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PDPM Reimbursement Calculator

Estimate a skilled nursing facility Medicare Part A per-diem under the Patient Driven Payment Model. Enter the primary diagnosis, Section GG function scores and clinical drivers to see the PT, OT, SLP, Nursing and NTA case-mix components, an estimated HIPPS code, and the wage-index-adjusted rate for your locality.

Clinical inputs
Values mirror the PDPM grouper drivers captured on the 5-day MDS.

Mapped clinical category: Major Joint Replacement or Spinal Surgery

Clinical drivers
Estimated payment
HIPPS T6A141 · function score 32

Adjusted per-diem

$505.43

National $505.43 · wage index 1.0000

Projected stay revenue

$12,635.75

25 days

PDPM component case-mix and dollars
ComponentGroupCMIPer-diem
PTT61.24$76.93
OTT61.18$68.15
SLPA0.68$16.91
NursingC1.30$144.33
NTA41.24$102.13

Labor portion $346.88 (68.63% × wage index 1.0000) + non-labor $158.55 = $505.43 per day.

NTA pays 3× base for days 1-3, then 1× thereafter (variable per-diem adjustment).

PT/OT pay 100% for days 1-20, then decline 2% every 7 days.

Assumptions
These are the factors behind every dollar above. Edit any of them to model your own rates — the estimate, scenarios and PDF recompute immediately.
Federal base rates (per day)

Default $62.04

Default $57.75

Default $24.87

Default $111.02

Default $82.36

Default $96.98

CMS default 68.63%; the remainder is non-labor and is never wage adjusted.

Published value for National average, — (CBSA —).

Variable per-diem multipliers
Scenario comparison
Save the current input set, then change the drivers and save again to compare projected stay revenue side by side. Scenarios stay in this browser.

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Take this further
MDS Command runs the same grouper against live referrals, evidence mapping and audit packets.
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How PDPM reimbursement is calculated

Under PDPM, a SNF Part A day is the sum of five case-mix adjusted components plus a fixed non-case-mix component. Each component has a federal base rate multiplied by the case-mix index of the resident's group: PT and OT are driven by the primary diagnosis clinical category and the Section GG function score, SLP by cognition, swallowing and SLP comorbidities, Nursing by the RUG-IV derived nursing category, and NTA by comorbidity points.

Variable per-diem adjustments

NTA pays at three times the base rate for days 1–3, then drops to 1.0. PT and OT decline by 2% every seven days starting on day 21, which is why a long stay averages below the day-one rate.

Wage index adjustment

CMS splits the per-diem into a labor share of 68.63% and a non-labor share of 31.37%. Only the labor share is multiplied by your CBSA wage index, so a facility in a high-wage market earns materially more per day than the national average for the identical HIPPS code.

Estimates are for planning only and are not a substitute for the completed MDS assessment or your MAC's published rates.