# 20 C.F.R. § 10.810 (2026): How are payments for inpatient medical services determined? > Federal · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_810 ## Section - **Citation:** 20 C.F.R. § 10.810 (2026) - **Heading:** How are payments for inpatient medical services determined? - **Jurisdiction:** Federal - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Title 20 CFR: Employees' Benefits / Chapter I: OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR / Part 10: CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED / Subpart I: Information for Medical Providers / § 10.810: § 10.810 How are payments for inpatient medical services determined? ## Text (a) OWCP will pay for inpatient medical services according to pre-determined, condition-specific rates based on the Inpatient Prospective Payment System (IPPS) devised by CMS (42 CFR parts 412, 413, 424, 485, and 489). Using this system, payment is derived by multiplying the diagnosis-related group (DRG) weight assigned to the hospital discharge by the provider-specific factors. (1) All inpatient hospital discharges will be classified according to the DRGs prescribed by the CMS in the form of the DRG Grouper software program. Each DRG represents the average resources necessary to provide care in a case in that DRG relative to the national average of resources consumed per case. (2) The provider-specific factors will be provided by CMS in the form of their PPS Pricer software program. The software takes into consideration the type of facility, census division, actual geographic location (MSA) of the hospital, case mix cost per discharge, number of hospital beds, intern/beds ratio, operating cost to charge ratio, and other factors used by CMS to determine the specific rate for a hospital discharge under their PPS. The Director may devise price adjustment factors as appropriate using OWCP's processing experience and internal data. (3) OWCP will base payments to facilities excluded from CMS' IPPS on consideration of detailed medical reports and other evidence. (4) The Director shall review the pre-determined hospital rates at least once a year, and may adjust any or all components when he or she deems it necessary or appropriate. (b) The Director shall review the schedule of fees at least once a year, and may adjust the schedule or any of its components when he or she deems it necessary or appropriate. ## Nearby sections - [20 C.F.R. § 10.800 (2026) § 10.800 How do providers enroll with OWCP for authorizations and billing?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_800.md) - [20 C.F.R. § 10.801 (2026) § 10.801 How are medical bills to be submitted?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_801.md) - [20 C.F.R. § 10.802 (2026) § 10.802 How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_802.md) - [20 C.F.R. § 10.803 (2026) § 10.803 What are the time limitations on OWCP's payment of bills?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_803.md) - [20 C.F.R. § 10.805 (2026) § 10.805 What services are covered by the OWCP fee schedule?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_805.md) - [20 C.F.R. § 10.806 (2026) § 10.806 How are the maximum fees defined?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_806.md) - [20 C.F.R. § 10.807 (2026) § 10.807 How are payments for particular services calculated?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_807.md) - [20 C.F.R. § 10.808 (2026) § 10.808 Does the fee schedule apply to every kind of procedure?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_808.md) - [20 C.F.R. § 10.809 (2026) § 10.809 How are payments for medicinal drugs determined?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_809.md) - [20 C.F.R. § 10.810 (2026) § 10.810 How are payments for inpatient medical services determined?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_810.md) - [20 C.F.R. § 10.811 (2026) § 10.811 When and how are fees reduced?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_811.md) - [20 C.F.R. § 10.812 (2026) § 10.812 If OWCP reduces a fee, may a provider request reconsideration of the reduction?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_812.md) - [20 C.F.R. § 10.813 (2026) § 10.813 If OWCP reduces a fee, may a provider bill the claimant for the balance?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_813.md) - [20 C.F.R. § 10.815 (2026) § 10.815 What are the grounds for excluding a provider from payment under the FECA?](https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_815.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/CFR_T20_P10_S10_810. 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