Home Health · Calculator
LUPA Calculator
Check whether a 30-day period falls below its LUPA threshold, and estimate the per-visit payment — including the first-visit LUPA add-on — when it does.
Data statusEstimator
- Status
- Estimator
- Data year / effective
- CY2026
- Last reviewed
- June 2026
- Last updated
- June 2026
- Primary source
- CMS Home Health PPS Final Rule, CY2026
- Known exclusions
- Wage-index / CBSA adjustment varies
- LUPA, PEP, and outlier policy may apply
- Sequestration and MAC edits not applied
Estimate only — wage index, sequestration, and payer/MAC edits are not applied. Validate against CMS and your MAC before billing.
LUPA threshold for this group
Each of the 432 case-mix groups has its own threshold — the higher of 2 visits or the 10th percentile of visits. Look up the exact value for the period's HIPPS in the CMS LUPA threshold table.
Projected visits by discipline
First-visit LUPA add-on
Per-period payment
$0.00
Enter visits to estimate
When total visits are at or above the threshold, the period is paid as a full case-mix-weighted 30-day period (use the PDGM Calculator for the case-mix-weighted amount). Below the threshold, it is paid per visit at the CY 2026 national rates shown here.
Per-visit amounts are national CY 2026 rates before wage-index adjustment; actual payment is wage-adjusted by CBSA.
