Patient-Driven Groupings Model Formula

PDGM ICD Lookup Tool

Ensure your primary diagnosis code is valid.
There are over 43,000+ primary Dx codes—but only those on CMS’s approved list will be accepted. Use this tool to confirm your primary diagnosis is billable.

PDGM ICD Lookup

PDGM Comorbidity Adjustment Tool

Check for comorbidity codes that may increase payment.
Secondary diagnosis codes can affect your plan of care and potentially increase payment by up to 20%. Use this tool to see if your comorbidity qualifies for an adjustment.

PDGM Comorbidity Adjustment

PDGM LUPA Lookup Tool

Avoid unnecessary payment reductions.
Determine the visit threshold for your 30-day period of care. This tool helps you avoid a LUPA adjustment when more visits are clinically appropriate.

PDGM Lupa Lookup Tool

What data source was used: HH PPS Grouper Software HH PDGM v05.1.24 posted on 8/13/2024.
The use of this tool does not replace clinical judgment. Providers should use their professional expertise and discretion when determining appropriate codes, and sequencing of codes. ICD-10 codes and guidelines may change over time. Users should regularly consult the official ICD-10 resources to stay informed of any updates.
This tool is not intended for direct use in billing. Users must consult official billing guidelines and policies before submission.
This tool is designed to align with current PDGM regulations. However, users are responsible for ensuring compliance with all applicable federal, state, and local laws.
The creators of this tool accept no liability for any errors or omissions in the information provided. Users are encouraged to seek professional advice when necessary.