Inpatient Rehabilitation · Reference
IRF PPS Rates & Method
The verified FY 2026 IRF PPS national values and the order of operations Medicare uses to turn a CMG relative weight into a paid claim. Effective for discharges on or after October 1, 2025.
Data statusReference Only
- Status
- Reference Only
- Data year / effective
- FY2026
- Last reviewed
- June 2026
- Last updated
- June 2026
- Primary source
- CMS IRF PPS Final Rule, FY2026
- Known exclusions
- Wage index and facility CCRs vary by provider
- Outlier, transfer, and short-stay adjustments are case-specific
- Sequestration and MAC edits not applied
- Validate against the IRF Pricer and your MAC
Published reference for the stated period — confirm the current figure and any corrections at the source before billing.
No PHIEstimator · BetaRuns entirely in your browser — no data leaves the page. Rates are CMS FY 2026 final-rule values; CMG relative weights live in CMS Table 2 — verify against the IRF Pricer and your MAC.
FY 2026 national values
CMS-1829-F| Element | FY 2025 | FY 2026 |
|---|---|---|
| Standard payment conversion factor | $18,907 | $19,371 |
| Fixed-loss outlier threshold | — | $10,062 |
| Labor-related share | — | 74.4% |
| National average CCR · urban | — | 0.398 |
| National average CCR · rural | — | 0.463 |
| National CCR ceiling | — | 1.54 |
Source: FY2026 IRF PPS Final Rule (CMS-1829-F). The conversion factor reflects a 2.6% net update. The labor-related share is 70.7% operating + 3.7% capital. National average CCRs replace a facility CCR that exceeds the ceiling.
How the payment is built
Order of operations| Unadjusted payment | CMG relative weight × $19,371 |
| Wage adjustment | conversion factor × (0.744 × wage index + 0.256) — only the labor share moves with the wage index |
| Rural | × 1.149 for rural IRFs (facility-level factor, frozen at FY 2014 levels) |
| LIP | low-income percentage adjustment, by facility |
| Teaching | resident-to-ADC teaching adjustment, by facility |
| Case adjustments | interrupted stay, transfer, short stay, in-hospital death |
| High-cost outlier | if (facility CCR × charges) > payment + $10,062, add 80% of the excess |
CMG relative weights and average length of stay values are published in Table 2 of the final rule and are not reproduced here. Enter the weight for your CMG/tier in the estimator. Facility-level adjustments (rural, LIP, teaching) vary by provider; confirm yours.
