US · guidance
CMS Pub. 100-04, ch. 6, § 120.6
Default Billing
As under RUG-IV, there may be instances in which providers may bill the “default” rate
on a SNF claim (e.g., when an MDS assessment is considered late).
• The default rate refers to the lowest possible per diem rate.
• The default code under PDPM is ZZZZZ, as compared to the default code under
RUG-IV of AAA00.
• Billing the default code under PDPM represents the equivalent of billing the
following PDPM groups:
PT Payment Group: TP
OT Payment Group: TP
SLP Payment Group: SA
Nursing Payment Group: PA1
NTA Payment Group: NF
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
2097c8fdafec312e08c92bec39274e137e83c2efbaae760e2255afee67d69c36
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