Home Health PPS Grouper Software (HHGS)

Home Health PPS Grouper Software (HHGS) Package (for claims starting 04-01-2023)

The April 2023 release of the HH PPS Grouper software (v04.1.23) is now available in the “Downloads” section of this webpage. Included in the v04.1.23 HH PPS Grouper software update are the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes, effective beginning April 1, 2023. 

In November 2018, CMS finalized a case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The PDGM, or Home Health PPS Grouper Software (HHGS), relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDGM, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.

Included in the v04.1.23 software update are:

• Addition of new ICD-10-CM diagnosis codes effective April 1, 2023. 
• ICD-10-CM diagnosis code deletions, as applicable.
• Modification of ICD-10-CM diagnosis code descriptions, as applicable.
• Updated the clinical group assignment(s) for applicable diagnosis codes; these updates also include the removal of clinical groups for some unspecified codes as designated by CMS.
• Updated External Cause of Injury codes with additions and deletions, as applicable.
• Updated Unacceptable PDX codes with additions and deletions, as applicable. 
• Updated Unspecified PDX codes which are separately identified in the Diagnosis_Codes table with a new column; there are no new unspecified diagnoses codes effective for April 1, 2023.
• Return Code Changes
  • Modification of RC 03 and RC 05 descriptions.
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Support for the HH-PPS Grouper Software

For related questions, please use the following contacts:

• Email: HHGrouperQuestions@cms.hhs.gov: Contact for questions with HH PPS Grouper

Note: Please do not submit Protected Health Information through this email system. It is not necessary to send personally identifiable data to demonstrate your question or concern.

Home Health PPS Grouper Software Package (for claims through 12-31-2019)

Archived versions of the Home Health Prospective Payment System (HH PPS) Grouper are available for download. The HH PPS Grouper software will only work for OASIS submissions with an assessment completion date from through December 31, 2019. Effective January 1, 2020 the Home Health Patient Driven Grouping Model, or revised Home Health PPS Grouper Software (HHGS), will be used to process Home Health claims.