CMS Pub. 100-04, ch. 6, § 120.1

Under PDPM, the HIPPS code is structured differently, as a result of there being five

case-mix adjusted rate components under the revised model. The first position represents

the Physical and Occupational Therapy case-mix group. The second position represents

the Speech-Language Pathology case-mix group. The third character represents the

nursing case-mix group. The fourth character represents the Non-Therapy Ancillary

(NTA) case-mix group. The fifth character represents the AI code. CMS would note that

this also affects the number of potentially valid HIPPS codes under PDPM, as compared

to RUG-IV.

The PPS assessment schedule under PDPM is also significantly different from that used

under RUG-IV. The only assessments under PDPM that would produce a HIPPS code

would be the initial Medicare (“5-day”) PPS assessment, which follows the same

schedule as under the previous RUG-IV model, and the optional Interim Payment

Assessment (IPA), which may be completed at any point during a PPS stay.

The initial SNF PDPM HIPPS Codes can be found online at:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes.html

Note: AAA00 default will be replaced with ZZZZZ effective October 1, 2019.