PDGM Clinical Groups
12 clinical groups
GroupICD-10 codesFunctional bandsLUPA
- AMMTA, OtherCatch-all for medication management, teaching, and assessment cases that do not fit any of the other 11 clinical groups.ICD-10 codes 12,503Bands ≤30 · 31–45 · 46+LUPA 2 to 4
- BNeuro RehabilitationRehab focused on neurological conditions including stroke sequelae and degenerative neurologic disease.G00–G99 (nervous system) · I60–I69 (cerebrovascular sequelae)ICD-10 codes 2,115Bands ≤34 · 35–52 · 53+LUPA 2 to 5
- CWoundSkilled wound care for surgical, pressure, vascular, or other chronic ulcers.L00–L99 (skin) · I70.x / I83.x (vascular ulcers) · T81.x / T87.x (post-op wounds)ICD-10 codes 4,102Bands ≤33 · 34–52 · 53+LUPA 3 to 5
- DComplex Nursing InterventionsCases requiring complex skilled nursing such as IV therapy, parenteral nutrition, or ostomy management.Z43.x (ostomy/parenteral aftercare) · selected complex skilled-nursing codesICD-10 codes 90Bands ≤31 · 32–54 · 55+LUPA 2 to 3
- EMusculoskeletal RehabilitationRehab focused on musculoskeletal conditions including post-orthopedic-surgery aftercare.M00–M99 (musculoskeletal) · selected S/T orthopedic injuries · Z47.x aftercareICD-10 codes 19,210Bands ≤31 · 32–45 · 46+LUPA 2 to 5
- FBehavioral HealthPsychiatric and behavioral conditions that drive the principal home health need.F04–F99 (mental, behavioral, neurodevelopmental)ICD-10 codes 856Bands ≤31 · 32–46 · 47+LUPA 2 to 4
- GMMTA, Surgical AftercareMedication management, teaching, and assessment focused on post-surgical recovery.Z47.x · Z48.x (encounters for aftercare)ICD-10 codes 21Bands ≤30 · 31–42 · 43+LUPA 2 to 4
- HMMTA, Cardiac and CirculatoryMedication management, teaching, and assessment for cardiac and circulatory diagnoses.I00–I99 (excluding cerebrovascular sequelae which go to Neuro Rehab)ICD-10 codes 688Bands ≤28 · 29–43 · 44+LUPA 2 to 4
- IMMTA, EndocrineMedication management, teaching, and assessment for endocrine and metabolic diagnoses.E00–E89 (endocrine, nutritional, metabolic)ICD-10 codes 426Bands ≤27 · 28–41 · 42+LUPA 3 to 5
- JMMTA, Gastrointestinal tract and Genitourinary systemMedication management, teaching, and assessment for GI and GU diagnoses.K00–K95 (digestive) · N00–N99 (genitourinary)ICD-10 codes 920Bands ≤34 · 35–48 · 49+LUPA 2 to 4
- KMMTA, Infectious Disease, Neoplasms, and Blood-Forming DiseasesMedication management, teaching, and assessment for infectious, neoplastic, and blood disorders.A00–B99 (infectious) · C00–D49 (neoplasms) · D50–D89 (blood and immune)ICD-10 codes 2,747Bands ≤32 · 33–46 · 47+LUPA 2 to 3
- LMMTA, RespiratoryMedication management, teaching, and assessment for respiratory diagnoses.J00–J99 (respiratory)ICD-10 codes 235Bands ≤33 · 34–46 · 47+LUPA 2 to 4
CMS HH PPS Grouper Software and the CY2026 HH PPS Final Rule (CMS-1828-F)
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, its functional impairment bands, and every HIPPS code in the group with its LUPA threshold.
- AMMTA — Other — 12,503 codes
- BNeuro Rehabilitation — 2,115 codes
- CWound — 4,102 codes
- DComplex Nursing Interventions — 90 codes
- EMusculoskeletal Rehabilitation — 19,210 codes
- FBehavioral Health — 856 codes
- GMMTA — Surgical Aftercare — 21 codes
- HMMTA — Cardiac and Circulatory — 688 codes
- IMMTA — Endocrine — 426 codes
- JMMTA — Gastrointestinal tract and Genitourinary system — 920 codes
- KMMTA — Infectious Disease, Neoplasms, and Blood-Forming Diseases — 2,747 codes
- LMMTA — Respiratory — 235 codes
Built on the CMS HH PPS Grouper Software (code counts), Table 9 of the CY2026 HH PPS Final Rule (CMS-1828-F, functional bands) and CMS’s CY2026 case-mix weights and LUPA thresholds file. Chapter examples are illustrative; the grouper decides. Not certified, endorsed or approved by CMS.