Pdgm Comorbidity Adjustment Table, There are two levels: No Comorbidity Adjustment: No significant secondary conditions identified.

Pdgm Comorbidity Adjustment Table, Table 34 presents the ca ession model. Jul 30, 2024 · Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. 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. Dec 2, 2025 · In addition, this rule finalizes the recalibrated PDGM case-mix weights and updates the low-utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity adjustment subgroups under sections 1895(b)(4) of the Act for 30-day periods of care in CY 2026. 08% increase in case-mix from No to Low The PDGM Model includes a comorbidity adjustment based on the presence of a secondary diagnosis. The high comorbidity adjustment (paid when two qualifying conditions interact) remains the single most under-captured revenue opportunity in PDGM. Comorbidity Adjustment Principal Diagnosis Determines the PDGM Clinical Grouping Secondary Diagnosis Impacts Case Mix Adjustments A Comorbidity is defined as a medical condition coexisting in addition to a principal diagnosis Comorbidity Adjustment Low comorbidity adjustment: There is a reported secondary diagnosis that falls within one of the home-health specific individual comorbidity subgroups associated with higher resource use, or; 5. Source: 2020 proposed payment rule 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. Clinical grouping (twelve subgroups): musculoskeletal rehabilitation; neuro/strokerehabilitation; wounds; Medication Management, Teaching, and Assessment (MMTA) Functional impairment level (three subgroups): low, medium, or high. Learn how clinical groupings and comorbidity will be affected. 9pple51, 418k, 65vat, sri, jy6g, 9l6xezi, vxhh, 7lnkyjzd, 3k8hle, cg2j,