Home Health · Builder
PDGM Component Builder
Set each PDGM dimension — admission source & timing, clinical group, functional level, comorbidity — and watch the 5-character HIPPS assemble. Then push it to the PDGM Calculator in one click.
Data statusExact
- Status
- Exact
- Data year / effective
- CY2026
- Last reviewed
- June 2026
- Last updated
- June 2026
- Primary source
- CMS Home Health PPS Final Rule, CY2026
- Formula notes
- Deterministic mapping of period characteristics to a PDGM HIPPS code.
Admission source
Institutional = an acute or post-acute stay (hospital, SNF, IRF, LTCH, IPF) within the 14 days before the home health period.
Period timing
Early = the first 30-day period. Late = the second or any later period in a sequence of adjacent periods.
Position 1: 1 — Community · Early
Clinical group primary diagnosis
The clinical group is set by the principal diagnosis reported on the claim. Use the ICD-10 → PDGM Mapper to find the group for a specific code.
Position 2: A — MMTA – Other
Functional impairment level
Determined from these OASIS items
Grooming M1800
Dress upper body M1810
Dress lower body M1820
Bathing M1830
Toilet transferring M1840
Transferring M1850
Ambulation / locomotion M1860
Risk for hospitalization M1033
Responses to these items are scored to points (Table 8) and compared to clinical-group-specific thresholds (Table 9) for Low / Medium / High. The exact CY 2026 point values vary by group — set the resulting level here and verify against the CMS grouper.
Position 3: A — Low
Comorbidity adjustment
Low = a secondary diagnosis in one of the 20 low-comorbidity subgroups. High = two or more secondary diagnoses that interact (one of the 98 high-comorbidity subgroups). Otherwise none.
Position 4: 1 — None
Assembling HIPPS
1AA11
All positions set
Position 5 is a placeholder and is always 1. The button hands the full HIPPS to the calculator, which applies the case-mix weight, wage index and any LUPA / PEP / outlier adjustments.
Functional level and comorbidity tier should be confirmed against the CMS PDGM grouper for the specific OASIS responses and diagnosis set.
How it fits together. Each 30-day period is grouped on four dimensions: admission source & timing (position 1), clinical group from the principal diagnosis (position 2), functional impairment level from OASIS (position 3), and comorbidity from secondary diagnoses (position 4). Together with the placeholder, that is the 5-character HIPPS and one of 432 case-mix groups.
Sources: CMS HH PDGM overview; CY 2026 HH PPS Final Rule (functional points/thresholds Tables 8–9, comorbidity subgroups Tables 10–11).
