LUPA Threshold Checker

Every PDGM case-mix group has a LUPA threshold: the number of visits a 30-day period needs before Medicare pays the full period amount. A period with fewer visits than the threshold is paid per visit instead. Enter the period’s HIPPS code, or build it on the tiles, and count the visits done or scheduled to see how many more it needs. Paste a column of codes, each with its visit count, to check a whole caseload at once.

The threshold

The large number is the CY2026 threshold for that case-mix group. CMS’s own example: with a threshold of four, a period with four or more visits is paid the full 30-day amount, and one with three or fewer is paid per visit.

Visits in this period

Visits done or scheduled in the 30-day period, counted against the threshold. The line underneath says how many more reach it, or that the period already meets it.

One step away

The codes one character away in the same clinical group, with their thresholds: what the period would need with a different period type, functional level or comorbidity level.

A pasted caseload

One row per period, in the order pasted, with its threshold, its visit count and how many more it needs. Periods without a visit count show the threshold only.

What is a LUPA in home health?

A LUPA (Low-Utilization Payment Adjustment) is what Medicare pays instead of the full 30-day amount when a home health period has fewer visits than its case-mix group’s LUPA threshold. Each visit is then paid at the national per-visit rate, usually far less than the full period amount (42 CFR 484.230).

How many visits avoid a LUPA in 2026?

It depends on the case-mix group. Across the 432 CY2026 case-mix groups the thresholds run from 2 to 5 visits per 30-day period, and CMS recalibrates them every year. Reaching the threshold, or going over it, avoids the LUPA.

Does the LUPA threshold change per case-mix group?

Yes. Each of the 432 case-mix groups, the combination of admission source, timing, clinical group, functional level and comorbidity adjustment, has its own threshold, set in the HH PPS Final Rule (CMS-1828-F). There is no single agency-wide number.