Home Health · Estimator
NOA Penalty Calculator
The Notice of Admission must be accepted within 5 calendar days of the start of care. File late and Medicare cuts the 30-day period payment by 1/30 for every day from admission until acceptance. Enter the dates to size the reduction.
Data statusEstimator
- Status
- Estimator
- Data year / effective
- CY2026
- Last reviewed
- July 2026
- Last updated
- July 2026
- Primary source
- CMS MM12256 / CR 11296
- Known exclusions
- Uses the payment amount you enter — case-mix/wage adjustment and outlier not computed here
- Exception-request outcomes not modeled
- Assumes subsequent periods pay the same amount when the NOA is >30 days late
Estimate only — the actual reduction is applied by the MAC to each period's adjusted payment. Validate against your remittance.
Start of care (admission)
NOA accepted date
Expected 30-day period payment ($)
Defaults to the CY2026 national base rate ($2038.22). Use your case-mix and wage-adjusted period amount for a real estimate — the reduction is taken from the adjusted payment, including outlier. Model the period →
Payment reduction
$0
Remaining period payment
$0
Visits furnished on the penalty days are not separately payable either — a late NOA in a LUPA period forfeits the per-visit payments for those days. An exception request (KX modifier + remarks on the claim) can waive the penalty for qualifying circumstances beyond the agency's control.
Sources: CMS MM12256 (NOA replaces RAPs, CY2022); CR 11296; Medicare Claims Processing Manual ch. 10.
How the reduction works
| NOA accepted | Effect |
|---|---|
| Day 0–5 | Timely. Full payment. |
| Day 9 | 9/30 of the period payment is forfeited (the reduction counts from day 1, not day 6). |
| Day 30 | The entire first period is unpaid. |
| Day 45 | First period unpaid + 15/30 of the second period. |
The penalty clock runs from the start of care to acceptance — an NOA that is submitted on day 4 but rejected (T-status/RTP'd) and only accepted on day 12 is 12 days late for penalty purposes. Submit early and work rejections same-day.
FAQ
When is a home health NOA due?
The Notice of Admission (type of bill 32A) must be submitted to, and accepted by, the MAC within 5 calendar days after the start of care. One NOA covers the whole admission — it is not per 30-day period.
How is the late-NOA penalty calculated?
Medicare reduces the period payment by 1/30 for each day from the start of care through the date the NOA is accepted. The reduction applies to the case-mix and wage-adjusted 30-day payment, including any outlier. Days before acceptance are effectively unpaid — and no LUPA per-visit payments are made for visits on those days.
What if the NOA is more than 30 days late?
The reduction rolls into subsequent 30-day periods: a 45-day-late NOA wipes out the first period (30/30) and half of the second (15/30).
Can the penalty be waived?
Yes — via an exception request for circumstances beyond the agency's control (fires, floods, natural disasters, CMS or MAC system issues, a newly Medicare-certified HHA notified late of certification). Request it on the claim with the KX modifier and remarks describing the circumstance.
