Guide · Skilled Nursing

Anatomy of a PDPM HIPPS Code

Five characters carry everything Medicare needs to pay a SNF Part A day. Once you know what each position means, the “alphabet soup” on the claim becomes readable. A companion to How PDPM Works and The Five PDPM Components.

In short

A PDPM HIPPS code is five characters. The first four are the resident’s case-mix groups — PT/OT, SLP, Nursing, NTA — one per position. The fifth is an assessment indicator naming which MDS produced the code. It rides on the claim and must match the validated MDS.

What the code is

HIPPS stands for Health Insurance Prospective Payment System. On a SNF Part A claim, the five-position HIPPS code is what tells Medicare how to pay the day. The first four characters encode the PDPM classification (one character per case-mix component); the fifth identifies the assessment behind it.

Five positions: the first four are the case-mix classification (one per component), the fifth is the assessment indicator. The letters shown are illustrative — each position is validated against the MDS.

Character 1 — PT and OT

The first character runs A through P, 16 values for the 16 PT/OT groups. The four clinical categories each own a block of four letters, and the function-score range picks the letter within the block. PT and OT always share this character, even though they pay with different case-mix indexes.

The first character runs A–P. The four clinical categories each claim a block of four letters; within a block, the function-score range picks the exact letter. PT and OT share it.

Characters 2, 3, and 4 — SLP, Nursing, NTA

The next three positions carry the SLP group (1 of 12), the Nursing group (1 of 25), and the NTA group (1 of 6), in that order. Those groups have multi-character names — like SA–SL for SLP — so CMS maps each to a single HIPPS character with a published lookup table.

Characters 2–4 each stand in for one component’s group. Because those groups have multi-character names (like SA–SL), CMS maps each to a single HIPPS character with a published table.

Character 5 — the assessment indicator

The last character isn’t a clinical group at all — it names the assessment that generated the code. Under PDPM there are only three: the scheduled 5-day assessment, the optional Interim Payment Assessment, and the discharge assessment.

The fifth character names the assessment that produced the code — not a clinical group. There are only three values, plus the ZZZZZ default when an assessment is missed.

Why it matters

The HIPPS code is what actually gets billed, and CMS validates it against the submitted MDS. If the documentation behind any character is missing, the assessment can’t produce a code at all — which is why interdisciplinary teams review HIPPS codes before billing, reading each character back to the resident’s characteristics.

Key takeaways

Five characters: four case-mix groups + one assessment indicator.
Char 1 (A–P) is PT/OT; 2 is SLP, 3 is Nursing, 4 is NTA.
Chars 2–4 are single-character stand-ins mapped from group codes by CMS tables.
Char 5 is the assessment: 1 (5-day), 0 (IPA), 6 (discharge).
ZZZZZ is the default code billed when an assessment is late.

Try it on the tools

HIPPS Decoder →Component Builder →PDPM Calculator →

Last reviewed May 2026. Educational overview only — verify against the current CMS PDPM guidance and the RAI Manual before billing.