PDGM · Clinical group

E — Musculoskeletal Rehabilitation

One of the twelve PDGM clinical groups. CMS maps 19200 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 19200 ICD-10-CM codes to Musculoskeletal Rehabilitation, spread across 40 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 Musculoskeletal Rehabilitation

The same OASIS point total means different things in different groups. In this group a patient scoring 31 or fewer points is low functional impairment, 32 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
S80-S89	Injuries to the knee and lower leg	2657
S60-S69	Injuries to the wrist, hand and fingers	2621
S50-S59	Injuries to the elbow and forearm	2507
S70-S79	Injuries to the hip and thigh	1985
S90-S99	Injuries to the ankle and foot	1485
S40-S49	Injuries to the shoulder and upper arm	1364
M80-M85	Osteopathies and chondropathies	968
M05-M14	Inflammatory polyarthropathies	774
S30-S39	Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals	732
S10-S19	Injuries to the neck	498
S20-S29	Injuries to the thorax	456
M86-M90	Other osteopathies	444
M20-M25	Other joint disorders	413
S00-S09	Injuries to the head	351
M60-M63	Soft tissue disorders	243
T80-T88	Complications of surgical and medical care, not elsewhere classified	239
M65-M67	Disorders of synovium and tendon	238
M45-M49	Spondylopathies	226
M70-M79	Other soft tissue disorders	221
M91-M94	Chondropathies	147
M50-M54	Other dorsopathies	109
M40-M43	Dorsopathies	105
M99-M99	Biomechanical lesions, not elsewhere classified	90
M15-M19	Osteoarthritis	68
M00-M02	Arthropathies	65
M30-M36	Systemic connective tissue disorders	59
M97-M97	Periprosthetic fracture around internal prosthetic joint	33
M96-M96	Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified	32
Q65-Q79	Congenital malformations and deformations of the musculoskeletal system	30
P10-P15	Birth trauma	11
Z40-Z53	Encounters for other specific health care	7
M26-M27	Dentofacial anomalies [including malocclusion] and other disorders of jaw	6
A15-A19	Tuberculosis	4
M95-M95	Other disorders of the musculoskeletal system and connective tissue	4
A50-A64	Infections with a predominantly sexual mode of transmission	2
M04-M04	Autoinflammatory syndromes	2
A00-A09	Intestinal infectious diseases	1
B00-B09	Viral infections characterized by skin and mucous membrane lesions	1
D80-D89	Certain disorders involving the immune mechanism	1
G40-G47	Episodic and paroxysmal disorders	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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