Per CMS Medicare Chapter 6 guidelines:
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update Fiscal Year (FY) 2023

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Transmittals/r11541cp

120.6 – Default Billing
(Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19)

As under RUG-IV, there may be instances in which providers may bill the “default” rate on a SNF claim (e.g., when an MDS assessment is considered late).

• The default rate refers to the lowest possible per diem rate.
• The default code under PDPM is ZZZZZ, as compared to the default code under

RUG-IV of AAA00.
• Billing the default code under PDPM represents the equivalent of billing the

following PDPM groups:
PT Payment Group: TP
OT Payment Group: TP
SLP Payment Group: SA Nursing Payment Group: PA1 NTA Payment Group: NF

The guideline provided above has lots of great information and is worth checking out.

Please reach out if need guidance related to PPS scheduling or education re: guidelines.

The information presented is informative and does not constitute direct legal or regulatory advice

September 2024\Skilled Nursing Support\maria.messina@skillednursingsupport.com

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