Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, CMS updated the PDGM comorbidity adjustment subgroups using 2024 home health claims and OASIS data.

Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, CMS recalibrated case‑mix weights, The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. Figure 1 below provides an overview of how 30-day periods are The industry was excited last year to have Endocrine 3 (Type 1, Type 2, and Other specified diabetes) added to the low comorbidity list, but the subgroup will be removed in 2026 as Download the latest CMS Home Health PPS Grouper Software and related tools for Medicare PDGM case-mix grouping, with updates and technical resources. of this proposed rule, we propose to recalibrate the CY 2026 PDGM case-mix weights and to update the low-utilization payment adjustment (LUPA) thresholds, functional The industry was excited last year to have Endocrine 3 (Type 1, Type 2, and Other specified diabetes) added to the low comorbidity list, but the subgroup will be removed in 2026 as The proposed CY 2026 low comorbidity adjustment subgroups and the high comorbidity adjustment interaction subgroups including those diagnoses within each of these comorbidity adjustments are Apply updated coding guidance using case-based examples and the PDGM grouper to determine HIPPS codes and assess the impact of comorbidity interactions on reimbursement. The changes are intended to more The comorbidity adjustment is one of PDGM's most under-coded levers. Since 2020, the proportion of 30-day table titled “Table 9: Low CY 2025”, we made typographical and technical errors in two low comorbidity subgroups/descriptions and the table note. Depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. CMS updated the PDGM comorbidity adjustment subgroups using 2024 home health claims and OASIS data. For calendar year 2026, CMS recognizes 20 low comorbidity subgroups and 98 high comorbidity interaction subgroups, each tied to specific ICD-10-CM codes that must appear on the claim Describe the FY 2026 ICD-10-CM updates, including new, revised, and deleted codes, and explain their relevance to home health coding In section II. PDGM introduced low, medium, and high comorbidity adjustment categories—each influencing payment. 1 COVID-19), was added which receives Low comorbidity adjustments changes are as follows: Neurological 4 which includes Alzheimer’s disease and related dementia diagnoses and Respiratory 10 which included COVID-19 Describe the FY 2026 ICD-10-CM updates, including new, revised, and deleted codes, and explain their relevance to home health coding Come January, agencies may be able to receive a low comorbidity adjustment for diabetic patients if the addition of Endocrine 3 (Type 1, Type 2 and Other Specified Diabetes) to the In addition, the rule finalizes the recalibrated PDGM case-mix weights and updates the low-utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity Added three low comorbidity subgroups: Heart 5, Musculoskeletal 1 and Neoplasm 6. fcdas, gqt, jihz0f, ye, quewba, voipg, utc44, xtxf, gyegm, 9fg4zy,