HIPPS Coding for PDPM

Skilled Nursing Facility (SNF) patients are classified into Health Insurance Prospective Payment System (HIPPS) payment groups, based on the MDS response. Effective October 1, 2019, the Patient Driven Payment Model (PDPM) will improve payments made under the SNF Prospective Payment System (PPS). All providers will be required to complete an Interim Payment Assessment (IPA) with an Assessment Reference Date (ARD) no later than October 7, 2019 for all SNF Part A patients.

Current RUG-IV HIPPS Code

  • Character 1-3: RUG Code
  • Character 4-5: Assessment Indicator

New PDPM HIPPS Code

  • Character 1: PT/OT Payment Group
  • Character 2: SLP Payment Group
  • Character 3: Nursing Payment Group
  • Character 4: NTA Payment Group
  • Character 5: Assessment Indicator

PT/OT, SLP, NTA Payment Groups to HIPPS Translation

PT/OT SLP NTA HIPPS Character
TA SA NA A
TB SB NB B
TC SC NC C
TD SD ND D
TE SE NE E
TF SF NF F
TG SG   G
TH SH   H
TI SI   I
TJ SJ   J
TK SK   K
TL SL   L
TM     M
TN     N
TO     O
TP     P

 

Nursing Payment Group to HIPPS Translation

Nursing ES3 ES2 ES1 HDE2 HDE1 HBC2 HBC1 LDE2 LDE1
HIPPS Character A B C D E F G H I

 

Nursing LBC2 LBC1 CDE2 CDE1 CBC2 CA2 CBC1 CA1
HIPPS Character J K L M N O P Q

 

Nursing BAB2 BAB1 PDE2 PDE1 PBC2 PA2 PBC1 PA1
HIPPS Character R S T U V W X Y

 

Assessment Indicator Crosswalk

HIPPS Character Assessment Type
0 Interim Payment Assessment (IPA)
1 PPS 5-day Scheduled Assessment
6 OBRA Assessment

 

Coding Example

  1. PT/OT Payment Group: TC
  2. SLP Payment Group: SD
  3. Nursing Payment Group: PBC1
  4. NTA Payment Group: NE
  5. Assessment Type: 5-day PPS Assessment

HIPPS Code: CDXE1

Default Billing

There may be instances in which providers may bill the "default" rate on the SNF claim (when an MDS assessment is late).

The default code under PDPM is ZZZZZ, instead of the default RUG-IV of AAA00.

Resource

 

Last Updated Dec 09 , 2023