TRICARE manuals now include a Patient-Driven Payment Model (PDPM) for Skilled Nursing Facility (SNF) reimbursement

June 9, 2020

Retroactive to October 1, 2019, TRICARE has adopted the Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) payment methods, including Minimum Data Set (MDS) assessments, Patient-Driven Payment Model (PDPM) classifications and Medicare weights and per diem rates.


Under PDPM, there are six payment components. Five are case-mix adjusted to allow for diagnostic variances and illness severity; the sixth is non-case-mix adjusted and covers SNF resources that do not vary according to beneficiary characteristics.

  • Physical Therapy (PT) – includes a variable per diem factor
  • Occupational Therapy (OT) – includes a variable per diem factor
  • Speech Language Pathology (SLP)
  • Nursing
  • Non-Therapy Ancillary (NTA) services – includes a variable per diem factor

See the TRICARE Reimbursement Manual, Chapter 8, Section 2 for more information.