Skilled Nursing Facility · Patient-Driven Payment Model
PDPM Per Diem Calculator
Enter the five HIPPS components and facility factors to compute the case-mix-adjusted Medicare Part A per diem rate, including the variable-per-diem schedule across a 100-day stay. Rate tables are from the published CMS SNF PPS Final Rules.
Inputs
HIPPS + FacilityResult
FY2026 · UrbanAACD1
A PT/OT · TA
A SLP · SA
C Nursing · ES1
D NTA · ND
1 AI · 5-Day scheduled PPS
A SLP · SA
C Nursing · ES1
D NTA · ND
1 AI · 5-Day scheduled PPS
| Component | CMG | CMI | Base | Daily $ |
|---|---|---|---|---|
| Physical Therapy | TA | 1.45 | $75.73 | $93.64 |
| Occupational Therapy | TA | 1.41 | $70.49 | $84.75 |
| Speech-Language Path. | SA | 0.64 | $28.28 | $15.43 |
| Nursing | ES1 | 2.77 | $132.00 | $311.80 |
| Non-Therapy Ancillary | ND | 1.26 | $99.59 | $107.00 |
| Non-Case-Mix | — | — | $118.21 | $100.80 |
| Total per diem (days 4–20) | $713.44 |
Days 1–3 (NTA ×3)
$927.44
Base per diem (days 4–20)
$713.44
Unadjusted total
$836.63
Daily figures above reflect the base per diem (days 4–20), fully adjusted for wage index, VBP, and QRP status. The variable-per-diem schedule below shows how the rate changes across the stay.
Estimated Per Diem by Medicare Day
Days 1–100 · VPD applied
→ $21,998.69 over 30 days (avg $733.29/day)
| Medicare days | PT | OT | SLP | Nursing | NTA | Non-Case Mix | Total / day | Subtotal |
|---|---|---|---|---|---|---|---|---|
| 1–3NTA ×3 | $93.64 | $84.75 | $15.43 | $311.80 | $321.01 | $100.80 | $927.44 | $2,782.32 |
| 4–20base | $93.64 | $84.75 | $15.43 | $311.80 | $107.00 | $100.80 | $713.44 | $12,128.40 |
| 21–27 | $91.77 | $83.06 | $15.43 | $311.80 | $107.00 | $100.80 | $709.87 | $4,969.07 |
| 28–34 | $89.89 | $81.36 | $15.43 | $311.80 | $107.00 | $100.80 | $706.30 | $4,944.10 |
| 35–41 | $88.02 | $79.67 | $15.43 | $311.80 | $107.00 | $100.80 | $702.73 | $4,919.12 |
| 42–48 | $86.15 | $77.97 | $15.43 | $311.80 | $107.00 | $100.80 | $699.16 | $4,894.15 |
| 49–55 | $84.28 | $76.28 | $15.43 | $311.80 | $107.00 | $100.80 | $695.60 | $4,869.17 |
| 56–62 | $82.40 | $74.58 | $15.43 | $311.80 | $107.00 | $100.80 | $692.03 | $4,844.19 |
| 63–69 | $80.53 | $72.89 | $15.43 | $311.80 | $107.00 | $100.80 | $688.46 | $4,819.22 |
| 70–76 | $78.66 | $71.19 | $15.43 | $311.80 | $107.00 | $100.80 | $684.89 | $4,794.24 |
| 77–83 | $76.79 | $69.50 | $15.43 | $311.80 | $107.00 | $100.80 | $681.32 | $4,769.27 |
| 84–90 | $74.91 | $67.80 | $15.43 | $311.80 | $107.00 | $100.80 | $677.76 | $4,744.29 |
| 91–97 | $73.04 | $66.11 | $15.43 | $311.80 | $107.00 | $100.80 | $674.19 | $4,719.32 |
| 98–100 | $71.17 | $64.41 | $15.43 | $311.80 | $107.00 | $100.80 | $670.62 | $2,011.86 |
Every dollar figure is wage-index adjusted and reflects the VBP rate and QRP status. With VBP = 1.0000 and quality data submitted, these match a standard wage-adjusted MAC per-diem table. PT/OT decline 2% every 7 days from day 21; NTA pays 300% on days 1–3.
