PDPM Payment Calculator
CMS FY2026 official case-mix adjusted federal rates (Oct 1, 2025 – Sep 30, 2026).
Or manually select Urban / Rural (no wage index):
PT/OT Therapy Function Score (TFS): GG0130A1 (Eating) + GG0130B1 (Oral Hygiene) + GG0130C1 (Toileting Hygiene) + avg(GG0170B1, GG0170C1) (Bed Mobility) + avg(GG0170D1, GG0170E1, GG0170F1) (Transfers) + avg(GG0170J1, GG0170K1) (Walking). Each item scored 01–06 (converted to 0–4). Total range 0–24. CMS groups into 4 TFS ranges for PT/OT classification.
The SLP group is determined by counting how many of 3 factors apply (0–3), then the swallowing dimension. Only an Acute Neurologic primary diagnosis qualifies as Factor 1 — it cannot count if another diagnosis is primary.
Factor 1: Acute Neurologic Primary Dx
Auto-set from Clinical Category above (I0020B maps to Acute Neurologic)
Factor 3: Cognitive Impairment (BIMS / CPS)
BIMS ≤ 12 or CPS ≥ 3 (Section C)
Swallowing Dimension (separate from factor count):
Check all MDS-coded conditions. The highest qualifying tier is used (hierarchical). Some conditions require both items to be present.
Highest acuity — at least one extensive service while a resident (NFS 0–14 required)
High-acuity conditions — NFS 0–14 required (NFS 15–16 drops to Clinically Complex)
Requires both:
Requires both:
Requires both:
Requires both:
Requires both:
Requires both:
Specific conditions — NFS 0–14 required; Parkinson's/CP/MS require NFS ≤ 11
Requires both:
Requires both:
Active skilled conditions — function score 0–16 (CA1/CA2 for NFS 15–16)
Requires both:
Requires both:
Requires both:
NFS must be ≥ 12 (if NFS ≤ 11 falls to Reduced Physical Function). Requires cognitive impairment (BIMS ≤ 9 or staff assessment) OR one or more qualifying behavioral symptoms.
Requires both:
Default category — applies when no higher-tier condition is met. Based solely on NFS and depression.
Nursing Function Score (NFS)
Sum of GG0130A1 (Eating) + GG0130C1 (Toileting Hygiene) + avg(GG0170B1, GG0170C1) (Bed Mobility) + avg(GG0170D1, GG0170E1, GG0170F1) (Transfers). Range: 0–16. Each item: 01/07/09/10/88=0, 02=1, 03=2, 04=3, 05–06=4.
Check all conditions/treatments present. Points are totaled automatically.
