Patient Driven Payment Model

PDPM Fact Sheets | FAQs | Training Presentation | PDPM Resources

Overview

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. This site includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation.

Fact Sheets

This section includes fact sheets on a variety of PDPM related topics.

• Administrative Level of Care Presumption under the PDPM (PDF)
• PDPM Payments for SNF Patients with HIV/AIDS (PDF)
• Concurrent and Group Therapy Limit (ZIP) (revision posted 8-30-19)
• PDPM Functional and Cognitive Scoring (ZIP) (revision posted 8-30-19)
• Interrupted Stay Policy (ZIP) (revision posted 8-30-19)
• MDS Changes (ZIP) (revision posted 8-30-19)
• NTA Comorbidity Score (PDF)
• PDPM Patient Classification (ZIP) (revision posted 8-30-19)
• Variable Per Diem Adjustment (PDF)

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PDPM Frequently Asked Questions

This section contains frequently asked questions (FAQs) related to PDPM policy and implementation.

• PDPM FAQs (ZIP) (revision posted 8-30-19)

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PDPM Training Presentation

This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.

• PDPM Presentation (PDF)

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PDPM Resources

This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.

• PDPM GROUPER Logic
• FY 2020 PDPM ICD-10 Mappings (ZIP) (revision posted 03-31-2020)
• FY 2021 PDPM ICD-10 Mappings (ZIP) (effective 01-01-2021)
• FY 2022 PDPM ICD-10 Mappings (ZIP) (revision posted 09-27-2021)
• FY 2023 PDPM ICD-10 Mapping (ZIP) (effective 10-01-2022)
• FY 2024 DRAFT PDPM ICD-10 Mapping (ZIP)  (see FY 2024 SNF PPS Proposed Rule) (revision posted 08-07-2023)
• FY 2024 PDPM ICD-10 Mapping (ZIP) (effective 10-01-2023; revision posted 04-12-2024)
• FY 2025 PDPM ICD-10 Mapping (ZIP) (effective 10-01-2024)

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