PDGM · Reference

PDGM Clinical Groups

All 12 PDGM clinical groups (A–L) with CMS labels, summaries, and ICD-10 chapter examples — searchable.

CY2026 PDGM · CMS-1828-F · ingested 2026-04-28

Search by group name, ICD-10 chapter (e.g. J00), or summary keyword.

HH PPS Grouper Software (HHGS)·Authoritative ICD-10-to-clinical-group crosswalk·42 CFR §484.220

All 12 groups

CY2026 PDGM

  1. APDGM clinical group

    MMTA — Other

    Catch-all for medication management, teaching, and assessment cases that do not fit any of the other 11 clinical groups.

    See full code list →
  2. BPDGM clinical group

    Neuro Rehabilitation

    Rehab focused on neurological conditions including stroke sequelae and degenerative neurologic disease.

    ICD-10 chapters (illustrative)

    • G00–G99 (nervous system)
    • I60–I69 (cerebrovascular sequelae)
    See full code list →
  3. CPDGM clinical group

    Wound

    Skilled wound care for surgical, pressure, vascular, or other chronic ulcers.

    ICD-10 chapters (illustrative)

    • L00–L99 (skin)
    • I70.x / I83.x (vascular ulcers)
    • T81.x / T87.x (post-op wounds)
    See full code list →
  4. DPDGM clinical group

    Complex Nursing Interventions

    Cases requiring complex skilled nursing such as IV therapy, parenteral nutrition, or ostomy management.

    ICD-10 chapters (illustrative)

    • Z43.x (ostomy/parenteral aftercare)
    • selected complex skilled-nursing codes
    See full code list →
  5. EPDGM clinical group

    Musculoskeletal Rehabilitation

    Rehab focused on musculoskeletal conditions including post-orthopedic-surgery aftercare.

    ICD-10 chapters (illustrative)

    • M00–M99 (musculoskeletal)
    • selected S/T orthopedic injuries
    • Z47.x aftercare
    See full code list →
  6. FPDGM clinical group

    Behavioral Health

    Psychiatric and behavioral conditions that drive the principal home health need.

    ICD-10 chapters (illustrative)

    • F04–F99 (mental, behavioral, neurodevelopmental)
    See full code list →
  7. GPDGM clinical group

    MMTA — Surgical Aftercare

    Medication management, teaching, and assessment focused on post-surgical recovery.

    ICD-10 chapters (illustrative)

    • Z47.x
    • Z48.x (encounters for aftercare)
    See full code list →
  8. HPDGM clinical group

    MMTA — Cardiac and Circulatory

    Medication management, teaching, and assessment for cardiac and circulatory diagnoses.

    ICD-10 chapters (illustrative)

    • I00–I99 (excluding cerebrovascular sequelae which go to Neuro Rehab)
    See full code list →
  9. IPDGM clinical group

    MMTA — Endocrine

    Medication management, teaching, and assessment for endocrine and metabolic diagnoses.

    ICD-10 chapters (illustrative)

    • E00–E89 (endocrine, nutritional, metabolic)
    See full code list →
  10. JPDGM clinical group

    MMTA — Gastrointestinal tract and Genitourinary system

    Medication management, teaching, and assessment for GI and GU diagnoses.

    ICD-10 chapters (illustrative)

    • K00–K95 (digestive)
    • N00–N99 (genitourinary)
    See full code list →
  11. KPDGM clinical group

    MMTA — Infectious Disease, Neoplasms, and Blood-Forming Diseases

    Medication management, teaching, and assessment for infectious, neoplastic, and blood disorders.

    ICD-10 chapters (illustrative)

    • A00–B99 (infectious)
    • C00–D49 (neoplasms)
    • D50–D89 (blood and immune)
    See full code list →
  12. LPDGM clinical group

    MMTA — Respiratory

    Medication management, teaching, and assessment for respiratory diagnoses.

    ICD-10 chapters (illustrative)

    • J00–J99 (respiratory)
    See full code list →

Every PDGM clinical group in detail

Each group has its own page: how many ICD-10-CM codes CMS assigns to it, which subchapters those come from, and the functional-impairment thresholds that go with it.

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