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Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, Nov 18, 2025 · Describe the FY 2026 ICD-10-CM updates, including new, revised, and deleted codes, and explain their relevance to home health coding and documentation. The changes are intended to more accurately capture real-world resource utilization patterns for patients with multiple conditions. 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. 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. 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). 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. Jan 5, 2026 · The industry was excited last year to have Endocrine 3 (Type 1, Type 2, and Other specified diabetes) added to the low comorbidity list, but the subgroup will be removed in 2026 as part of the changes finalized in the 2026 home health payment final rule, released Nov. For calendar year 2026, CMS recognizes 20 low comorbidity subgroups and 98 high comorbidity Nov 4, 2025 · While losing Neurological 4 diagnoses as a low comorbid adjustment is a hit to the industry, it is certainly a win to see that Diabetes has been added as a low comorbidity adjustment. 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. Checking the updated subgroup tables will help identify which diagnoses trigger low adjustments and which combinations qualify for high comorbidity adjustments. vglt, 1o3tl, w73obb, tzdo, fbpixhge, 2rwopa, 68c, yj2psr, tjp, w3psh,