Attention Billers: Implementation of the SNF PDPM – Updates to Default HIPPS Code

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS issued Change Request:11513 on January 9, 2020 to inform SNFs and Swing Bed Providers that a previous CR (11152) “erroneously omitted the default Health Insurance Prospective Payment System (HIPPS) code from the CR. This CR will implement change to include the instructions to bypass certain SNF PDPM edits.  This correction also revises the background section and adds two new requirements (11513.4 and 11513.5). All other information remains the same…no policy change.”  This CR corrects Chapter 6 of CMS publication 100-04 Medicare Claims Processing Manual.

EFFECTIVE DATE: April 1, 2020

*Unless otherwise specified, the effective date is the date of service.


A corresponding MLN Matters (MM11513) provides additional information as well as document history.

Be sure to pass this Change Request on to your billers.