PDGM · Clinical group

A — MMTA - Other

One of the twelve PDGM clinical groups. CMS maps 12438 ICD-10-CM codes to it in grouper v07.1.26.

OASIS-E2 v1.00.0 · ingested 2026-04-26

What lands a period in this group

The clinical group is set by the diagnosis reported in the primary position, and it is one of the five things that decide a 30-day period’s payment group — alongside admission source, timing, functional impairment level and comorbidity adjustment. CMS maps 12438 ICD-10-CM codes to MMTA - Other, spread across 122 ICD-10-CM ranges.

Those ranges are not always the ones you would expect from the chapter. Cerebrovascular disease sits in the circulatory chapter alongside heart failure, but CMS groups strokes as neurological rehabilitation — which is why the chapter a code lives in is a poor guide to how it pays.

Functional impairment thresholds for MMTA - Other

The same OASIS point total means different things in different groups. In this group a patient scoring 30 or fewer points is low functional impairment, 31 to 45 is medium, and 46 or more is high. CMS sets the bands so roughly a third of periods in each group land in each level, which is why the same documentation can produce a different level in a different group.

ICD-10-CM ranges that feed this group

Range	Description	Codes in this group
T36-T50	Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances	2140
T51-T65	Toxic effects of substances chiefly nonmedicinal as to source	1632
T80-T88	Complications of surgical and medical care, not elsewhere classified	907
H00-H05	Disorders of eyelid, lacrimal system and orbit	381
H15-H22	Disorders of sclera, cornea, iris and ciliary body	372
T66-T78	Other and unspecified effects of external causes	337
S30-S39	Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals	304
H30-H36	Disorders of choroid and retina	299
E70-E88	Metabolic disorders	262
T15-T19	Effects of foreign body entering through natural orifice	246
N80-N98	Noninflammatory disorders of female genital tract	212
T20-T25	Burns and corrosions	210
O30-O48	Maternal care related to the fetus and amniotic cavity and possible delivery problems	207
H65-H75	Diseases of middle ear and mastoid	204
H40-H42	Glaucoma	192
O20-O29	Other maternal disorders predominantly related to pregnancy	191
G40-G47	Episodic and paroxysmal disorders	181
Q65-Q79	Congenital malformations and deformations of the musculoskeletal system	170
T33-T34	Frostbite	156
O94-O9A	Other obstetric conditions, not elsewhere classified	152
S20-S29	Injuries to the thorax	144
H43-H44	Disorders of vitreous body and globe	139
H49-H52	Disorders of ocular muscles, binocular movement, accommodation and refraction	125
H10-H11	Disorders of conjunctiva	118
S80-S89	Injuries to the knee and lower leg	108
H53-H54	Visual disturbances and blindness	105
H60-H62	Diseases of external ear	99
Q20-Q28	Congenital malformations of the circulatory system	93
O85-O92	Complications predominantly related to the puerperium	92
O00-O08	Pregnancy with abortive outcome	90
O60-O77	Complications of labor and delivery	90
H25-H28	Disorders of lens	83
Q50-Q56	Congenital malformations of genital organs	83
O10-O16	Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium	80
H90-H94	Other disorders of ear	77
L60-L75	Disorders of skin appendages	74
L20-L30	Dermatitis and eczema	73
Q90-Q99	Chromosomal abnormalities, not elsewhere classified	71
H46-H47	Disorders of optic nerve and visual pathways	68
P19-P29	Respiratory and cardiovascular disorders specific to the perinatal period	64
S60-S69	Injuries to the wrist, hand and fingers	63
S90-S99	Injuries to the ankle and foot	60
L80-L99	Other disorders of the skin and subcutaneous tissue	58
Q60-Q64	Congenital malformations of the urinary system	57
Q38-Q45	Other congenital malformations of the digestive system	56
Q80-Q89	Other congenital malformations	56
P00-P04	Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery	55
S10-S19	Injuries to the neck	54
T26-T28	Burns and corrosions confined to eye and internal organs	54
