Medicare Pricing — eKlotho Nexus

Geographic Adjustment Factor (GAF)

Current locality: Illinois — Chicago Metro (Locality 16)

1.0847

Work GPCI

1.1203

PE GPCI

1.0000

MP GPCI

$33.8872

CF 2025

MS-DRG Rates — FY 2025

Medicare Severity Diagnosis Related Groups

DRG	Description	MDC	Type	Rel. Weight	Avg LOS	Rate (IL)
470	Major Joint Replacement or Reattachment — Lower Extremity w/o MCC	08	Medical	2.1047	2.8d	$21,048
291	Heart Failure and Shock w MCC	05	Medical	1.8923	5.2d	$18,921
065	Intracranial Hemorrhage or Cerebral Infarction w MCC	01	Medical	2.5178	6.4d	$25,175
392	Esophagitis, Gastroent & Miscellaneous Digest Disorders w MCC	06	Medical	0.9234	3.7d	$9,232
683	Renal Failure w MCC	11	Medical	1.4412	4.9d	$14,410
190	Chronic Obstructive Pulmonary Disease w MCC	04	Medical	1.2678	4.1d	$12,676
178	Respiratory Infections & Inflammations w MCC	04	Medical	1.9341	5.8d	$19,339
811	Red Blood Cell Disorders w MCC	16	Medical	1.1023	3.3d	$11,021

Multiple Procedure Payment Reduction (MPPR)

CMS payment reduction rules for multiple procedures same encounter

CPT Code	Description	Payment Category	1st Procedure	Reduction %	Allowable (IL)
93971	Duplex scan — extremity unilateral	Diagnostic Imaging	100%	25%	$82.44
93970	Duplex scan — extremity bilateral	Diagnostic Imaging	100%	50%	$115.22
77055	Mammography unilateral	Diagnostic Imaging	100%	25%	$60.11
97014	Electrical stimulation therapy	Therapy	100%	50%	$14.89
97035	Ultrasound therapy	Therapy	100%	50%	$11.24

Home Infusion Therapy Rates

Medicare Part B home infusion per-diem rates (2025)

HCPCS	Drug Category	Per Diem Rate	Max Days	Route	Status
S9494	Antibiotic drugs (complex IV)	$192.00	60d	IV	Active
S9500	Antibiotic drugs (routine IV)	$103.00	60d	IV	Active
S9501	Hydration (3 hrs or less)	$54.00	30d	IV	Active
S9537	Hematopoietic hormone infusion	$219.00	90d	SubQ/IV	Active
S9542	Insulin infusion (complex)	$192.00	Ongoing	SubQ	Active