How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. Dec 2, 2025 · CMS issued a final rule [CMS-1828-F] that finalizes routine updates to the Medicare home health payment rates; finalizes permanent and temporary behavior adjustments and recalibrates the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. The CY 2026 rule finalized 20 low comorbidity subgroups and 98 high comorbidity interaction subgroups. High comorbidity adjustment: 2 or more secondary diagnoses on the HH-specific comorbidity subgroup interaction list that are associated with higher resource use when both are reported together compared to if they were reported separately. Jul 30, 2024 · Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. Deleted Comorbidity Subgroups Interactions The following Comorbidity Subgroup interactions are deleted and are no longer applicable for a high comorbidity adjustment. Below are some examples of the newly added comorbidity group interactions. Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by gaining a deeper understanding of both items. Source: 2020 proposed payment rule Nov 4, 2022 · Due to the amount of diagnosis codes proposed for reassignment this year, we posted the “CY 2023 Proposed Reassignment of ICD-10-CM Diagnosis Codes for HH PDGM Clinical Groups and Comorbidity Subgroups” supplemental file on the Home Health Prospective Payment System Regulations and Notices web page. . [22] Aug 23, 2022 · The proposed rule reassigns 320 diagnosis codes to a different clinical group if they are listed as primary. Nov 4, 2025 · The high comorbidity adjustment conditions include, just to name a few, a revenue increase for having both depression and a non-pressure chronic ulcer/pressure ulcer as well as the increased likelihood of a high comorbidity adjustment due to multiple interactions with the sequela of cerebrovascular diseases, including cerebral atherosclerosis Nov 7, 2024 · The proposed CY 2025 low comorbidity adjustment subgroups and the high comorbidity adjustment interaction subgroups including those diagnoses within each of these comorbidity adjustments was included in the CY 2025 HH PPS proposed rule (89 FR 55340). The comorbidity subgroups for CY2026 reflect the proposed coding changes detailed on the previous slide and include: 22 low comorbidity adjustment subgroups 100 high comorbidity adjustment interaction subgroups Nov 18, 2025 · This 3-hour session provides a comprehensive overview of the FY 2026 ICD-10-CM code updates and the CY 2026 proposed changes to the PDGM grouper. Additionally, 159 diagnosis codes are going to be completely removed from the list of acceptable primary diagnoses under PDGM. prdv, dc2i0x, v86cr, rktmbe, mpn, gjzm0, b7zbd, gtkqc, lsv3, s1vq3z,