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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Skilled Nursing Facilities (SNFs)
Chapter 8
Addendum D (FY 2019)
Example Of Computation of Adjusted Prospective Payment System (PPS) Rates And Skilled Nursing Facility (SNF) Payment - FY 2019 For Services Received Prior To October 1, 2019
Revision:  C-44, December 13, 2019
Using the SNF XYZ, the following shows the adjustments made to the Federal per diem rate to compute the provider’s actual per diem PPS payment. SNF XYZ’s total PPS payment would equal $48,779.14. The Labor and Non-Labor columns are derived from Addendum F (FY 2019). Wage index is derived from Addendum G (FY 2019).
SNF XYZ: Located In Frederick, MD (Urban CBSA 43524) Wage Index: 0.9880
RUG-IV
Group
Labor
Wage Index
Adj. Labor
Non-Labor
Adj. Rate
Percent Adj.
SNF Days
Payment
Source: 83 FR 39178; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities For FY 2019.
RVX
$522.48
0.9880
$516.21
$218.62
$734.83
$734.83
14
$10,287.62
ES2
$419.50
0.9880
$414.47
$175.54
$590.01
$590.01
30
$17,700.30
RHA
$263.59
0.9880
$260.43
$110.29
$370.72
$370.72
16
$5,931.52
CC2*
$242.99
0.9880
$240.07
$101.67
$341.74
$779.17
10
$7,791.70
BA2
$167.52
0.9880
$165.51
$70.09
$235.60
$235.60
30
$7,068.00
100
$48,779.14
*  Reflects a 128% adjustment from section 511 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
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