PostAcuteTools
Guide · Skilled Nursing

The Five PDPM Components

PDPM classifies a SNF resident into one group for each of five components, every one scored from different MDS data. This is what drives each classification — the inputs, the number of groups, and the quirks worth knowing. A companion to How PDPM Works.

In short

The five case-mix components are PT, OT, SLP, Nursing, and NTA. Each is classified separately and paid at base × CMI. PT and OT share 16 groups; SLP has 12; Nursing has 25; NTA has 6. Together that’s 28,800 possible combinations — and a sixth, flat non-case-mix amount on top.

One resident, five classifications

Unlike RUG-IV, which reduced a resident to a single group, PDPM scores five components independently. A resident might land high on nursing complexity, low on therapy, and somewhere in the middle on NTA — and the payment reflects each axis. Here’s how many groups each component has and what feeds it.

COMPONENTCLASSIFIED BYGROUPSPhysical TherapyPTClinical category + function score16Occupational TherapyOTClinical category + function score16Speech-Language Path.SLPCognition + comorbidity/neuro + swallowing12NursingNURClinical conditions/services + function score25Non-Therapy AncillaryNTAComorbidity points (50-condition list)616 × 12 × 25 × 6 = 28,800 possible combinations
Each resident is sorted into one group per component. PT and OT share the same 16 groups but carry different case-mix indexes. The non-case-mix amount (room, board, capital) is flat and not shown.

PT and OT

Physical therapy and occupational therapy use the same two inputs. The first is the clinical category from the primary diagnosis, collapsed into four buckets: major joint replacement or spinal surgery, other orthopedic, medical management, and non-orthopedic surgery / acute neurologic. The second is a function score (0–24) built from ten Section GG self-care and mobility items, where a higher score means more independence. That score is banded into four ranges — 0–5, 6–9, 10–23, and 24 — so four categories crossed with four ranges give the 16 groups, TA through TP. That code is the first character of the HIPPS code. PT and OT always land in the same group, but each pays with its own case-mix index, and both taper under the variable per-diem after day 20.

Clinical categoryfrom primary diagnosisGG function scoremore dependent ←→ more independent0–56–910–2324Major joint replacement /spinal surgeryA–DTATBTCTDOther orthopedicE–HTETFTGTHMedical managementI–LTITJTKTLNon-orthopedic surgery /acute neuroM–PTMTNTOTP
The 16 PT/OT groups (TA–TP) are a 4 × 4 grid: four collapsed clinical categories (rows, set by the primary diagnosis) crossed with four GG function-score ranges (columns). PT and OT always land in the same code — the HIPPS first character — but each pays with its own case-mix index.

SLP

Speech-language pathology is also a grid, but built differently. One axis is a count: how many of three things are present — an acute neurologic condition, an SLP-related comorbidity (a list of 12, such as aphasia, stroke, dysphagia, or a tracheostomy), or a cognitive impairment (from the BIMS). That gives four rows: none, any one, any two, or all three. The other axis is whether the resident has a swallowing disorder or a mechanically altered diet — neither, either, or both — giving three columns. Four rows by three columns is the 12 groups, SA through SL. SLP is flat: no variable per-diem, so the same amount pays every day of the stay.

Acute neuro condition, SLPcomorbidity, or cognitiveimpairment — how many?Swallowing disorder or mechanically altered dietNeitherEitherBothNone presentSASBSCAny oneSDSESFAny twoSGSHSIAll threeSJSKSL
The 12 SLP groups (SA–SL) are a 4 × 3 grid: how many of the three conditions are present (rows) crossed with the swallowing / altered-diet status (columns). SA (none + neither) carries the lowest index, SL (all three + both) the highest. SLP has no variable per-diem — it pays the same every day.

Nursing

The nursing component carries the most groups — 25 — and is the one component that isn’t a grid. It uses the hierarchical logic carried over from RUG-IV: the 25 groups sit in six categories, and you work down them in priority order, assigning the resident to the first category they qualify for. Extensive Services sits at the top; Reduced Physical Function is the catch-all at the bottom.

Checked top to bottom — the first category the resident qualifies for is assigned1Extensive ServicesTracheostomy, ventilator, or isolationES1ES2ES32Special Care HighAcutely ill — serious conditions or servicesHBC1HBC2HDE1HDE23Special Care LowSignificant needs (e.g. tube feeding, injections)LBC1LBC2LDE1LDE24Clinically ComplexComplex conditions (e.g. pneumonia, wounds, IV meds)CA1CA2CBC1CBC2CDE1CDE25Behavioral Symptoms & Cognitive PerformanceBehavioral symptoms or cognitive impairmentBAB1BAB26Reduced Physical FunctionFallback — if none of the above qualifyPA1PA2PBC1PBC2PDE1PDE2
The 25 nursing groups sit in six categories, checked in order — the resident is placed in the first one they qualify for, so Reduced Physical Function is the fallback. Within a category, groups split further by the nursing function score (0–16) and a depression or restorative-nursing indicator.

Within each category, the groups split further by the nursing function score (0–16) and an end-split — a depression indicator for the higher categories, or a restorative-nursing indicator for the lower ones. Nursing is flat across the stay (no variable per-diem). One add-on to know: a resident with an AIDS diagnosis (ICD-10 B20) reported on the claim gets an 18% bump to the nursing component.

NTA

The non-therapy ancillary component captures the cost of drugs and supplies. CMS identified about 50 comorbidities, each worth a weighted number of points (the most expensive conditions are worth more). Sum the points for everything the resident has, and the total lands them in one of six groups — more points, higher group, higher CMI. NTA front-loads hard: it pays three times the rate for the first three days of the stay.

higher CMI →0pts1–2pts3–5pts6–8pts9–11pts12+ptsNTA comorbidity score (sum of weighted points from up to 50 conditions)
The NTA score is a weighted point count of the resident’s comorbidities; more points place them in a higher of six groups with a larger case-mix index. NTA pays triple for the first three days of the stay.

How they come back together

Each component is paid at its base rate times its CMI; the labor share is wage-adjusted; PT, OT, and NTA get their variable per-diem factor for the day; and the flat non-case-mix amount is added. The sum is the daily rate. For the full assembly and the HIPPS code, see How PDPM Works.

Key takeaways

  • PT & OT share 16 groups (4 clinical categories × 4 function ranges) but pay with different CMIs.
  • SLP (12 groups) keys on cognition, neuro/comorbidity, and swallowing/diet — and is flat.
  • Nursing (25 groups) uses hierarchical classification + a 0–16 function score; AIDS adds 18%.
  • NTA (6 groups) is a weighted comorbidity point count, paid ×3 for days 1–3.
  • Five components → 28,800 combinations, plus a flat non-case-mix amount.

Try it on the tools

Component Builder →PDPM Calculator →Comorbidity Checker →HIPPS Decoder →

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