A00–B99Ch. 1low RTP
Certain infectious and parasitic diseases
PDGM clinical-group hint
K — MMTA — Infectious Disease, Neoplasms, and Blood-Forming Diseases
ICD-10 · Reference
ICD-10-CM Chapter Reference
All 22 ICD-10-CM chapters (FY2026) with chapter labels, RTP risk, and PDGM clinical-group hints — searchable.
ICD-10-CM FY2026 · ingested 2026-04-28
Search by chapter range (e.g. J00), label keyword, or PDGM group keyword.
ICD-10-CM FY2026 (CDC/CMS)·FY2026 Tabular List — chapter structureHH PPS Grouper Software (HHGS)·Authoritative ICD-10-CM-to-clinical-group crosswalk·42 CFR §484.220
All 22 chapters
ICD-10-CM FY2026
- C00–D49Ch. 2low RTP
Neoplasms
PDGM clinical-group hint
K — MMTA — Infectious Disease, Neoplasms, and Blood-Forming Diseases
- D50–D89Ch. 3low RTP
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
PDGM clinical-group hint
K — MMTA — Infectious Disease, Neoplasms, and Blood-Forming Diseases
- E00–E89Ch. 4low RTP
Endocrine, nutritional and metabolic diseases
PDGM clinical-group hint
I — MMTA — Endocrine
- F01–F99Ch. 5low RTP
Mental, Behavioral and Neurodevelopmental disorders
PDGM clinical-group hint
F — Behavioral Health
- G00–G99Ch. 6low RTP
Diseases of the nervous system
PDGM clinical-group hint
B — Neuro Rehabilitation
- H00–H59Ch. 7high RTP
Diseases of the eye and adnexa
PDGM clinical-group hint
Most eye/adnexa codes do not map to a PDGM clinical group when reported as principal — verify with the HHGS grouper
- H60–H95Ch. 8high RTP
Diseases of the ear and mastoid process
PDGM clinical-group hint
Most ear/mastoid codes do not map to a PDGM clinical group when reported as principal — verify with the HHGS grouper
- I00–I99Ch. 9low RTP
Diseases of the circulatory system
PDGM clinical-group hint
H — MMTA — Cardiac and Circulatory (cerebrovascular sequelae I60–I69 typically map to Neuro Rehabilitation)
- J00–J99Ch. 10low RTP
Diseases of the respiratory system
PDGM clinical-group hint
L — MMTA — Respiratory
- K00–K95Ch. 11low RTP
Diseases of the digestive system
PDGM clinical-group hint
J — MMTA — Gastrointestinal tract and Genitourinary system
- L00–L99Ch. 12low RTP
Diseases of the skin and subcutaneous tissue
PDGM clinical-group hint
C — Wound (most skin ulcers and post-op wound care)
- M00–M99Ch. 13low RTP
Diseases of the musculoskeletal system and connective tissue
PDGM clinical-group hint
E — Musculoskeletal Rehabilitation
- N00–N99Ch. 14low RTP
Diseases of the genitourinary system
PDGM clinical-group hint
J — MMTA — Gastrointestinal tract and Genitourinary system
- O00–O9ACh. 15high RTP
Pregnancy, childbirth and the puerperium
PDGM clinical-group hint
Obstetric codes are rarely valid as a Medicare home-health primary diagnosis — verify with the HHGS grouper
- P00–P96Ch. 16high RTP
Certain conditions originating in the perinatal period
PDGM clinical-group hint
Perinatal codes typically do not apply to Medicare home health — verify with the HHGS grouper
- Q00–Q99Ch. 17high RTP
Congenital malformations, deformations and chromosomal abnormalities
PDGM clinical-group hint
Many congenital codes do not map as a PDGM principal — verify with the HHGS grouper
- R00–R99Ch. 18high RTP
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PDGM clinical-group hint
Symptom codes (R-codes) are not valid PDGM principal diagnoses — claims with an R-code as principal will be RTP'd
- S00–T88Ch. 19medium RTP
Injury, poisoning and certain other consequences of external causes
PDGM clinical-group hint
E — Often Musculoskeletal Rehabilitation (orthopedic injuries) or Wound (T81/T87 post-op wounds) — verify with the HHGS grouper
- V00–Y99Ch. 20high RTP
External causes of morbidity
PDGM clinical-group hint
External-cause codes (V/W/X/Y) cannot be reported as a principal diagnosis on a PDGM claim
- Z00–Z99Ch. 21medium RTP
Factors influencing health status and contact with health services
PDGM clinical-group hint
G — Most Z-codes are NOT valid PDGM principal — explicit aftercare codes Z47.x / Z48.x typically map to MMTA — Surgical Aftercare. Verify with the HHGS grouper
- U00–U85Ch. 22medium RTP
Codes for special purposes
PDGM clinical-group hint
Special-purpose codes (e.g., COVID-19 emergency codes) — verify with the HHGS grouper