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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Skilled Nursing Facilities (SNFs)
Chapter 8
Addendum A
Resource Utilization Group-III/IV (RUG-III/IV)
Revision:  
Figure 8.A-1  RUG-44 Category (RUG-III Before January 1, 2006)
RUG-44 Code
Category And Definition
ADL Index
Rehabilitation Groups
RUC
Rehabilitation, Ultra High
16-18
RUB
Rehabilitation, Ultra High
9-15
RUA
Rehabilitation, Ultra High
4-8
RVC
Rehabilitation, Very High
16-18
RVB
Rehabilitation, Very High
9-15
RVA
Rehabilitation, Very High
4-8
RHC
Rehabilitation, High
13-18
RHB
Rehabilitation, High
8-12
RHA
Rehabilitation, High
4-7
RMC
Rehabilitation, Medium
15-18
RMB
Rehabilitation, Medium
8-14
RMA
Rehabilitation, Medium
4-7
RLB
Rehabilitation, Low
14-18
RLA
Rehabilitation, Low
4-13
Extensive Services
SE3
Extensive Services 3
7-18
SE2
Extensive Services 2
7-18
SE1
Extensive Services 1
7-18
Special Care
SSC
Special Care
17-18
SSB
Special Care
15-16
SSA
Special Care
7-14
Clinically Complex
CC2
Clinically Complex with Depression
17-18
CC1
Clinically Complex
17-18
CB2
Clinically Complex with Depression
12-16
CB1
Clinically Complex
12-16
CA2
Clinically Complex with Depression
4-11
CA1
Clinically Complex
4-11
Impaired Cognition
IB2
Impaired Cognition
6-10
IB1
Impaired Cognition, not receiving Nursing Rehab
6-10
IA2
Impaired Cognition
4-5
IA1
Impaired Cognition, not receiving Nursing Rehab
4-5
Behavior Only
BB2
Behavior Only
6-10
BB1
Behavior Only, not receiving Nursing Rehab
6-10
BA2
Behavior Only
4-5
BA1
Behavior Only, not receiving Nursing Rehab
4-5
Physical Function Reduced
PE2
Physical Function Reduced
16-18
PE1
Physical Function Reduced, not receiving Nursing Rehab
16-18
PD2
Physical Function Reduced
11-15
PD1
Physical Function Reduced, not receiving Nursing Rehab
11-15
PC2
Physical Function Reduced
9-10
PC1
Physical Function Reduced, not receiving Nursing Rehab
9-10
PB2
Physical Function Reduced
6-8
PB1
Physical Function Reduced, not receiving Nursing Rehab
6-8
PA2
Physical Function Reduced
4-5
PA1
Physical Function Reduced, not receiving Nursing Rehab
4-5
Figure 8.A-2  RUG-53 Category (RUG-III Effective January 1, 2006)
RUG-53 Code
Category And Definition
ADL Index
Rehabilitation Plus Extensive Services Groups
RUX
Rehabilitation, Ultra High, Plus Extensive Services, High
16-18
RUL
Rehabilitation, Ultra High, Plus Extensive Services, Low
7-15
RVX
Rehabilitation, Very High, Plus Extensive Services, High
16-18
RVL
Rehabilitation, Very High, Plus Extensive Services, Low
7-15
RHX
Rehabilitation, High, Plus Extensive Services, High
13-18
RHL
Rehabilitation, High, Plus Extensive Services, Low
7-12
RMX
Rehabilitation, Medium, Plus Extensive Services, High
15-18
RML
Rehabilitation, Medium, Plus Extensive Services, Low
7-14
RLX
Rehabilitation, Low, Plus Extensive Services
7-18
Rehabilitation Groups
RUC
Rehabilitation, Ultra High
16-18
RUB
Rehabilitation, Ultra High
9-15
RUA
Rehabilitation, Ultra High
4-8
RVC
Rehabilitation, Very High
16-18
RVB
Rehabilitation, Very High
9-15
RVA
Rehabilitation, Very High
4-8
RHC
Rehabilitation, High
13-18
RHB
Rehabilitation, High
8-12
RHA
Rehabilitation, High
4-7
RMC
Rehabilitation, Medium
15-18
RMB
Rehabilitation, Medium
8-14
RMA
Rehabilitation, Medium
4-7
RLB
Rehabilitation, Low
14-18
RLA
Rehabilitation, Low
4-13
Extensive Services
SE3
Extensive Services 3
7-18
SE2
Extensive Services 2
7-18
SE1
Extensive Services 1
7-18
Special Care
SSC
Special Care
17-18
SSB
Special Care
15-16
SSA
Special Care
7-14
Clinically Complex
CC2
Clinically Complex with Depression
17-18
CC1
Clinically Complex
17-18
CB2
Clinically Complex with Depression
12-16
CB1
Clinically Complex
12-16
CA2
Clinically Complex with Depression
4-11
CA1
Clinically Complex
4-11
Impaired Cognition
IB2
Impaired Cognition
6-10
IB1
Impaired Cognition, not receiving Nursing Rehab
6-10
IA2
Impaired Cognition
4-5
IA1
