PDGM Functional Level Calculator

PDGM places every 30-day period at a low, medium or high functional impairment level. The level comes from points: seven OASIS function items score points by response, and the risk of hospitalization item (M1033) adds 12 points when four or more of its items are marked, not counting 8, 9 or 10. Each clinical group has its own bands, so the same points can be medium in one group and high in another.

Points

The running total from the responses picked so far. Each response shows its own points underneath, from Table 8 of the CY2026 final rule.

Functional level

Low, medium or high for the chosen clinical group, and the gap to the next band. In a HIPPS code it is character 3: A for low, B for medium, C for high.

Bands in the group

The point ranges CMS set for that clinical group in Table 9, with the band the score lands in marked.

Every clinical group

The same total read against all twelve groups. A different principal diagnosis can move a period to another group, and with it to another level.

Why does the same score give a different level in another group?

CMS sets the low, medium and high bands separately for each of the twelve clinical groups. In MMTA, Cardiac and Circulatory, 29 to 43 points is medium; in MMTA, Endocrine, medium is 28 to 41.

Which OASIS items count?

M1800 Grooming, M1810 and M1820 upper and lower body dressing, M1830 Bathing, M1840 Toilet transferring, M1850 Transferring and M1860 Ambulation, plus M1033 Risk of hospitalization.

Do higher responses always score more points?

Not always. CMS publishes the points per response, and some are grouped or uneven: for M1860, response 2 scores more than response 3. The calculator uses the published table as it stands.

Where does the functional level show up on the claim?

As character 3 of the HIPPS code on the 30-day claim: A for low, B for medium, C for high. With the admission source and timing, the clinical group and the comorbidity adjustment, it sets the case-mix group, and the case-mix group sets the period’s LUPA threshold.

How does M1033 score?

M1033 lists risk factors for hospitalization that the assessing clinician marks. For PDGM, four or more marked items score 12 points, not counting responses 8, 9 and 10. Fewer than four score nothing, so the item either adds 12 points or adds none.