PDPM Case Mix Calculator (FY 2026) | Generate HIPPS Billing Codes

Clinical Category

Select primary clinical category

Section GG Function Score

MDS Response Codes & PDPM Point Values

6 Independent 5 Setup/clean-up 4 Supervision/touching 3 Partial/mod assist 2 Max/substantial assist 1 Dependent/2-person 7 Refused 88 Not attempted (medical) 9 Not applicable 10 Not done (environment)

Codes 5 & 6 = 4 pts | Code 4 = 3 pts | Code 3 = 2 pts | Code 2 = 1 pt | Codes 1, 7, 9, 10, 88 = 0 pts

GG0130A – Eating

GG0130B – Oral hygiene

GG0130C – Toileting hygiene

Bed mobility — averaged (GG0170B + GG0170C) ÷ 2

GG0170B – Sit to lying

GG0170C – Lying to sitting on side of bed

Transfers — averaged (GG0170D + GG0170E + GG0170F) ÷ 3

GG0170D – Sit to stand

GG0170E – Chair/bed-to-chair transfer

GG0170F – Toilet transfer

Walking — averaged (GG0170J + GG0170K) ÷ 2

GG0170I (Walk 10 ft) coded not attempted (7, 88, 9, or 10) — walking items GG0170J & GG0170K auto-scored 0 pts

GG0170J – Walk 50 feet with 2 turns

GG0170K – Walk 150 feet

PT / OT Result

Acute Neurologic Condition / SLP Comorbidities / Cognitive Impairment

SLP-related comorbidities: Aphasia (I4300), CVA/TIA/Stroke (I4500), Hemiplegia or Hemiparesis (I4900), TBI (I5500), Tracheostomy (O0110E1b), Invasive mechanical ventilator (O0110F1b), Laryngeal cancer, Apraxia, Dysphagia, ALS, Oral cancers, Speech and language deficits (I8000).

Cognitive impairment is based on BIMS or PDPM staff assessment for mental status. See RAI Manual Ch. 6.

None of the above Any one present (acute neurologic condition, SLP comorbidity, OR cognitive impairment) Any two present All three present

Swallowing Disorder (K0100A–D) / Mechanically Altered Diet (K0520C3)

Neither present Either one present Both present

SLP Result

Nursing Classification — Select Highest Applicable

Category

Depression End-Split

Depressed — D0160 Total Severity Score ≥ 10 (not 99), or D0600 Total Severity Score ≥ 10

Nursing GG-Based Function Score

MDS Response Codes & PDPM Point Values

6 Independent 5 Setup/clean-up 4 Supervision/touching 3 Partial/mod assist 2 Max/substantial assist 1 Dependent/2-person 7 Refused 88 Not attempted (medical) 9 Not applicable 10 Not done (environment)

Codes 5 & 6 = 4 pts | Code 4 = 3 pts | Code 3 = 2 pts | Code 2 = 1 pt | Codes 1, 7, 9, 10, 88 = 0 pts

GG0130A – Eating

GG0130C – Toileting hygiene

GG0170B – Sit to lying

GG0170C – Lying to sitting on side of bed

GG0170D – Sit to stand

GG0170E – Chair/bed-to-chair transfer

GG0170F – Toilet transfer

Nursing Result

NTA Conditions / Extensive Services — Check All That Apply

Total NTA Score 0

NTA Result

Assessment Type

5-Day PPS assessment Interim Payment Assessment (IPA)

All Component Results

PDPM HIPPS Billing Code

– – – – –

HIPPS Code Key

Character	Represents
1st	PT and OT case-mix group
2nd	SLP case-mix group
3rd	Nursing case-mix group
4th	Non-therapy ancillary (NTA) case-mix group
5th	Assessment indicator (0 = IPA, 1 = 5-Day PPS)