Home Health · Reference
PDGM Rates
The CY 2026 national, standardized 30-day period base rate and national per-visit amounts, how the period payment is assembled, and the adjustment factors behind the number.
CY 2026 30-day period base rate
Eff. Jan 1 2026$2,038.22
National standardized 30-day period · submits quality data
HHAs that don't submit required quality data are updated by 0.4% instead of 2.4% (about $1,998). The base rate is then multiplied by the period's case-mix weight and wage index. Down 0.93% from the CY 2025 rate of $2,057.35.
Source: CY 2026 HH PPS Final Rule (CMS-1828-F); CMS MLN Matters MM14304, eff. Jan 1 2026.
Adjustment factors
Market basket update (3.2% − 0.8% productivity)+2.4%
Permanent behavior adjustment×0.98977
Temporary adjustment (CY 2026 only)×0.97000
Case-mix recalibration budget neutrality×1.0052
Wage index budget neutrality×1.0025
Labor-related share (wage-adjusted)74.9%
Outlier FDL ratio · loss-sharing0.37 · 0.80
Disposable NPWT device$282.10
CY 2026 national per-visit amounts
LUPA & outliersPer-visit amounts pay LUPA periods (when visits fall below the threshold) and feed outlier cost imputation. The LUPA add-on applies to the first skilled visit when the period is the only or initial 30-day period in a sequence.
| Discipline | CY 2025 | CY 2026 | CY 2026 + LUPA add-on |
|---|---|---|---|
| Skilled Nursing SN | $172.73 | $176.96 | $304.37 ×1.7200 |
| Physical Therapy PT | $188.79 | $193.42 | $313.82 ×1.6225 |
| Occupational Therapy OT | $190.08 | $194.74 | $335.69 ×1.7238 |
| Speech-Language Pathology SLP | $205.22 | $210.25 | $351.03 ×1.6696 |
| Medical Social Services MSS | $276.85 | $283.64 | — |
| Home Health Aide HHA | $78.20 | $80.12 | — |
Per-visit amounts are not subject to the permanent, temporary, or case-mix budget-neutrality adjustments — only the wage-index budget-neutrality factor (1.0005) and the payment update.
Open the LUPA Calculator → Open the PDGM Calculator →
Source: CY 2026 HH PPS Final Rule, national per-visit table; LUPA add-on factors SN 1.7200 · PT 1.6225 · OT 1.7238 · SLP 1.6696. Verify against the CMS HH PDGM source before billing.
How the period payment is built
1 · Group the 30-day period into 1 of 432 case-mix groupsHIPPS
2 · Multiply the base rate by the group's case-mix weight$2,038.22 × CMW
3 · Wage-index adjust the labor-related share (74.9%)× WI
4 · If visits < LUPA threshold → pay per-visit insteadLUPA
5 · Apply PEP proration / outlier / NOA reductions as applicable± adj
The 432 groups come from 4 admission-source/timing combinations × 12 clinical groups × 3 functional levels × 3 comorbidity levels. Build a HIPPS →