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​​​​​​​​​​Distinct Part Pediatric Subacute

DP/PSA reimbursement will shift from an August to July rate year basis to a calendar rate year basis, effective January 1, 2024, pending federal approval in State Plan Amendment 23-0032.​

2024 Rates - Updated in Accordance with the LTC Claim Form and Code Conversion Data Elements​​

Effective 2/1/2024 through 12/31/2024

Service Type​​​
Value Code​​Value Code Amount
​​Revenue Code
​Per Diem
​​Rehab Therapy
​24
​83
​0199
​$85.64
​Vent Weaning
​24
​84
​0199
​$79.84
​Ventilator
​24
​85
​0190
​$1,375.00
​Non-Ventilator
​24
​86
​0190
​$1,259.58


Bed Hold/Leave of Absence Rates - Effective 2/1/2024 through 12/31/2024​

​​Service Type
​Value Code
​Value Code Amount
​​Revenue Code
Bed Hold/Leave of Absense Per Diem​
Ventilator​
​​24
​87
​0185
​$1,365.48
​​Non-Ventilator
​24
​88
​0185
​$1,250.06
​Ventilator
​24
​89
​0180
​$1,365.48
​​Non-Ventilator​
​24
​90
​0180
​$1,250.06​

Notes:

For more information, please visit LTC Claim Form and Code Conversion​​ webpage. ​​

2024 Rates - ​​​​Local Accommodation Codes​

Effective 1/1/2024 through 1/31/2024

​​​Serv​ice Type

 Accommodation Code Per Diem Bed Hold / Leave of Absence Accommodation Code
Bed Hold / Leave of Absence
Per Diem
Rehab Therapy
83
$85.64
n/a
n/a
Vent Weaning
84
$79.84
n/a
n/a
Ventilator
85
$1,375.00
87/89
$1,365.48
Non-Ventilator
86
$1,259.58
88/90
$1,250.06


 

DP/PSA Bridge Period Rates - Effective 8/1/2023 to 12/31/2023

​​​​Service Type

 Accommodation Code Per Diem Bed Hold / Leave of Absence Accommodation Code
Bed Hold / Leave of Absence
Per Diem
Rehab Therapy
83
$82.42
n/a
n/a
Vent Weaning
84
$76.84
n/a
n/a
Ventilator85
$1,322.07
87/89
$1,312.61
Non-Ventilator86
$1,210.45
88/90
$1,200.99

​​2022-23 Rates

Helpful Links

Freestanding Skilled Nursing Facilities and Subacute Units (ca.gov) 

​Contact Us

Please send questions regarding DP/PSA rates to LTCReimbursement@dhcs.ca.gov​​​​​​

Last modified date: 5/28/2024 9:39 AM