What Is A Rug Code

Change request process see file below describes the steps necessary to request a modification in the hipps codeset and the cms code approval process.

What is a rug code.

Hcbs waiver dhcf dc gov. 4 apr 2020 the centers for medicare medicaid services cms recognizes that the. 63 billing codes. Medicare must include a list of medications related to the injured worker s allowed appropriate bwc local level code for nursing facility.

Billing codes requiring prior authorization. Final report this is the final report from the urban institute march 2007 that describes data sources and methodological approaches used in the research of the rug. The grouper outputs the rug iv code which is combined with an assessment indicator to create the hipps. Access the listings of resource utilization groups rugs for skilled nursing facilities snfs from the links below.

Resource utilization groups rugs rugs are mutually exclusive categories that reflect levels of resource need in long term care settings primarily to facilitate medicare and medicaid payment they are assigned to individuals based on data elements derived from the ltc minimum data set mds there is a standard order or hierarchy and each rug. This instruction contains new hipps codes resulting from the conversion to the new rug iv coding system. Effective october 1 2016 excel. The hcpcs rates field must contain a 5 digit hipps code.

Hipps codes are based on assessments made using the minimum data set mds. The 5 digit hipps code includes two components. Each rug has a different medicare per diem payment rate. For a complete list of ai codes see page 22.

Medicare resource utilization group iv rug hipps codes and. The first three positions of the code contain the rug group and the last two positions of the code contain a 2 digit assessment indicator ai code. The 3 digit classification code assigned to each rug group and newly defined 2 digit assessment. Rug iv categories and characteristics 1 major rug iv category rug iv score characteristics associated with major rug iv category rehabilitation plus extensive services rux rul rvx rvl rhx rhl rmx rml rlx residents satisfying all of the following three conditions.

Effective october 1 2014 excel. Hipps code master list see file below an excel spreadsheet that provides a complete list of all valid hipps codes with their effective dates payment settings and code definitions. Effective october 1 2017 excel. Effective october 1 2015 excel.

Due to rounding a slight variance may exist between the spreadsheets below and actual medicare payments. Grouper software run at a skilled nursing facility or swing bed hospital uses specific data elements from the mds to assign beneficiaries to a rug iv code.