On October 1, 2025, the MDS moved from version 1.19.1 to version 1.20.1. A few items were added, replaced or removed, and several coding rules were rewritten. Some of those rewrites change what gets coded, and so what shows up in your quality measures. This is the short list, taken from CMS’s manual and change tables.
One thing to know up front: v1.20.1 is still the item set in use. The manual that took effect on October 1, 2026 (v1.20.11) changed coding guidance but did not bring a new item set. That update has its own article.
The item changes
| Item | What changed on October 1, 2025 |
|---|---|
| A0800 → A0810 | Gender was removed and replaced with A0810, Sex. The manual says it must match the Social Security record. |
| A1250 → A1255 | The old transportation item was replaced with A1255, Transportation, a single question about the past 12 months. |
| O0390 (new) | Therapy Services: check each therapy (speech, OT, PT, respiratory, psychological) given for at least 15 minutes a day on one or more of the last 7 days. |
| O0400 (revised) | The minutes and start and end dates are gone. What remains is the number of days of respiratory therapy (O0400D2). |
| O0420 (removed) | Distinct Calendar Days of Therapy was taken off the MDS. |
| J1900 (wording) | CMS reissued the item sets on September 23, 2025 (v1.20.1v4) with new J1900 wording, made in response to provider concerns. CMS said it was the only change from the previous version. |
CMS also restructured the Section GG guidance for GG0130 (self-care) and GG0170 (mobility), to make it clearer and to line it up with the same guidance in CMS’s other post-acute manuals.
Falls: a wider definition, on both ends
This is the change most likely to move a quality measure. Two things changed in Section J.
What counts as a fall. The old manual said a fall is not the result of an overwhelming external force, and gave a resident pushing another resident as the example. v1.20.1 turns that around: the definition of a fall now includes the result of an overwhelming external force, with the same example. A resident knocked over by another resident is now a fall. A new coding tip covers therapy too. A planned loss of balance during supervised therapy is still not an intercepted fall, but if the resident comes to rest on the floor or the next lower surface despite the clinician’s effort to catch them, it is a fall.
What counts as a major injury. Under v1.19.1 the list was short: bone fractures, joint dislocations, closed head injuries with altered consciousness, and subdural hematoma. The v1.20.1 definition is open-ended:
“Includes, but is not limited to, traumatic bone fractures, joint dislocations/subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries, and crush injuries.”
Note what dropped away: a head injury no longer needs altered consciousness to count. There is one new carve-out in the other direction:
“Fractures confirmed to be pathologic (vs. traumatic) are not considered a major injury resulting from a fall.”
Why it matters: the long-stay falls with major injury measure (N013.02) counts a resident if any assessment in the look-back scan has J1900C coded 1 or 2. A wider definition means more J1900C codes, and each one stays in the measure for months. Read the imaging and the physician’s note before you code: a fracture confirmed as pathologic is not a major injury from the fall. More on this measure in falls with major injury, explained.
See your building’s falls and other quality measure rates, free.
Weight loss and gain: which weight to use
K0300 and K0310 still compare the current weight with the weight closest to 30 days ago and the weight closest to 180 days ago. The manual now says plainly that those two weights are the only two that count, adds a worked table of weight comparisons, and settles a common question:
“In cases in which multiple weights for the resident may exist during the time period being evaluated, select the weight on the date closest to the appropriate time point.”
Medications: N0415 tips and the GDR wording
The N0415 items themselves did not change in v1.20.1. Column 1 is still whether the drug class was received and Column 2 whether an indication is noted for every drug in that class. What changed is the coding tips:
- Facilities may want to pick one resource their staff always use to identify a drug’s pharmacological class, because assessors should be able to name the source behind the code.
- Assessors should check the manufacturer’s package insert and can work with the resident’s pharmacist to confirm the class. The older tip about what to do when reference materials disagree was taken out.
- The flush rule is now specific: do not code flushes that keep an IV access patent as N0415E, Anticoagulant.
The gradual dose reduction (GDR) tip for N0450 was also rewritten:
“Compliance with the requirement to perform a GDR may be met if, for example, within the first year in which a resident is admitted on an antipsychotic medication or after the facility has initiated an antipsychotic medication, the facility attempts a GDR in two separate quarters (with at least one month between the attempts), unless physician documentation is present in the medical record indicating that a GDR is clinically contraindicated.”
The old version said the facility must attempt a GDR in two quarters and must then attempt one at least annually. The new one gives the two-quarter pattern as an example of meeting the requirement and points to the State Operations Manual (42 CFR 483.45) for the rule itself.
Knock-on effects in the quality measures
CMS’s QM User’s Manual v18.0 lists what the item changes touched. A0810, Sex, is a risk adjuster in the long-stay walking measure (N035.06), and the discharge function score (S042.03) now reads its “no physical or occupational therapy” adjuster from the discharge item O0425 instead of the retired O0400 minutes. CMS says the transition did not affect any other nursing home quality measures. The v18.0 changes are covered in QM User’s Manual v18.0: what changed.
Where to look in your own data
- Falls coded since October 1, 2025 where J1900B was chosen for an injury now on the major list, or the reverse.
- Resident-to-resident altercations that ended with someone on the floor and no J1800 code.
- Weight items where a different weight in the window was used than the one closest to 30 or 180 days.
SuperQM reads the charting behind each of these codes, so you can check a fall or a weight before the assessment is locked.
Sources
- CMS, MDS 3.0 RAI Manual page (release notes for v1.20.1 and item sets v1.20.1v4)
- Final MDS 3.0 RAI Manual v1.20.1, October 2025 (PDF)
- Final MDS 3.0 RAI Manual v1.19.1, October 2024 (for comparison)
- MDS 3.0 Item Matrix v1.20.1v4, J1900 update (PDF)
- MDS 3.0 Quality Measures User’s Manual v18.0, Chapter 1, Section 5