P50-P61	Hemorrhagic and hematological disorders of newborn	53
H59-H59	Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified	51
J30-J39	Other diseases of upper respiratory tract	51
H80-H83	Diseases of inner ear	49
S40-S49	Injuries to the shoulder and upper arm	48
S70-S79	Injuries to the hip and thigh	48
N00-N08	Glomerular diseases	47
P05-P08	Disorders of newborn related to length of gestation and fetal growth	47
O09-O09	Supervision of high risk pregnancy	45
T79-T79	Certain early complications of trauma	42
E50-E64	Other nutritional deficiencies	41
N40-N53	Diseases of male genital organs	38
P90-P96	Other disorders originating in the perinatal period	36
J00-J06	Acute upper respiratory infections	34
L40-L45	Papulosquamous disorders	34
P35-P39	Infections specific to the perinatal period	31
P70-P74	Transitory endocrine and metabolic disorders specific to newborn	31
H95-H95	Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified	30
S50-S59	Injuries to the elbow and forearm	30
N60-N65	Disorders of breast	27
Q30-Q34	Congenital malformations of the respiratory system	27
L10-L14	Bullous disorders	25
L55-L59	Radiation-related disorders of the skin and subcutaneous tissue	23
H55-H57	Other disorders of eye and adnexa	22
L49-L54	Urticaria and erythema	21
S00-S09	Injuries to the head	21
K55-K64	Other diseases of intestines	18
M20-M25	Other joint disorders	18
M30-M36	Systemic connective tissue disorders	17
P76-P78	Digestive system disorders of newborn	17
E65-E68	Overweight, obesity and other hyperalimentation	16
G89-G99	Other disorders of the nervous system	16
P10-P15	Birth trauma	16
P80-P83	Conditions involving the integument and temperature regulation of newborn	16
E20-E35	Disorders of other endocrine glands	14
G20-G26	Extrapyramidal and movement disorders	14
K00-K14	Diseases of oral cavity and salivary glands	14
N70-N77	Inflammatory diseases of female pelvic organs	13
L76-L76	Intraoperative and postprocedural complications of skin and subcutaneous tissue	12
K40-K46	Hernia	11
I80-I89	Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified	10
K50-K52	Noninfective enteritis and colitis	10
E89-E89	Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified	9
Q35-Q37	Cleft lip and cleft palate	9
N30-N39	Other diseases of the urinary system	8
P09-P09	Abnormal findings on neonatal screening	8
K70-K77	Diseases of liver	7
L00-L08	Infections of the skin and subcutaneous tissue	7
E08-E13	Diabetes mellitus	5
E40-E46	Malnutrition	5
N25-N29	Other disorders of kidney and ureter	5
E36-E36	Intraoperative complications of endocrine system	4
J09-J18	Influenza and pneumonia	4
K20-K31	Diseases of esophagus, stomach and duodenum	4
N99-N99	Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified	4
K35-K38	Diseases of appendix	3
K80-K87	Disorders of gallbladder, biliary tract and pancreas	3
K90-K95	Other diseases of the digestive system	3
M95-M95	Other disorders of the musculoskeletal system and connective tissue	3
E15-E16	Other disorders of glucose regulation and pancreatic internal secretion	2
I10-I1A	Hypertensive diseases	2
I70-I79	Diseases of arteries, arterioles and capillaries	2
I95-I99	Other and unspecified disorders of the circulatory system	2
N10-N16	Renal tubulo-interstitial diseases	2
E00-E07	Disorders of thyroid gland	1
G00-G09	Inflammatory diseases of the central nervous system	1
M04-M04	Autoinflammatory syndromes	1
M26-M27	Dentofacial anomalies [including malocclusion] and other disorders of jaw	1
M80-M85	Osteopathies and chondropathies	1
P84-P84	Other problems with newborn	1
Z00-Z13	Persons encountering health services for examinations	1
Z40-Z53	Encounters for other specific health care	1
Z77-Z99	Persons with potential health hazards related to family and personal history and certain conditions influencing health status	1

Source: CMS HH PPS Grouper Software v07.1.26. Counts are read from the CMS table, not transcribed.

The other eleven groups

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