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

How Many Pdgm High Comorbidity Subgroup Interactions Are Included In 2026, 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. 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. 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 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. 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. This includes the addition of 44 new interactions eligible for high comorbidity adjustments, while 40 existing interactions were removed. s31h, ffa, g8l, xx7, iyk, os58ku, vctt, ivifo, bhp, qfpwgh3,