TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Skilled Nursing Facilities (SNFs) Chapter 8 Addendum F (FY 2019) Case-Mix Adjusted Federal Rates For Skilled Nursing Facilities (SNFs) - FY 2019 For Services Received Prior To October 1, 2019 Revision: C-44, December 13, 2019 Figure 8.F.2019-1 Case-Mix Adjusted Federal Rates For Urban SNFs By Labor And Non-Labor Component (RUG-66 Rates) RUG-IV Category Total Rate Labor Portion Non-Labor Portion Source: 83 FR 39175; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2019. RUX 832.61 586.99 245.62 RUL 814.47 574.20 240.27 RVX 741.10 522.48 218.62 RVL 664.89 468.75 196.14 RHX 671.44 473.37 198.07 RHL 598.87 422.20 176.67 RMX 6l15.93 434.23 181.70 RML 565.12 398.41 166.71 RLX 540.92 381.35 159.57 RUC 631.22 445.01 186.21 RUB 631.22 445.01 186.21 RUA 527.80 372.10 155.70 RVC 541.51 381.76 159.75 RVB 468.94 330.60 138.34 RVA 467.12 329.32 137.80 RHC 471.86 332.66 139.20 RHB 424.68 299.40 125.28 RHA 373.88 263.59 110.29 RMC 414.53 292.24 122.29 RMB 389.13 274.34 114.79 RMA 320.18 225.73 94.45 RLB 403.03 284.14 118.89 RLA 259.69 183.08 76.61 ES3 760.16 535.91 224.25 ES2 595.04 419.50 175.54 ES1 531.54 374.74 156.80 HE2 513.40 361.95 151.45 HE1 426.31 300.55 125.76 HD2 480.74 338.92 141.82 HD1 400.90 282.63 118.27 HC2 453.52 319.73 133.79 HC1 379.13 267.29 111.84 HB2 448.08 315.90 132.18 HB1 375.50 264.73 110.77 LE2 466.22 328.69 137.53 LE1 390.02 274.96 115.06 LD2 448.08 315.90 132.18 LD1 375.50 264.73 110.77 LC2 393.65 277.52 116.13 LC1 331.96 234.03 97.93 LB2 373.69 263.45 110.24 LB1 317.44 223.80 93.64 CE2 415.42 292.87 122.55 CE1 382.76 269.85 112.91 CD2 393.65 277.52 116.13 CD1 360.99 254.50 106.49 CC2 344.66 242.99 101.67 CC1 319.26 225.08 94.18 CB2 319.26 225.08 94.18 CB1 295.67 208.45 87.22 CA2 270.27 190.54 79.73 CA1 252.12 177.74 74.38 BB2 286.60 202.05 84.55 BB1 273.90 193.10 80.80 BA2 237.61 167.52 70.09 BA1 226.72 159.84 66.88 PE2 382.76 269.85 112.91 PE1 364.62 257.06 107.56 PD2 360.99 254.50 106.49 PD1 342.84 241.70 101.14 PC2 310.18 218.68 91.50 PC1 295.67 208.45 87.22 PB2 263.01 185.42 77.59 PB1 252.12 177.74 74.38 PA2 217.65 153.44 64.21 PA1 208.58 147.05 61.53 Figure 8.F.2019-2 Case-Mix Adjusted Federal Rates For Rural SNFs By Labor And Non-Labor Component (RUG-66 Rates) RUG-IV Category Total rate Labor Portion Non-Labor Portion Source: 83 FR 39176; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2019. RUX 851.84 600.55 251.29 RUL 834.50 588.32 246.18 RVX 748.46 527.66 220.80 RVL 675.65 476.33 199.32 RHX 670.29 472.55 197.74 RHL 600.95 423.67 177.28 RMX 609.14 429.44 179.70 RML 560.60 395.22 165.38 RLX 530.19 373.78 156.41 RUC 659.43 464.90 194.53 RUB 659.43 464.90 