HOME HEALTH · PATIENT-DRIVEN GROUPINGS MODEL

PDGM Payment Calculator

Estimate the Medicare home-health 30-day period payment from a HIPPS code and county, with wage-index adjustment, HHVBP, late-NOA reduction, and options for partial periods, outliers, and LUPA. Rates are from the CY2025 and CY2026 HH PPS final rules.

EstimatorCMS-based

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.

Inputs

30-Day Period

Loads a sample period — every field stays editable.

Year (calendar year)

HIPPS Code — 5 characters

Enter a 5-character HH HIPPS code.

County (FIPS) — grouped by state

Select a county to set the wage index.

HHVBP Rate (multiplier)

NOA days late (1/30 each)

LUPALow Utilization Payment Adjustment (pay per-visit) Partial Period (PEP)Prorate by days served ÷ 30 High-Cost OutlierAdd outlier payment when cost exceeds threshold

Result

CY2026

Estimated period payment—

Inputs

Result

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