Impaired Cognition, not receiving Nursing Rehab
4-5
Behavior Only
BB2
Behavior Only
6-10
BB1
Behavior Only, not receiving Nursing Rehab
6-10
BA2
Behavior Only
4-5
BA1
Behavior Only, not receiving Nursing Rehab
4-5
Physical Function Reduced
PE2
Physical Function Reduced
16-18
PE1
Physical Function Reduced, not receiving Nursing Rehab
16-18
PD2
Physical Function Reduced
11-15
PD1
Physical Function Reduced, not receiving Nursing Rehab
11-15
PC2
Physical Function Reduced
9-10
PC1
Physical Function Reduced, not receiving Nursing Rehab
9-10
PB2
Physical Function Reduced
6-8
PB1
Physical Function Reduced, not receiving Nursing Rehab
6-8
PA2
Physical Function Reduced
4-5
PA1
Physical Function Reduced, not receiving Nursing Rehab
4-5
Figure 8.A-3  RUG-66 Category (RUG-IV Effective October 1, 2010)
RUG-66 Code
Category And Definition
ADL Index
Rehabilitation Plus Extensive Services Groups
RUX
Rehabilitation, Ultra High, Plus Extensive Services, High
11-16
RUL
Rehabilitation, Ultra High, Plus Extensive Services, Low
2-10
RVX
Rehabilitation, Very High, Plus Extensive Services, High
11-16
RVL
Rehabilitation, Very High, Plus Extensive Services, Low
2-10
RHX
Rehabilitation, High, Plus Extensive Services, High
11-16
RHL
Rehabilitation, High, Plus Extensive Services, Low
2-10
RMX
Rehabilitation, Medium, Plus Extensive Services, High
11-16
RML
Rehabilitation, Medium, Plus Extensive Services, Low
2-10
RLX
Rehabilitation, Low, Plus Extensive Services, Low
2-16
Rehabilitation Groups
RUC
Rehabilitation, Ultra High
11-16
RUB
Rehabilitation, Ultra High
6-10
RUA
Rehabilitation, Ultra High
0-5
RVC
Rehabilitation, Very High
11-16
RVB
Rehabilitation, Very High
6-10
RVA
Rehabilitation, Very High
0-5
RHC
Rehabilitation, High
11-16
RHB
Rehabilitation, High
6-10
RHA
Rehabilitation, High
0-5
RMC
Rehabilitation, Medium
11-16
RMB
Rehabilitation, Medium
6-10
RMA
Rehabilitation, Medium
0-5
RLB
Rehabilitation, Low
11-16
RLA
Rehabilitation, Low
0-10
Extensive Services
ES3
Tracheostomy & Ventilator/Respirator
2-16
ES2
Tracheostomy & Ventilator/Respirator
2-16
ES1
Isolation for Active Infectious Disease
2-16
Special Care High
HE2
Clinically High with Depression
15-16
HD2
Clinically High with Depression
11-14
HC2
Clinically High with Depression
6-10
HB2
Clinically High with Depression
2-5
HE1
Clinically High
15-16
HD1
Clinically High
11-14
HC1
Clinically High
6-10
HB1
Clinically High
2-5
Special Care Low
LE2
Clinically Low with Depression
15-16
LD2
Clinically Low with Depression
11-14
LC2
Clinically Low with Depression
6-10
LB2
Clinically Low with Depression
2-5
LE1
Clinically Low
15-16
LD1
Clinically Low
11-14
LC1
Clinically Low
6-10
LB1
Clinically Low
2-5
Clinically Complex
CE2
Clinically Complex with Depression
15-16
CD2
Clinically Complex with Depression
11-14
CC2
Clinically Complex with Depression
6-10
CB2
Clinically Complex with Depression
2-5
CA2
Clinically Complex with Depression
0-1
CE1
Clinically Complex
15-16
CD1
Clinically Complex
11-14
CC1
Clinically Complex
6-10
CB1
Clinically Complex
2-5
CA1
Clinically Complex
0-1
BEHAVIORAL SYMPTOMS AND COGNITIVE PERFORMANCE
BB2
Nursing Rehab 2+
2-5
BA2
Nursing Rehab 2+
0-1
BB1
Nursing Rehab 0 to 1
2-5
BA1
Nursing Rehab 0 to 1
0-1
Physical Function Reduced
PE2
Physical Function Reduced, with Nursing Rehab 2+
15-16
PD2
Physical Function Reduced, with Nursing Rehab 2+
11-14
PC2
Physical Function Reduced, with Nursing Rehab 2+
6-10
PB2
Physical Function Reduced, with Nursing Rehab 2+
2-5
PA2
Physical Function Reduced, with Nursing Rehab 2+
0-1
PE1
Physical Function Reduced, with Nursing Rehab 0 to 1
15-16
PD1
Physical Function Reduced, with Nursing Rehab 0 to 1
11-14
PC1
Physical Function Reduced, with Nursing Rehab 0 to 1
6-10
PB1
Physical Function Reduced, with Nursing Rehab 0 to 1
2-5
PA1
Physical Function Reduced, with Nursing Rehab 0 to 1
0-1
- END -
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