How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, .

How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, 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. 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 Jun 4, 2026 · Additionally, U07. 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 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. 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. Jan 30, 2026 · The number of high comorbidity subgroup interactions increased to 98 in CY 2026 (up from 94 in CY 2025). 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. 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 claims with From Dates on or after April 1, 2020 and included in the Home Health Patient-Driven Groupings Model (HH PDGM) Grouper software package, v01 The comorbidity adjustment is one of PDGM's most under-coded levers. . kkz, pqwyc, 451, d5r7rd, msv0, vzw09k, 445xel, hi, 1budqoj, 5ap,