SNF PPS Pricer Software

30.4 - SNF PPS Pricer Software (Rev. 13089; Issued: 02-21-25; Effective: 05-22-25; Implementation: 05-22-25) The Balanced Budget Act (BBA) of 1997 (Public Law 105-33) mandated the implementation of a per diem prospective payment system (PPS) for skilled nursing facilities (SNFs), covering all costs (routine, ancillary, and capital) of covered SNF services furnished to beneficiaries under Part A of the Medicare program. Effective for cost reporting periods beginning on or after July 1, 1998, all skilled nursing services billed on TOB 21x will be paid based on calculations made by the SNF Pricer. The SNF Pricer operates as a module within CMS’ claims processing systems. The SNF Pricer makes all payment calculations applicable under SNF PPS. Medicare claims processing systems maintain a client that communicates with the SNF Pricer application programming interface (API). The Pricer is made available electronically to the shared systems and is updated at least annually. The API describing the elements of SNF PPS claims that are used and the source code that calculates payments in the SNF Pricer are available to SNFs and their software vendors at: https://www.cms.gov/pricersourcecodesoftware. This is code is shared informationally. No part of the SNF Pricer logic is required to be incorporated into a SNF’s billing system in order to bill Medicare. A web-based version of the SNF Pricer Program that may be used to estimate SNF PPS payments can be found at: https://webpricer.cms.gov/ . Annual Updates to the SNF Pricer Rate and weight information used by the SNF Pricer is updated periodically, usually annually. Updates occur each October, to reflect the fact that SNF PPS rates are effective for a Federal fiscal year. Updates may also occur at other points in the year when required by legislation. As of October 1, 2019, SNF PPS payments are made using the Patient-Driven Payment Model (PDPM). The rate components under the PDPM are described in Section 120. Whenever these components are updated, Medicare also publishes a Recurring Update Notification to inform providers and A/B MACs about the changes. These Recurring Update Notifications also describe how the changes will be implemented through the SNF Pricer.