What are the 12 clinical groupings in PDGM?

by Keith Grunig

What are the 12 clinical groupings in PDGM?

PDGM Graphic with Question Marks

Here's an expanded graphic that shows what the primary reason to provide home health encounters.  

PDGM 2022

Many agencies felt like they were ready for PDGM in 2020.  Then we faced a pandemic and it was all hands-on deck understandably.  However, many agencies lost out on valuable data and information gathering to understand PDGM and its impacts to agencies.  What we found out, is that many agencies weren't able to implement PDGM because of the challenges they faced with patient care, staffing, and the many challenges a pandemic brought.  Further, CMS was understandably helping fund and finance agencies.  Many agencies just took the cash but didn't pay attention to PDGM.  Fast forward to today and agencies are now scratching their head saying "Why am I not making any money?"  The answer is PDGM.  Many agencies failed to understand PDGM and are only now recognizing the impacts PDGM is having after federal money has dried up.  

We have written several articles about PDGM and explaining what PDGM is..  You can read about them.  How does PDGM Impact HHAs? and PDGM For Dummies

What are the 12 Clinical Groupings in PDGM?

This is kind of a trick question.  Technically there are six groupings.  However, one of the groupings is broken up into six sub groups.  Here they are in order:

  • Musculoskeletal Rehabilitation
  • Neuro/Stroke Rehabilitation
  • Wounds- Post Op Wound Aftercare and Skin/Non-Surgical Wound Care
  • Complex Nursing Interventions
  • Behavioral Healthcare
  • Medication Management, Teaching, and Assessment
    • MMTA- Surgical Aftercare
    • MMTA- Cardiac/Circulatory
    • MMTA- Endocrine
    • MMTA- GI/GU
    • MMTA- Infectious Disease/Neoplasms/Blood-Forming Diseases
    • MMTA- Respiratory
    • MMTA- Other

Here is what they look like in a graphic from CMS

12 PDGM Clinical Groupings


Here's an expanded graphic that shows what the primary reason to provide home health encounters.  

Expanded PDGM Groupings

CMS has produced a lot of great help for agencies.  Here's a link that provides a high level view of PDGM.  You can read that here

Home Care Answers has helped agencies thrive in PDGM.  Where several have seen a decrease in reimbursement, many client partners of Home Care Answers has experienced and increase in reimbursement.  OASIS and Coding are how agencies are paid.  There is too much risk to agencies to not trust experts to ensure accuracy.  Accuracy leads to reimbursement, better outcomes, and ultimately more resources to provide better patient care.  Ask us how we can help you.  


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