194.53 RUA 560.63 395.24 165.39 RVC 557.78 393.23 164.55 RVB 488.45 344.36 144.09 RVA 486.71 343.13 143.58 RHC 479.61 338.13 141.48 RHB 434.54 306.35 128.19 RHA 386.01 272.14 113.87 RMC 416.73 293.79 122.94 RMB 392.46 276.68 115.78 RMA 326.60 230.25 96.35 RLB 398.45 280.91 117.54 RLA 261.51 184.36 77.15 ES3 734.10 517.54 216.56 ES2 576.36 406.33 170.03 ES1 515.69 363.56 152.13 HE2 498.35 351.34 147.01 HE1 415.15 292.68 122.47 HD2 467.15 329.34 137.81 HD1 390.88 275.57 115.31 HC2 441.15 311.01 130.14 HC1 370.08 260.91 109.17 HB2 435.95 307.34 128.61 HB1 366.62 258.47 108.15 LE2 453.29 319.57 133.72 LE1 380.48 268.24 112.24 LD2 435.95 307.34 128.61 LD1 366.62 258.47 108.15 LC2 383.95 270.68 113.27 LC1 325.01 229.13 95.88 LB2 364.88 257.24 107.64 LB1 311.15 219.36 91.79 CE2 404.75 285.35 119.40 CE1 373.55 263.35 110.20 CD2 383.95 270.68 113.27 CD1 352.75 248.69 104.06 CC2 337.15 237.69 99.46 CC1 312.88 220.58 92.30 CB2 312.88 220.58 92.30 CB1 290.35 204.70 85.65 CA2 266.08 187.59 78.49 CA1 248.75 175.37 73.38 BB2 281.68 198.58 83.10 BB1 269.55 190.03 79.52 BA2 234.88 165.59 69.29 BA1 224.48 158.26 66.22 PE2 373.55 263.35 110.20 PE1 356.22 251.14 105.08 PD2 352.75 248.69 104.06 PD1 335.42 236.47 98.95 PC2 304.21 214.47 89.74 PC1 290.35 204.70 85.65 PB2 259.15 182.70 76.45 PB1 248.75 175.37 73.38 PA2 215.81 152.15 63.66 PA1 207.14 146.03 61.11 Figure 8.F.2019-3 Case-Mix Adjusted Federal Rates And Associated Indexes - Urban (RUG-66 Rates) RUG-iv Category Nursing Index Therapy Index Nursing Component Therapy Component Non-Case Mix Therapy Component Non-Case Mix Component Total Rate Source: 83 FR 39170; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2019. RUX 2.67 1.87 484.44 255.57 . . . . . . . . . . 92.60 832.89 RUL 2.57 1.87 466.30 255.57 . . . . . . . . . . 92.60 814.74 RVX 2.61 1.28 473.56 174.94 . . . . . . . . . . 92.60 741.34 RVL 2.19 1.28 397.35 174.94 . . . . . . . . . . 92.60 665.11 RHX 2.55 0.85 462.67 116.17 . . . . . . . . . . 92.60 671.66 RHL 2.15 0.85 390.10 116.17 . . . . . . . . . . 92.60 599.06 RMX 2.47 0.55 448.16 75.17 . . . . . . . . . . 92.60 616.13 RML 2.19 0.55 397.35 75.17 . . . . . . . . . . 92.60 565.31 RLX 2.26 0.28 410.05 38.27 . . . . . . . . . . 92.60 541.10 RUC 1.56 1.87 283.05 255.57 . . . . . . . . . . 92.60 631.42 RUB 1.56 1.87 283.05 255.57 . . . . . . . . . . 92.60 631.42 RUA 0.99 1.87 179.63 255.57 . . . . . . . . . . 92.60 527.97 RVC 1.51 1.28 273.97 174.94 . . . . . . . . . . 92.60 541.69 RVB 1.11 1.28 201.40 174.94 . . . . . . . . . . 92.60 469.09 RVA 1.10 1.28 199.58 174.94 . . . . . . . . . . 92.60 467.27 RHC 1.45 0.85 263.09 116.17 . . . . . . . . . . 92.60 472.01 RHB 1.19 0.85 215.91 116.17 . . . . . . . . . . 