PDPM HIPPS Codes: How They Will Be Determined

By Caralyn Davis, Staff Writer - April 10, 2019

When the Patient-Driven Payment Model (PDPM) implements as the case-mix classification system for the skilled nursing facility prospective payment system (SNF PPS) on Oct. 1, 2019, SNFs will have to code a new set of health insurance prospective payment system (HIPPS) codes in MDS item Z0100A (Medicare Part A HIPPS code) and on the Part A claim to identify a SNF resident’s payment classification, pointed out officials with the Centers for Medicare & Medicaid Services (CMS) during the Dec. 11 SNF PPS: PDPM National Provider Call. Note: Access the call slides, as well as a transcript and recording, here.


The RUG-IV system uses a 5-character HIPPS code. “The first three characters represent the patient’s RUG classification, while the last two characters represent the assessment used to classify the patient,” said officials.