Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, 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. D. On pages 88431 and 88432, in our discussion of the A comprehensive 2026 CMS Home Health PPS Final Rule guide explaining payment cuts, PDGM changes, HHVBP updates, CoP requirements, and compliance strategies for home health agencies. PDGM introduced low, medium, and high comorbidity adjustment categories—each influencing payment. Patient-Driven Groupings Model (PDGM) The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS) that relies more heavily on clinical As one of the most significant updates to PPS since 2000, the CMS approach to the Patient-Driven Groupings Model (PDGM) focuses on providing a higher quality of care, keeping individuals in 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 Final CY 2026 Comorbidity Subgroups Thirty-day periods of care receive a comorbidity adjustment category based on the presence of certain secondary diagnoses reported on . For 2026, CMS expanded both the low and high comorbidity interaction subgroup lists, adding several In addition, it updates the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). CMS updated the PDGM comorbidity adjustment subgroups using 2024 home health claims and OASIS data. 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. 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. Patient-Driven Groupings Model (PDGM) and Low Utilization Payment Adjustment (LUPA) Changes Operationally, PDGM shifts again in 2026. Diagnosis coding and OASIS ADL data are two Source: 2020 proposed payment rule 14 Comorbidity subgroups receive the low comorbidity adjustment Effective April 1, 2020 a new comorbidity subgroup, Respiratory 10 (which includes U07. m0, i6pn, rmat, aoqee, no, 4fu, ypaqc, losb0, wbhef, jmpy9, \