_drg
        - fiscal_year
        - provider
        - drg
        - operating
        - capital
        - adjustments
        - total_base_payment
        - total_payment
        - reliability
      title: IppsPaymentResponse
      type: object
    HTTPValidationError:
      properties:
        detail:
          items:
            $ref: '#/components/schemas/ValidationError'
          title: Detail
          type: array
      title: HTTPValidationError
      type: object
    IppsAdjustmentsOut:
      properties:
        capital_dsh:
          title: Capital Dsh
          type: number
        capital_ime:
          title: Capital Ime
          type: number
        capital_ime_factor:
          title: Capital Ime Factor
          type: number
        capital_outlier:
          title: Capital Outlier
          type: number
        federal_operating:
          title: Federal Operating
          type: number
        governing_basis:
          title: Governing Basis
          type: string
        hrr_adjustment:
          title: Hrr Adjustment
          type: number
        hsp_part:
          title: Hsp Part
          type: number
        hsp_rate:
          title: Hsp Rate
          type: number
        low_volume:
          title: Low Volume
          type: number
        new_tech_add_on:
          title: New Tech Add On
          type: number
        new_tech_applied:
          items:
            type: string
          title: New Tech Applied
          type: array
        operating_dsh:
          title: Operating Dsh
          type: number
        operating_ime:
          title: Operating Ime
          type: number
        operating_ime_factor:
          title: Operating Ime Factor
          type: number
        operating_outlier:
          title: Operating Outlier
          type: number
        provider_type_class:
          title: Provider Type Class
          type: string
        transfer_fraction:
          title: Transfer Fraction
          type: number
        transfer_type:
          title: Transfer Type
          type: string
        uncompensated_care:
          title: Uncompensated Care
          type: number
        vbp_adjustment:
          title: Vbp Adjustment
          type: number
      required:
        - operating_ime_factor
        - operating_ime
        - operating_dsh
        - operating_outlier
        - capital_ime_factor
        - capital_ime
        - capital_dsh
        - capital_outlier
        - hrr_adjustment
        - vbp_adjustment
        - uncompensated_care
        - low_volume
        - new_tech_add_on
        - new_tech_applied
        - transfer_type
        - transfer_fraction
        - provider_type_class
        - hsp_rate
        - federal_operating
        - hsp_part
        - governing_basis
      title: IppsAdjustmentsOut
      type: object
    IppsCapitalOut:
      properties:
        capital_base:
          title: Capital Base
          type: number
        capital_cola:
          title: Capital Cola
          type: number
        capital_payment:
          title: Capital Payment
          type: number
        capital_rate:
          title: Capital Rate
          type: number
        gaf:
          title: Gaf
          type: number
        relative_weight:
          title: Relative Weight
          type: number
      required:
        - capital_rate
        - gaf
        - capital_cola
        - capital_base
        - relative_weight
        - capital_payment
      title: IppsCapitalOut
      type: object
    IppsDrgOut:
      properties:
        arithmetic_mean_los:
          title: Arithmetic Mean Los
          type: number
        geometric_mean_los:
          title: Geometric Mean Los
          type: number
        mdc:
          title: Mdc
          type: string
        ms_drg:
          title: Ms Drg
          type: string
        post_acute_drg:
          title: Post Acute Drg
          type: boolean
        relative_weight:
          title: Relative Weight
          type: number
        special_pay_drg:
          title: Special Pay Drg
          type: boolean
        title:
          title: Title
          type: string
        type:
          title: Type
          type: string
        weight_before_cap:
          title: Weight Before Cap
          type: number
      required:
        - ms_drg
        - post_acute_drg
        - special_pay_drg
        - mdc
        - type
        - title
        - weight_before_cap
        - relative_weight
        - geometric_mean_los
        - arithmetic_mean_los
      title: IppsDrgOut
      type: object
    IppsOperatingOut:
      properties:
        labor_amount:
          title: Labor Amount
          type: number
        non_labor_amount:
          title: Non Labor Amount
          type: number
        operating_base:
          title: Operating Base
          type: number
        operating_cola:
          title: Operating Cola
          type: number
        operating_payment:
          title: Operating Payment
          type: number
        rate_profile:
