Low Utilization Payment Adjustment (LUPA) Threshold Lookup

With the home health Patient-Driven Groupings Model (PDGM), the LUPA thresholds vary for a 30-day period of care depending on which of the 432 case-mix groups it is assigned. The LUPA threshold ranges between 2 and 6 visits. A 30-day period with visits less than the LUPA threshold for the payment group is paid the national per visit amount by discipline. For more information, please visit the CMS Home Health Patient-Drivien Groupings Model homepage