92.60 424.82 RHA 0.91 0.85 165.11 116.17 . . . . . . . . . . 92.60 374.00 RMC 1.36 0.55 246.76 75.17 . . . . . . . . . . 92.60 414.66 RMB 1.22 0.55 221.36 75.17 . . . . . . . . . . 92.60 389.25 RMA 0.84 0.55 152.41 75.17 . . . . . . . . . . 92.60 320.28 RLB 1.50 0.28 272.16 38.27 . . . . . . . . . . 92.60 403.16 RLA 0.71 0.28 128.82 38.27 . . . . . . . . . . 92.60 259.78 ES3 3.58 . . . . . . . 649.56 . . . . . . . . . . 18.00 92.60 760.41 ES2 2.67 . . . . . . . 484.44 . . . . . . . . . . 18.00 92.60 595.25 ES1 2.32 . . . . . . . 420.94 . . . . . . . . . . 18.00 92.60 531.72 HE2 2.22 . . . . . . . 402.80 . . . . . . . . . . 18.00 92.60 513.57 HE1 1.74 . . . . . . . 315.71 . . . . . . . . . . 18.00 92.60 426.45 HD2 2.04 . . . . . . . 370.14 . . . . . . . . . . 18.00 92.60 480.90 HD1 1.60 . . . . . . . 290.30 . . . . . . . . . . 18.00 92.60 401.04 HC2 1.89 . . . . . . . 342.92 . . . . . . . . . . 18.00 92.60 453.68 HC1 1.48 . . . . . . . 268.53 . . . . . . . . . . 18.00 92.60 379.26 HB2 1.86 . . . . . . . 337.48 . . . . . . . . . . 18.00 92.60 448.23 HB1 1.46 . . . . . . . 264.90 . . . . . . . . . . 18.00 92.60 375.63 LE2 1.96 . . . . . . . 355.62 . . . . . . . . . . 18.00 92.60 466.38 LE1 1.54 . . . . . . . 279.42 . . . . . . . . . . 18.00 92.60 390.15 LD2 1.86 . . . . . . . 337.48 . . . . . . . . . . 18.00 92.60 448.23 LD1 1.46 . . . . . . . 264.90 . . . . . . . . . . 18.00 92.60 375.63 LC2 1.56 . . . . . . . 283.05 . . . . . . . . . . 18.00 92.60 393.78 LC1 1.22 . . . . . . . 221.36 . . . . . . . . . . 18.00 92.60 332.07 LB2 1.45 . . . . . . . 263.09 . . . . . . . . . . 18.00 92.60 373.82 LB1 1.14 . . . . . . . 206.84 . . . . . . . . . . 18.00 92.60 317.55 CE2 1.68 . . . . . . . 304.82 . . . . . . . . . . 18.00 92.60 415.56 CE1 1.50 . . . . . . . 272.16 . . . . . . . . . . 18.00 92.60 382.89 CD2 1.56 . . . . . . . 283.05 . . . . . . . . . . 18.00 92.60 393.78 CD1 1.38 . . . . . . . 250.39 . . . . . . . . . . 18.00 92.60 361.11 CC2 1.29 . . . . . . . 234.06 . . . . . . . . . . 18.00 92.60 344.78 CC1 1.15 . . . . . . . 208.66 . . . . . . . . . . 18.00 92.60 319.37 CB2 1.15 . . . . . . . 208.66 . . . . . . . . . . 18.00 92.60 319.37 CB1 1.02 . . . . . . . 185.07 . . . . . . . . . . 18.00 92.60 295.77 CA2 0.88 . . . . . . . 159.67 . . . . . . . . . . 18.00 92.60 270.36 CA1 0.78 . . . . . . . 141.52 . . . . . . . . . . 18.00 92.60 252.21 BB2 0.97 . . . . . . . 176.00 . . . . . . . . . . 18.00 92.60 286.70 BB1 0.90 . . . . . . . 163.30 . . . . . . . . . . 18.00 92.60 273.99 BA2 0.70 . . . . . . . 127.01 . . . . . . . . . . 18.00 92.60 237.69 BA1 0.64 . . . . . . . 116.12 . . . . . . . . . . 18.00 92.60 226.80 PE2 1.50 . . . . . . . 