Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Skilled Nursing Facilities (SNFs)
Chapter 8
Addendum C
Resource Utilization Group-III/IV (RUG-III/IV) For Services Received Prior To October 1, 2019
Revision:  C-44, December 13, 2019
Figure 8.C-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.C-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.C-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 -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.11.8372.15705

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.