PDPM Calculator
Price a Medicare Part A skilled nursing stay on the CMS FY2026 SNF PPS rates, effective October 1, 2025.
How PDPM payment works
How is a PDPM per diem calculated?
Five case-mix components - PT, OT, SLP, Nursing and NTA - plus a flat non-case-mix amount. Each is a federal base rate times the case-mix index for its group, then adjusted by the variable per diem schedule and the facility's CBSA wage index.
What is the PDPM variable per diem adjustment?
NTA pays 3x the base rate for days 1 to 3, then 1x. PT and OT pay full rate through day 20, then 2 percent less every 7 days. SLP and Nursing are never adjusted.
How do I find my facility's CBSA and wage index?
By county. Every US county sits in exactly one wage index area - a CBSA if it is urban, the statewide rural area if not. Pick your state and county and both are filled in from the CMS FY2026 crosswalk.
Does PDPM payment include sequestration?
Not in the rate. It withholds a flat percentage from the Medicare payment after the rate is set, so it is optional here and you enter the percentage in effect for your dates.
Does the calculator include Part A coinsurance?
Yes. Days 1 to 20 cost the beneficiary nothing; days 21 to 100 cost a fixed daily amount, $217.00 in calendar year 2026. It is prefilled and editable, and the schedule splits each day between the beneficiary and Medicare.
What is a HIPPS code?
A five-character billing code. The first four identify the PT/OT, SLP, Nursing and NTA case-mix groups and are what determine payment; the fifth is the assessment type.
Your facility’s actual numbers
This page prices what you type. SNF Insights, our skilled nursing platform, looks it up instead — a facility’s own market, wage index and VBP multiplier — and prices it against the facilities that actually compare to it.
See SNF Insights →
Estimate only. Rates, wage index and county-to-CBSA crosswalk are the published CMS FY2026
figures effective October 1, 2025. CMS publishes no wage index for rural Puerto Rico,
so it is omitted.
You set the VBP multiplier, wage index override and sequestration percentage; coinsurance is
prefilled with the CY2026 amount, which CMS resets each January and a stay can span. This page
looks nothing up for a particular facility, beneficiary or date, so confirm them.
Coinsurance applies to days 21–100 of the stay as entered and takes no account of benefit
days already used, a prior spell of illness or any secondary coverage. It applies no
interrupted-stay policy or other facility-specific adjustment, and is not a payment
determination — verify against the CMS final rule before relying on a number.
BARA Analytics is independent and is not affiliated with or endorsed by CMS.