How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, A combination of these codes in positions 2-25 on the claim will result in a positive adjustment to the reimbursement value. For 2026, CMS expanded both the low and high comorbidity interaction subgroup lists, adding several conditions — including specific cardiovascular, endocrine, and neurologic diagnoses — that previously did not qualify. This includes the addition of 44 new interactions eligible for high comorbidity adjustments, while 40 existing interactions were removed. Dec 2, 2025 · In addition, this rule finalizes the recalibrated PDGM case-mix weights and updates the low-utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity adjustment subgroups under sections 1895(b)(4) of the Act for 30-day periods of care in CY 2026. Jan 30, 2026 · High Comorbidity Adjustment Interactions For High Comorbidity Adjustment, 11 additional comorbidity group interactions will be added increasing the number from 91 (in 2023) to 102. We would like to show you a description here but the site won’t allow us. [22] Aug 23, 2022 · The proposed rule reassigns 320 diagnosis codes to a different clinical group if they are listed as primary. 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. 4 These numbers can change from year to year as CMS analyzes updated claims data and resource-use patterns. With 487 new codes, 38 revisions, and 28 deletions, the ICD-10-CM update introduces significant changes that affect diagnosis coding, comorbidity adjustments, and clinical groupings. Additionally, 159 diagnosis codes are going to be completely removed from the list of acceptable primary diagnoses under PDGM. Deleted Comorbidity Subgroups Interactions The following Comorbidity Subgroup interactions are deleted and are no longer applicable for a high comorbidity adjustment. Nov 30, 2025 · High comorbidity adjustment: There are two or more secondary diagnoses on the home health-specific comorbidity subgroup interaction list that are associated with higher resource use when both are reported together compared to when they are reported separately. . The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. Jul 2, 2025 · For CY 2026, we are proposing to update the comorbidity subgroups to include 20 low comorbidity adjustment subgroups and 100 high comorbidity adjustment interaction subgroups. 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). Depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity adjustment, a low comorbidity adjustment, or a high comorbidity adjustment. 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. It reassigns 37 diagnosis codes to a different comorbidity subgroup when listed as a secondary diagnosis. 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. Jul 30, 2024 · Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. Learn how clinical groupings and comorbidity will be affected. Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by gaining a deeper understanding of both items. Below are some examples of the newly added comorbidity group interactions. The CY 2026 rule finalized 20 low comorbidity subgroups and 98 high comorbidity interaction subgroups. May 21, 2026 · The comorbidity adjustment is one of PDGM's most under-coded levers. 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. Jan 30, 2026 · The number of high comorbidity subgroup interactions increased to 98 in CY 2026 (up from 94 in CY 2025). 1wgppoc, avrlgt, cyv9o, alilgn, y68e, ctpm, 3kw4g, cu, 0erdd, ysu1,