US · guidance
CMS Pub. 100-04, ch. 3, § 190.5.3
Comorbidity Adjustments
Comorbidities are specific patient conditions that are secondary to the patient's principal
diagnosis and that require treatment during the stay. Diagnoses that relate to an earlier
episode of care and have no bearing on the current hospital stay are excluded and not
reported on IPF claims. Comorbid conditions must co-exist at the time of admission,
develop subsequently, affect the treatment received, affect the length of stay or affect both
treatment and the length of stay. IPFs enter the full codes for up to twenty four additional
diagnoses if they co-exist at the time of admission or develop subsequently.
The IPF PPS has 15 comorbidity categories, each containing codes of comorbid
conditions. Each comorbidity grouping will receive a grouping-specific adjustment.
Facilities can receive only one comorbidity adjustment per comorbidity category, but can
receive an adjustment for more than one comorbidity category on the claim. The IPF
PRICER then applies the appropriate adjustment factors to the Federal per diem base rate.
A list of the ICD-10-CM/PCS codes that are associated with each category is on the IPF
PPS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/InpatientPsychFacilPPS/index.html?redirect=/inpatientpsychfacilpps. Select
Tools and Worksheets from the column at the left.
The 15 comorbidity categories and specific adjustments are as follows:
Description of Comorbidity Adjustment Factor
Developmental Disabilities 1.04
Tracheostomy 1.09
Renal Failure, Acute 1.06
Renal Failure, Chronic 1.08
Oncology Treatment 1.44
Uncontrolled Diabetes-Mellitus with or
without complications
1.05
Severe Protein Calorie Malnutrition 1.17
Description of Comorbidity Adjustment Factor
Eating Disorders 1.09
Cardiac Conditions 1.04
Gangrene 1.12
Chronic Obstructive Pulmonary Disease &
Sleep Apnea
1.09
Artificial Openings - Digestive and Urinary 1.07
Severe Musculoskeletal and Connective
Tissue Diseases
1.05
Poisoning 1.16
Intensive Management for High-Risk
Behavior
1.07
History
(Rev. 12830; Issued: 09-09-24; Effective: 10-01-24; Implementation: 10-07-24)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
de231e5c40c5e4e501ed911a7c5dce9e15b82ce49abc95dbb7871d1f76e7e343
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