HH grouper v08.0.27 for 2027: diabetes joins the low comorbidity list, lupus and lung cancer drop off

On November 5, 2026, CMS posted the January 2027 Home Health PPS Grouper software, version 08.0.27, for home health claims starting January 1, 2027. Five days later, on November 10, CMS posted Change Request 14668, the CY2027 Home Health PPS rate update that tells Medicare contractors how to pay those claims. Together they carry the lists and rates from the CY2027 home health final rule into the grouper and the Pricer.

For home health coders, the change to watch is which secondary diagnoses earn a comorbidity adjustment. Diabetes is now on the low comorbidity list, and lupus and lung cancer are off it.

What's in home health grouper v08.0.27

CMS says v08.0.27 has no logic or interface changes. It updates four sets of grouper tables effective January 1, 2027:

• Clinical group thresholds for the low, medium, and high functional impairment levels
• Functional impairment response points for certain OASIS items
• The comorbidity group table, which marks the subgroups that earn a low comorbidity adjustment
• The comorbidity interaction table, which lists the subgroup pairs that earn a high comorbidity adjustment

CMS also notes that the grouper now runs on Java 17. Agencies and vendors who run it in a mainframe environment get one COBOL Java bridge module that uses the 64-bit Java 17 environment.

Diabetes joins the low comorbidity list

Under the PDGM, a 30-day period gets the low comorbidity adjustment when a reported secondary diagnosis falls in a subgroup on the home health comorbidity list. It gets the high adjustment when two reported secondary diagnoses form one of the listed interaction pairs. The final rule describes both.

In the grouper's comorbidity tables, the October 2026 release (v07.2.26) flags 20 subgroups for the low adjustment and v08.0.27 flags 22. Four are added and two are removed:

The example codes map to the same subgroups in both grouper versions. What changed is whether that subgroup earns the low adjustment. Diabetes with neuropathy (Neurological_10, which includes E11.40) was already on the low list and stays there.

High comorbidity pairs: 51 added, 46 deleted

The interaction table changes more. CMS's summary of data changes for v08.0.27 lists 51 added pairs and 46 deleted pairs, for 103 pairs in the new table. That matches the 22 low and 103 high subgroups CMS finalized in the CY2027 rule.

A few pairs show how much the list moved:

• Added: diabetes (Endocrine_3) with stage 2 through 4 and unstageable pressure ulcers (Skin_4), and diabetes with cutaneous abscess, cellulitis, and lymphangitis (Skin_1).
• Deleted: sequelae of cerebrovascular disease (Cerebral_4) with diabetes (Endocrine_3).

So a stroke-sequelae patient with diabetes no longer earns the high adjustment from that pair, while diabetes on its own now earns the low adjustment. Check every pair your agency sees often against the new table, not your CY2026 tip sheet. The summary of data changes in the download is labeled preliminary, so recheck it against the final CMS-1844-F lists.

Functional thresholds and OASIS points

Eleven of the twelve clinical groups get new functional impairment thresholds. MMTA - Surgical Aftercare is the one that doesn't change. Here's where the high functional impairment level now starts:

Point values also change for responses to five OASIS items. M1850 (transferring) gains points: response 1 goes from 1 to 3, and responses 2 through 5 go from 4 to 5. M1033 (risk of hospitalization), M1820 (dress lower body), M1830 (bathing), and M1860 (ambulation) lose a point or two on certain responses.

CR 14668: CY2027 home health rates on the claim

CR 14668 is Transmittal 14031. It's dated October 29, 2026 and was re-communicated for public posting on November 10. It's effective January 1, 2027, with a January 4, 2027 implementation date. Contractors apply the CY2027 rates to periods with claim Through dates on or after January 1, 2027.

The LUPA add-on factors stay at 1.7200 for skilled nursing, 1.6225 for physical therapy, 1.6696 for speech-language pathology, and 1.7238 for occupational therapy. Billers should note requirement 14668.4. It tells contractors to instruct providers to report the CBSA code, or a special 500xx wage index transition code, for the patient's state and county of residence in value code 61. Table 6 of the CR lists the affected counties with their CY2027 500xx transition codes.

CMS also posted CR 14671 on November 10 with the CY2027 home infusion therapy services rates, a 2.5% update for HCPCS G0068 through G0070 and G0088 through G0090. Those are HCPCS codes, so check them in the CMS files. HCC Buddy's Code Book and encoder cover ICD-10-CM diagnosis codes only.

What home health coders should do before January 1

Start with the secondary diagnoses. A documented type 2 diabetes diagnosis that isn't coded on the claim can't earn the new low adjustment, and lupus or lung cancer alone no longer earns one. Use the Code Book to confirm the full ICD-10-CM code, then check its subgroup in the grouper's diagnosis table.

Next, ask your billing vendor when it will load v08.0.27 and the CY2027 Pricer, and whether it tested the Java 17 change. And for the rest of the CY2027 home health picture, see the January 2027 home health consolidated billing HCPCS update (CR 14639).