Home Health PPS Grouper Software (HHGS)

Home Health PPS Grouper Software (HHGS) Package (for claims starting 10-01-2023)

The October 2023 release of the HH PPS Grouper software (v04.2.23) is now available in the “Downloads” section of this webpage. Included in the v04.2.23 HH PPS Grouper software update are the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes, effective beginning October 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 v04.2.23 software update are:

• Diagnosis Code Changes
  • Addition of new ICD-10-CM diagnosis codes effective October 1, 2023. 
  • ICD-10-CM diagnosis code deletions, as applicable.
  • Modification of ICD-10-CM diagnosis code descriptions, as applicable.
  • External Cause of Injury changes
  • Unacceptable principal diagnosis (pdx) changes
  • Unspecified principal diagnosis (pdx) changes
  • Manifestation code changes
  • Code First changes
• Return Code Changes
  • Logic Modification and Description update for Return Code 01: From or Through Date Error
• Validity Flag Changes
  • New Validity flags 08-15
  • Modification of VF descriptions to change “primary diagnosis” to “principal diagnosis”
• Interface Change to include a “Through Date” field.
• Logic Update: Due to the addition of the claim “Through date” field, the Claim Spanning logic (implemented April 2023) has been updated:
  • For claim dates on and after October 1, 2023, both the From and Through date fields are required when reporting a HH period of care.
  • For claim dates on and after April 1, 2023, through September 30, 2023, only the From date field is available for reporting a HH period of care. The HH grouper calculates the Through date, by adding 29 days to the From date, in order to calculate a 30-day HH period of care, and to monitor the reported principal diagnosis over the span of a quarter boundary date.
• Implementation of new validity flags: 08-15 to identify errors regarding the From or Through dates

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

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.