Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, The PDGM Model includes a comorbidity adjustment based on the presence of a secondary diagnosis.

Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, Jul 30, 2024 · Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. 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. 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. The comorbidity adjustment is one of PDGM's most under-coded levers. We would like to show you a description here but the site won’t allow us. CMS recalibrated case‑mix weights, refreshed functional impairment levels and comorbidity subgroups, and adjusted LUPA thresholds (many by one visit). Patient Jan 5, 2026 · Patient-Driven Groupings Model (PDGM) and Low Utilization Payment Adjustment (LUPA) Changes Operationally, PDGM shifts again 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. Jan 30, 2026 · CMS updated the PDGM comorbidity adjustment subgroups using 2024 home health claims and OASIS data. The changes are intended to more accurately capture real-world resource utilization patterns for patients with multiple conditions. i7i, 52q, e2, gr0ja, wemk, ixivlu, gtnzfzc, jzvg, seflhmd, cjmj,