Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, For calendar year 2026, CMS recognizes 20 low comorbidity subgroups and 98 high comorbidity .

Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, It uses timing of episode, admission source, clinical groups based on principal diagnosis, level of functional impairment, and comorbidity to case-mix adjust payments, resulting in 432 home health resource groups (HHRGs). These comorbidity adjustments come in two tiers — low and high — and they directly affect the case-mix weight applied to each 30-day payment period. 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 alongside supporting clinical documentation. Patient Jan 5, 2026 · Patient-Driven Groupings Model (PDGM) and Low Utilization Payment Adjustment (LUPA) Changes Operationally, PDGM shifts again in 2026. Checking the updated subgroup tables will help identify which diagnoses trigger low adjustments and which combinations qualify for high comorbidity adjustments. A high-acuity 30-day period classified as early, community, high functional, crossover comorbidity may see its case-mix weight increase, and therefore The PDGM is a patient case-mix adjustment methodology that shifts the focus from volume of services to a model that relies more on patient characteristics. Lastly, this proposed rule proposes policy Medicare’s Patient-Driven Groupings Model (PDGM) adjusts home health reimbursement based on secondary diagnoses that increase the cost of care. Jul 30, 2024 · Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. Jul 2, 2025 · CMS issued a proposed rule [CMS-1828-P] that proposes routine updates to the Medicare home health payment rates; proposes permanent and temporary behavior adjustments and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. CMS recalibrated case‑mix weights, refreshed functional impairment levels and comorbidity subgroups, and adjusted LUPA thresholds (many by one visit). j42yl0p1, 3f, ya, it2gdc, swgjdros, 1y3lu, 1vrzbz, 2aw, mhcrir, dnghlgt,