Implementation of New International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes, Effective April 1, 2020:
The Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) has implemented two new ICD-10-CM diagnosis codes, effective April 1, 2020:
- In response to the national emergency that was declared concerning the COVID-19 outbreak, NCHS is implementing a new diagnosis code, U07.1, COVID-19, into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and;
- In response to recent occurrences of vaping related disorders, the NCHS is implementing a new diagnosis code, U07.0, Vaping-related disorder, into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting vaping-related disorders.
CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The PDGM relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories. One case-mix variable is the assignment of the principal diagnosis to one of 12 clinical groups to explain the primary reason for home health services.
Both U07.1, COVID-19 and U07.0, Vaping-related disorder will be assigned to the Medication Management, Teaching and Assessment-Respiratory (MMTA-Respiratory) clinical group for purposes of case-mix adjustment under the HH PPS. Additionally, U07.1, COVID-19, will be added to a new comorbidity subgroup, Respiratory 10, and will receive the Low Comorbidity adjustment under the HH PPS case-mix system. The clinical group assignment for U07.1, COVID-19, and Vaping-related Disorder, U07.0, and the Low Comorbidity adjustment for COVID-19, U07.1 will be included in the Home Health Patient-Driven Groupings Model (HH PDGM) Grouper software package, v01.1.20, available for download on the HH Grouper Software webpage. It is effective for home health claims with From Dates on or after April 1, 2020.
HHAs: Avoid Payment Delays, Register for iQIES by December 23
Act now. Home Health Agencies (HHAs) need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit assessment data beginning January 1. We will return claims that cannot be matched to assessments, delaying your Medicare payments. See the MLN Connects Special Edition article (PDF) SE 19025 for:
- Step-by-step instructions
- Training videos
- Frequently asked questions
- How to get help
CMS-1711-FCThe Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period (CMS-1711-FC) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2020. The final rule with comment period results in a 1.3 percent increase ($250 million) in payments to HHAs in CY 2020. This rule with comment period also implements the Patient‑Driven Groupings Model (PDGM), a revised case‑mix adjustment methodology, for home health services beginning on or after January 1, 2020. This final rule with comment period also implements a change in the unit of payment from 60‑day episodes of care to 30-day periods of care, as required by section 51001 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123) and finalizes the 30-day payment amount for CY 2020. Additionally, this final rule with comment period modifies the payment regulations pertaining to the content of the home health plan of care; allows therapy assistants to furnish maintenance therapy; and changes the split percentage payment approach under the HH PPS. A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2020 HH PPS final rule (click here). View the current HH PPS Grouper Software on the Home Health PPS Software webpage. This final rule with comment period also sets forth routine updates to the home infusion therapy payment rates for CY 2020 and finalizes payment provisions for home infusion therapy services for CY 2021 and subsequent years.
- CY 2020 HH PPS Wage Index (ZIP)
- CY 2019 HH PPS Case Mix Weights for 60-day episodes into CY 2020 (ZIP)
- CY 2020-CY 2022-Rural-Add-On-Payment Designations (ZIP)
- CY 2020 PDGM Case Mix Weights and LUPA Thresholds (ZIP)
- CY 2020 PDGM Interactive Grouper Tool (ZIP)
- CY 2020 PDGM Agency Level Impacts (ZIP)
Home Health Patient-Driven Groupings Model: Operational Issues Call– August 21, 2019
- The presentation (PDF), presentation clarification (PDF), audio recording (ZIP), and transcript (PDF) are available from the August 31 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. During this call, learn information to help your agency prepare to implement billing changes for the Patient-Driven Groupings Model (PDGM) on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.
Overview of the PDGM Model Medicare Learning Network Call – February 12, 2019
- The presentation (PDF), audio recording (ZIP), and transcript (PDF) are available from the February 12 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.
Home Health, Hospice and DME Open Door Forum
Physician Certification of Patient Eligibility for the Medicare Home Health Benefit
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For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.