US · guidance
CMS Pub. 100-04, ch. 6, § 120
Skilled Nursing Facility (SNF) Patient Driven Payment Model
(PDPM)
(Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19)
SNFs billing on Type of Bill (TOB) 21X and rural hospital (non-CAH) swing-bed
providers billing on TOB 18X (subject to SNF PPS), will be subject to these
requirements. Currently, under the SNF PPS, revenue code 0022 indicates that this claim
is being paid under the SNF PPS. This revenue code can appear on a claim as often as
necessary to indicate different Health Insurance Prospective Payment System (HIPPS)
Rate Code(s) and assessment periods. The HCPCS/Rates field must contain a 5-digit
“HIPPS Code”. Under the previous case-mix classification model, the Resource
Utilization Groups, version 4 (RUG-IV), the first three positions of the code contained
the RUG group, and the last two positions of the code contained a 2-digit assessment
indicator (AI) code.
History
(Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5974b8014b3f20b24d65eee343b2832df4a4c31fee5b55c7910813a3618867f2
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