272.16 . . . . . . . . . . 18.00 92.60 382.89 PE1 1.40 . . . . . . . 254.02 . . . . . . . . . . 18.00 92.60 364.74 PD2 1.38 . . . . . . . 250.39 . . . . . . . . . . 18.00 92.60 361.11 PD1 1.28 . . . . . . . 232.24 . . . . . . . . . . 18.00 92.60 342.96 PC2 1.10 . . . . . . . 199.58 . . . . . . . . . . 18.00 92.60 310.29 PC1 1.02 . . . . . . . 185.07 . . . . . . . . . . 18.00 92.60 295.77 PB2 0.84 . . . . . . . 152.41 . . . . . . . . . . 18.00 92.60 263.10 PB1 0.78 . . . . . . . 141.52 . . . . . . . . . . 18.00 92.60 252.21 PA2 0.59 . . . . . . . 107.05 . . . . . . . . . . 18.00 92.60 217.73 PA1 0.54 . . . . . . . 97.98 . . . . . . . . . . 18.00 92.60 208.65 Figure 8.F.2019-4 Case-Mix Adjusted Federal Rates And Associated Indexes - Rural (RUG-66 Rates) RUG-iv Category Nursing Index Therapy Index Nursing Component Therapy Component Non-Case Mix Therapy Component Non-Case Mix Component Total Rate Source: 83 FR 39171; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2019. RUX 2.67 1.87 462.82 294.71 . . . . . . . . . . 94.31 852.10 RUL 2.57 1.87 445.48 294.71 . . . . . . . . . . 94.31 834.76 RVX 2.61 1.28 452.42 201.73 . . . . . . . . . . 94.31 748.68 RVL 2.19 1.28 379.61 201.73 . . . . . . . . . . 94.31 675.85 RHX 2.55 0.85 442.02 133.96 . . . . . . . . . . 94.31 670.48 RHL 2.15 0.85 372.68 133.96 . . . . . . . . . . 94.31 601.13 RMX 2.47 0.55 428.15 86.68 . . . . . . . . . . 94.31 609.32 RML 2.19 0.55 379.61 86.68 . . . . . . . . . . 94.31 560.77 RLX 2.26 0.28 391.75 44.13 . . . . . . . . . . 94.31 530.34 RUC 1.56 1.87 270.41 294.71 . . . . . . . . . . 94.31 659.64 RUB 1.56 1.87 270.41 294.71 . . . . . . . . . . 94.31 659.64 RUA 0.99 1.87 171.61 294.71 . . . . . . . . . . 94.31 560.81 RVC 1.51 1.28 261.74 201.73 . . . . . . . . . . 94.31 557.95 RVB 1.11 1.28 192.41 201.73 . . . . . . . . . . 94.31 488.59 RVA 1.10 1.28 190.67 201.73 . . . . . . . . . . 94.31 486.86 RHC 1.45 0.85 251.34 133.96 . . . . . . . . . . 94.31 479.76 RHB 1.19 0.85 206.27 133.96 . . . . . . . . . . 94.31 434.67 RHA 0.91 0.85 157.74 133.96 . . . . . . . . . . 94.31 386.12 RMC 1.36 0.55 235.74 86.68 . . . . . . . . . . 94.31 416.86 RMB 1.22 0.55 211.47 86.68 . . . . . . . . . . 94.31 392.59 RMA 0.84 0.55 145.61 86.68 . . . . . . . . . . 94.31 326.70 RLB 1.50 0.28 260.01 44.13 . . . . . . . . . . 94.31 398.57 RLA 0.71 0.28 123.07 44.13 . . . . . . . . . . 94.31 261.59 ES3 3.58 . . . . . . . 620.56 . . . . . . . . . . 19.23 94.31 734.31 ES2 2.67 . . . . . . . 462.82 . . . . . . . . . . 19.23 94.31 576.52 ES1 2.32 . . . . . . . 402.15 . . . . . . . . . . 19.23 94.31 515.83 HE2 2.22 . . . . . . . 384.81 . . . . . . . . . . 19.23 94.31 498.50 HE1 1.74 . . . . . . . 