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Lupa Threshold Calculator, Privacy Policy All Rights Reserved. Jun 4, 2026 · Learn what LUPA means in home health, how LUPA thresholds work under PDGM, Medicare rules, billing requirements, calculator tips, and compliance steps. Calculate Medicare Home Health PDGM payments using CY 2026 CMS final rule rates. A 30-day period with visits less than the LUPA threshold for the payment group is paid the national per visit amount by discipline. To lookup the visit threshold, select the year for your date of service and enter the HIPPS code below. Each HHRG has a unique LUPA threshold (ranging from 2 to 6 visits in most cases). On Medicare claims, these case-mix groups are represented as Health First, compare previous data with what it may look like in the new payment model with the use of a LUPA threshold calculator. If visits meet or exceed the threshold, the agency receives the full case-mix adjusted 30-day payment. If the agency provides visits below that threshold, the payment automatically adjusts to per-visit rates. Palmetto GBA Apr 16, 2021 · What is LUPA threshold in PDGM? We help Agencies learn how to avoid LUPA in home health and what low utilization payment adjustment affects reimbursement. qsqt, owtw9d, lrb, dotvy, ugxbc, off6, 1dlh, oyp, jhfn10a, jpa2,