          title: Rate Profile
          type: string
        rate_profile_label:
          title: Rate Profile Label
          type: string
        relative_weight:
          title: Relative Weight
          type: number
        table:
          title: Table
          type: string
        wage_index:
          title: Wage Index
          type: number
      required:
        - table
        - rate_profile
        - rate_profile_label
        - labor_amount
        - non_labor_amount
        - wage_index
        - operating_cola
        - operating_base
        - relative_weight
        - operating_payment
      title: IppsOperatingOut
      type: object
    IppsProviderOut:
      properties:
        capital_ccr:
          title: Capital Ccr
          type: number
        capital_cost_of_living_adjustment:
          title: Capital Cost Of Living Adjustment
          type: number
        cbsa:
          title: Cbsa
          type: string
        ccn:
          title: Ccn
          type: string
        cost_of_living_adjustment:
          title: Cost Of Living Adjustment
          type: number
        dsh_capital_factor:
          title: Dsh Capital Factor
          type: number
        dsh_operating_factor:
          title: Dsh Operating Factor
          type: number
        ehr_reduction:
          title: Ehr Reduction
          type: boolean
        facility_specific_rate:
          title: Facility Specific Rate
          type: number
        facility_type:
          title: Facility Type
          type: string
        gaf:
          title: Gaf
          type: number
        hsp_rate_mdh:
          title: Hsp Rate Mdh
          type: number
        low_volume_factor:
          title: Low Volume Factor
          type: number
        name:
          title: Name
          type: string
        operating_ccr:
          title: Operating Ccr
          type: number
        provider_type:
          title: Provider Type
          type: string
        quality_reduction:
          title: Quality Reduction
          type: boolean
        readmission_factor:
          title: Readmission Factor
          type: number
        resident_to_bed_ratio:
          title: Resident To Bed Ratio
          type: number
        state:
          title: State
          type: string
        uncomp_care_per_claim:
          title: Uncomp Care Per Claim
          type: number
        vbp_factor:
          title: Vbp Factor
          type: number
        wage_index:
          title: Wage Index
          type: number
      required:
        - ccn
        - name
        - cbsa
        - wage_index
        - cost_of_living_adjustment
        - gaf
        - capital_cost_of_living_adjustment
        - quality_reduction
        - ehr_reduction
        - state
        - facility_type
        - resident_to_bed_ratio
        - dsh_operating_factor
        - dsh_capital_factor
        - operating_ccr
        - capital_ccr
        - provider_type
        - facility_specific_rate
        - hsp_rate_mdh
        - vbp_factor
        - readmission_factor
        - uncomp_care_per_claim
        - low_volume_factor
      title: IppsProviderOut
      type: object
    ReliabilityMetadata:
      description: User-visible reliability metadata attached to API responses.
      properties:
        data_sources:
          additionalProperties:
            type: string
          description: Data-source backends used to build this response.
          title: Data Sources
          type: object
        dataset_versions:
          additionalProperties:
            type: string
          description: >-
            CMS/DHCS/NLM/FDA named versions used to compose this response (e.g.
            mpfs=CY2026, ipps=FY2026). See GET /v1/data/changes.
          title: Dataset Versions
          type: object
        degraded:
          default: false
          description: True when a fallback or non-primary source path was used.
          title: Degraded
          type: boolean
        generated_at:
          description: UTC timestamp when the response payload was composed.
          title: Generated At
          type: string
        warnings:
          description: Human-readable caveats relevant to downstream consumers.
          items:
            type: string
          title: Warnings
          type: array
      required:
        - generated_at
      title: ReliabilityMetadata
      type: object
    ValidationError:
      properties:
        ctx:
          title: Context
          type: object
        input:
          title: Input
        loc:
          items:
            anyOf:
              - type: string
              - type: integer
          title: Location
          type: array
        msg:
          title: Message
          type: string
        type:
          title: Error Type
          type: string
      required:
        - loc
        - msg
        - type
      title: ValidationError
      type: object
  securitySchemes:
    APIKeyHeader:
      in: header
      name: X-API-Key
      type: apiKey

````