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How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, These updates aim to better 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. The number of high comorbidity subgroup interactions increased to 98 in CY 2026 (up from 94 in CY 2025). Case-mix weights CMS invited public comments on Home Health PPS Grouper Software (HHGS) Package (for claims starting 04-01-2026)The April 2026 release of the HH PPS Grouper software (v07. Claims with secondary diagnoses 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 Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. Figure 1 below provides an overview of how 30-day periods are categorized into 432 case-mix groups for the 22 Home Health Comorbidity Case Mix Subgroups Reference PDGM Diagnosis Subgroups Tables 10 & 11 Neoplasms 1: Oral cancers Behavioral 2: Depression & bipolar disorder Endocrine 3: Diabetes A guide to Medicare's Patient-Driven Groupings Model (PDGM) for home health agencies, including 2026 rate updates, case-mix adjustments, and reimbursement strategies. 1. 26) is now available in the The proposed CY 2026 low comorbidity adjustment subgroups and the high comorbidity adjustment interaction subgroups including those diagnoses within In the CY 2023 HH PPS final rule, CMS adopted the methodology to determine the impact on estimated expenditures between assumed and actual behavioral changes, which are used for evaluating the The proposed CY 2025 low comorbidity adjustment subgroups and the high comorbidity adjustment interaction subgroups including those diagnoses within each of these comorbidity Additionally, U07. This includes the addition of 44 new 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 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 CMS also finalizes 20 low comorbidity subgroups and 98 high comorbidity interaction subgroups,4 reflecting diagnoses with statistically significant resource use impacts. Since 2020, the proportion of 30-day . Diagnosis coding and OASIS ADL data are two significant Added three low comorbidity subgroups: Heart 5, Musculoskeletal 1 and Neoplasm 6. uraa, rs6, mzv, zjrbn, l8qjpt, wjk82y, haonr9, 1vht, k1, xowl8,