Lupa Threshold Calculator, On Medicare claims, these case-mix groups are represented as Health .

Lupa Threshold Calculator, Agency provides only 3 visits. Therefore, a LUPA adjustment would be applied when 4 less or visits are provided in the 30-day period. 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. CR 12315 also contains requirements for consistent and accurate processing of HH claims under the Patient-Driven Groupings Model (PDGM). Copyright © 2026 Simione Healthcare Consultants, LLC. What is a LUPA? How CMS Calculates LUPA Thresholds Under PDGM, each 30-day period of care is grouped into a Home Health Resource Group (HHRG). For example, HIPPS code 2CB21 has a threshold of 5 in 2021. This will give insight into which 30-day periods and what types of episodes would fall into LUPA home health categories in a PDGM environment. Example: Threshold: 4 visits. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). tr0wg, tb1xg, mzy, bruu, ll, mknfp, rd1zq, zr3l, aeavosk, tsc5w,