F · Behavioral Health

One of the twelve PDGM clinical groups. CMS maps 856 ICD-10-CM codes to it in grouper v07.2.26.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Group F

ICD-10-CM codes

856

Across 14 ICD-10-CM ranges, in grouper v07.2.26.

Functional bands

≤31 · 32–46 · 47+

OASIS points for low, medium and high functional impairment in this group.

LUPA thresholds

2 to 4 visits

Across the group’s 36 case-mix codes. Fewer visits than the threshold pays per visit.

Every HIPPS code in group F, with its LUPA threshold

1 · Community, Early

2 · Institutional, Early

3 · Community, Late

4 · Institutional, Late

ICD-10-CM ranges that feed this group

RangeDescriptionCodes in group

What lands a period in this group

The clinical group is set by the principal diagnosis on the claim, and it is one of the five things that decide a 30-day period’s case-mix group, alongside admission source, timing, functional impairment level and comorbidity adjustment. CMS maps 856 ICD-10-CM codes to Behavioral Health, spread across 14 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.

The other eleven groups

Source: CMS HH PPS Grouper Software v07.2.26 for the codes and bands, read from the CMS table, not transcribed; CMS’s CY2026 case-mix weights and LUPA thresholds file for the thresholds. Not certified, endorsed or approved by CMS.

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