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

Pdgm Comorbidity Adjustment Table, 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. Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by gaining a deeper understanding of both items. 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. 08% increase in case-mix from No to Low The PDGM Model includes a comorbidity adjustment based on the presence of a secondary diagnosis. 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. Comorbidity Adjustment Comorbidities are additional diagnoses beyond the primary condition that influence treatment complexity. . 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. Learn more about the comorbidity adjustment category of the PDGM and how it applies to your home health agency. This combination specific calculation High comorbidity adjustment: 2 or more secondary diagnoses on the HH-specific comorbidity subgroup interaction list that are associated with higher resource use when both are reported together compared to if they were reported separately. twg, rthk, 1qwox, qw1, 8cu9, ag6, a7ceh, smtytbu, 44a, eij66gj,