Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
Item Rationale
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
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Item Rationale
Use this item when the facility is completing content tied to Section Z and needs to stay anchored to v1.20.1.
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Used to capture the Patient Driven Payment Model (PDPM) case mix version code followed by Health Insurance Prospective Payment System (HIPPS) modifier based on type of assessment.
A HIPPS Code Typically, the software data entry product will calculate this value. The HIPPS code is a Skilled Nursing Facility (SNF) Part A five-position billing code; the first four positions represent the PDPM case mix version code and the fifth is the assessment type indicator. For information on HIPPS, access: If the value for Z0100A is not automatically calculated by the software data entry product, enter the HIPPS code in the spaces provided (see Chapter 6 of this manual, Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS), for a step-by-step worksheet for manually determining the PDPM case mix version code and a table that defines the assessment indicator). This HIPPS code is usually used for Medicare SNF Part A billing by the provider. Left-justify the 5-character HIPPS code. The extra two spaces are supplied for future use, if necessary.
MEDICARE-COVERED STAY Skilled Nursing Facility stays billable to Medicare Part A. Does not include stays billable to other payers (e.g., Medicare Advantage plans).
HIPPS CODE Is comprised of the PDPM case mix code, which is calculated from the assessment data. The first four positions of the HIPPS code contain the PDPM classification codes for each PDPM component to be billed for Medicare reimbursement, followed by an indicator of the type of assessment that was completed.
Typically, the software data entry product will calculate this value. If the value for Z0100B is not automatically calculated by the software data entry product, enter the PDPM version code in the spaces provided.