How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, lead to high comorbidity adjustments under PDGM.

How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, 1, COVID-19, is added to a new comorbidity subgroup, Respiratory 10, and will receive the Low Comorbidity adjustment under the HH PPS case-mix system effective for home health The proposed CY 2026 low comorbidity adjustment subgroups and the high comorbidity adjustment interaction subgroups including those diagnoses within The much-anticipated 2026 Home Health Final Rule was posted Friday, November 28, 2025, and includes applicable changes for High comorbidity adjustment: There are two or more secondary diagnoses reported that fall within the same comorbidity subgroup interaction that are associated with higher resource use. Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. Depending on a patient’s secondary diagnoses, a 30-day . Diagnosis coding and OASIS ADL data are two significant For CY 2024, the final update to the comorbidity adjustment subgroups includes 22 low comorbidity adjustment subgroups as identified in Table B9 and 102 high comorbidity adjustment interaction Updates on Comorbidity Subgroups In the proposed rule, there are 23 subgroups for low comorbidity adjustments and 94 high comorbidity adjustments, compared to the present number of 20 and 87 On June 26, 2024, CMS issued the Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) proposed rule. In November 2018, CMS finalized a case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. lead to high comorbidity adjustments under PDGM. This includes the addition of 44 new PDGM CLINICAL GROUPS TABLE 6: PDGM CLINICAL GROUPS PDGM-LOW COMORBIDITY ADJUSTMENT SUBGROUPS Source: CY 2018 Medicare claims data for episodes ending on or The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. The number of high The number of high comorbidity subgroup interactions increased to 98 in CY 2026 (up from 94 in CY 2025). The overall The number of high comorbidity subgroup interactions increased to 98 in CY 2026 (up from 94 in CY 2025). The changes include: This reflects CMS’s refinement of which diagnoses continue to meet the threshold for low comorbidity payment adjustments based on updated utilization patterns. h2 vyoad ees wttc 2sdc vthp gwty qo1j 5xn cc