301.61 . . . . . . . . . . 19.23 94.31 415.27 HD2 2.04 . . . . . . . 353.61 . . . . . . . . . . 19.23 94.31 467.29 HD1 1.60 . . . . . . . 277.34 . . . . . . . . . . 19.23 94.31 390.99 HC2 1.89 . . . . . . . 327.61 . . . . . . . . . . 19.23 94.31 441.28 HC1 1.48 . . . . . . . 256.54 . . . . . . . . . . 19.23 94.31 370.19 HB2 1.86 . . . . . . . 322.41 . . . . . . . . . . 19.23 94.31 436.08 HB1 1.46 . . . . . . . 253.08 . . . . . . . . . . 19.23 94.31 366.72 LE2 1.96 . . . . . . . 339.75 . . . . . . . . . . 19.23 94.31 453.41 LE1 1.54 . . . . . . . 266.94 . . . . . . . . . . 19.23 94.31 380.59 LD2 1.86 . . . . . . . 322.41 . . . . . . . . . . 19.23 94.31 436.08 LD1 1.46 . . . . . . . 253.08 . . . . . . . . . . 19.23 94.31 366.72 LC2 1.56 . . . . . . . 270.41 . . . . . . . . . . 19.23 94.31 384.06 LC1 1.22 . . . . . . . 211.47 . . . . . . . . . . 19.23 94.31 325.11 LB2 1.45 . . . . . . . 251.34 . . . . . . . . . . 19.23 94.31 364.99 LB1 1.14 . . . . . . . 197.61 . . . . . . . . . . 19.23 94.31 311.23 CE2 1.68 . . . . . . . 291.21 . . . . . . . . . . 19.23 94.31 404.87 CE1 1.50 . . . . . . . 260.01 . . . . . . . . . . 19.23 94.31 373.66 CD2 1.56 . . . . . . . 270.41 . . . . . . . . . . 19.23 94.31 384.06 CD1 1.38 . . . . . . . 239.21 . . . . . . . . . . 19.23 94.31 352.85 CC2 1.29 . . . . . . . 223.61 . . . . . . . . . . 19.23 94.31 337.24 CC1 1.15 . . . . . . . 199.34 . . . . . . . . . . 19.23 94.31 312.97 CB2 1.15 . . . . . . . 199.34 . . . . . . . . . . 19.23 94.31 312.97 CB1 1.02 . . . . . . . 176.81 . . . . . . . . . . 19.23 94.31 290.43 CA2 0.88 . . . . . . . 152.54 . . . . . . . . . . 19.23 94.31 266.15 CA1 0.78 . . . . . . . 135.21 . . . . . . . . . . 19.23 94.31 248.81 BB2 0.97 . . . . . . . 168.14 . . . . . . . . . . 19.23 94.31 281.76 BB1 0.90 . . . . . . . 156.01 . . . . . . . . . . 19.23 94.31 269.62 BA2 0.70 . . . . . . . 121.34 . . . . . . . . . . 19.23 94.31 234.94 BA1 0.64 . . . . . . . 110.94 . . . . . . . . . . 19.23 94.31 224.54 PE2 1.50 . . . . . . . 260.01 . . . . . . . . . . 19.23 94.31 373.66 PE1 1.40 . . . . . . . 242.68 . . . . . . . . . . 19.23 94.31 356.32 PD2 1.38 . . . . . . . 239.21 . . . . . . . . . . 19.23 94.31 352.85 PD1 1.28 . . . . . . . 221.88 . . . . . . . . . . 19.23 94.31 335.51 PC2 1.10 . . . . . . . 190.67 . . . . . . . . . . 19.23 94.31 304.30 PC1 1.02 . . . . . . . 176.81 . . . . . . . . . . 19.23 94.31 290.43 PB2 0.84 . . . . . . . 145.61 . . . . . . . . . . 19.23 94.31 259.22 PB1 0.78 . . . . . . . 135.21 . . . . . . . . . . 19.23 94.31 248.81 PA2 0.59 . . . . . . . 102.27 . . . . . . . . . . 19.23 94.31 215.87 PA1 0.54 . . . . . . . 93.60 . . . . . . . . . . 19.23 94.31 207.20 - END -