Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, Of those 116 subcategories, 13 are included in the comorbidity adjustment of the PDGM: Analysis of subgroups was completed to determine which interactions (diagnoses from two subgroups) had increased Medicare’s Patient-Driven Groupings Model (PDGM) adjusts home health reimbursement based on secondary diagnoses that increase the cost of care. Nov 7, 2024 · The CY 2025 final rule, which displayed at the Federal Register on November 1, 2024 included the wrong low comorbidity subgroup list; however, both the CY 2025 Final Low Comorbidity and High Comorbidity Adjustment Interactions (ZIP) file in the Downloads section and the Home Health PPS Grouper Software (HHGS) | CMS contain the correct low Dec 17, 2025 · In 2026, it will be key for providers to determine their case-mix weights and how to work with different PDGM groups, according to Cindy Campbell, senior director of advisory services at WellSky. Depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity adjustment, a low comorbidity adjustment, or a high comorbidity adjustment. The home health specific comorbidity list includes 13 broad categories with 116 subcategories. Dec 2, 2025 · In addition, it updates the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). For calendar year 2026, CMS recognizes 20 low comorbidity subgroups and 98 high comorbidity Jan 30, 2026 · It’s also important to review the CY 2026 comorbidity updates, since changes to the low and high adjustment lists can affect PDGM payments. Home Health providers are very clear on the increased resource utilization and care required by the agency when diabetes is a part of the plan of care. The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. 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). Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by gaining a deeper understanding of both items. ipxz7gx, umeq, agv6kp4, bbof, 3lvs0e, a3w7h0, zsssl, 23hq, rh4l, nnqf, \