About this tool. Base per-diem rates and case-mix indexes are drawn from the published CMS SNF PPS Final Rules for FY 2025 and FY 2026 (the case-mix indexes are unchanged between these two years; only the base rates differ). Labor-related share: 71.9% (FY2026) / 72.0% (FY2025). Wage adjustment = (rate × labor share × wage index) + (rate × non-labor share). The AIDS/HIV (ICD-10 B20) add-on applies an 18% increase to the nursing component only. The Assessment Indicator sets the 5th HIPPS character and does not itself change payment. Submitted Quality Data off applies a 2% reduction representing the 2-percentage-point SNF QRP penalty (a practical approximation). VBP Rate is applied as a direct multiplier — enter your facility's incentive payment multiplier from CMS (1.0000 = neutral; the 2% withhold is embedded in that published figure). This is an estimation and educational tool, not an official payment determination. CBSA wage index: choose your area from the CBSA dropdown — it sets the wage index and urban/rural automatically. Wage indexes and base per-diem rates are embedded for FY2025 (CMS-1802-CN correction), FY2026 final (CMS-1827-F), and FY2027 (CMS-1843-P proposed) — all 468 areas from Table A urban (by metropolitan-division code) and Table B rural (by state), so each fiscal year applies its own area index. FY2027 figures are PROPOSED and not final — the base rates, labor share (72.0%), and wage indexes may change in the final rule (expected ~Aug 2026); comments were due June 1, 2026. CMIs are unchanged for FY2027 (no PDPM case-mix changes proposed). Indexes are uncapped here; CMS applies a 5% cap on year-over-year decreases at the provider level via the MAC, so your facility's effective index may be slightly higher. CBSAs are multi-county areas keyed by a 5-digit code, not by ZIP. Figures should be verified against the FY 2026 SNF PPS Final Rule and your MAC.
Medicare reimbursement & billing tools for post-acute, home health, and hospice
PostAcuteTools is a free set of Medicare reimbursement calculators and billing references built for post-acute, skilled nursing, and long-term care teams, home health agencies, and hospice providers. Estimate skilled nursing facility per diem rates under the Patient-Driven Payment Model (PDPM), model home health 30-day period payments under the Patient-Driven Groupings Model (PDGM), decode HIPPS codes, look up ICD-10-CM diagnosis codes, map claim forms with UB-04 and CMS-1500 crosswalks, and reference Medicare hospice billing codes — all from one page, with rates drawn from the published CMS SNF PPS and HH PPS Final Rules.
PDGM CalculatorHome health 30-day period payment, HIPPS, LUPA, wage index, HHVBP & outliers.
Claim CrosswalksUB-04 ↔ 837I institutional and CMS-1500 ↔ 837P professional claim maps.
Hospice CodesMedicare hospice billing codes — TOB, revenue, HCPCS, occurrence & condition.
ICD-10-CM LookupSearch the full set of valid FY2026 diagnosis codes by code or description.
Frequently asked questions
What is a PDPM calculator?
A PDPM calculator estimates the case-mix-adjusted Medicare Part A per diem rate a skilled nursing facility is paid under the Patient-Driven Payment Model. You enter the HIPPS code and facility factors, and it computes the rate across the five PDPM case-mix components and the variable per-diem schedule over a 100-day stay.
What is PDGM in home health?
The Patient-Driven Groupings Model (PDGM) is the Medicare home health payment system that classifies each 30-day period of care into one of 432 case-mix groups based on admission timing, admission source, clinical group, functional impairment level, and comorbidity adjustment, producing a HIPPS code and case-mix weight that determine payment. Try the PDGM calculator.
Are the PDPM and PDGM calculators free to use?
Yes. The PDPM and PDGM calculators and all of the Medicare billing reference tools on PostAcuteTools are free to use.
What hospice billing codes does the site cover?
The hospice reference lists the codes most frequently submitted on Medicare hospice notices of election and claims — types of bill, levels-of-care revenue codes, HCPCS/Q-codes, occurrence and condition codes, and patient discharge status — drawn from the CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 11.
What is the difference between the UB-04 and the 837I claim?
The UB-04 (CMS-1450) is the paper institutional claim form and the 837I is its electronic EDI equivalent. The crosswalk maps each UB-04 form locator to the corresponding 837I loop, segment, and element, with a parallel CMS-1500 to 837P map for professional claims.