View the Medicare Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Expected Reimbursement Detail

Effective with discharges on and after 10/01/2019, CMS is converting from the current SNF pricing model to the new PDPM model. This page displays the Medicare SNF PDPM expected reimbursement details.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Use the following procedure to view the Medicare Skilled Nursing Facility Patient Driven Payment Model (PDPM) Expected Reimbursement Detail.

Field Descriptions

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare SNF PDPM inpatients.

Field	Description
Error Code	Reason for rejection or return, if applicable.
Total Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Inpatient Deductible	The deductible amount on the claim. Deductible amounts are determined by the patient Point of Origin (FL15). If FL15 = 4 or D, there is no deductible. If the source is NOT another inpatient facility, the deductible is applied for each benefit period (60 days).
Inpatient Co-Payment	The co-payment amount on the claim.
Sequestration Reduction	The 2% sequestration reduction on Medicare Inpatient claims for patients discharged on or after 04/01/2013. The reduction is applied to the Total Expected Payment after any applicable co-payment and deductible amounts are applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Payor Reimbursement	The reimbursement amount due to the payor after the deductible, co-payment, and sequestration reductions are applied.
Component	Lists the various service components in a SNF stay.
Late Assessment (if applicable) -	When applicable HIPPS code "ZZZZZ" is billed with the applicable number of days. This default code maps to HIPPS components PPAY, which represents the lowest payment rates for each category.
Component Group	The HIPPS code assigned to each component (i.e., PT, OT, SLP, etc.)
Component Rate	Base Rate (not wage adjusted) for the HIPPS code assigned to the component group.
Variable Per Diem (VPD) Adjustment Factor PT/OT	The adjustment factor assigned to PT & OT services.
Variable Per Diem (VPD) Adjustment Factor NT	The adjustment factor assigned to NT services.
VPD Wage - Adjusted Rate PT/OT	PT/OT rate with wage and per diem adjustments applied.
VPD Wage - Adjusted Rate NT	NT rate with wage and per diem adjustments applied.
Nursing with HIV add-on (if applicable)	When diagnosis code B20 is present, the nursing component receives a 1.18% adjustment.
SLP, Nursing & Non Case Mix Wage - Adjusted Amount - No Variable Per Diem	This is the wage adjusted amount on the Nursing and Non-Case mix components.
Calculation	The final adjusted amount per component.
Total PDPM Case Mix & Wage Adjusted Per Diem	The sum of the final adjusted per diem for all component groups.
Quality Reporting/Value Based Purchasing Percentages	If applicable, the Quality Reporting and/or Value Based Purchasing Percentage displays in this column.
Subtotal	Includes the variable per diem adjusted totals for each day range.
No. Days in Range	The number of days assigned to each day range.
Variable Per Diem	The total expected payment for each day range.