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    LUPA & PDGM

    Low Utilization Payment Adjustment (LUPA)

    Medicare payment adjustment under the Patient-Driven Groupings Model (PDGM) that applies.

    Definition

    Low Utilization Payment Adjustment (LUPA) is a Medicare payment adjustment under the Patient-Driven Groupings Model (PDGM) that applies when a home health agency provides fewer visits than the CMS-established threshold during a 30-day payment period. Instead of receiving the full PDGM payment, the agency is reimbursed on a per-visit basis.

    Why it matters

    LUPA can significantly reduce reimbursement, making visit planning, documentation, and care coordination critical for financial sustainability.

    Listen While You Read

    Conversations on lupa & pdgm

    Episodes from Inside Home Health that put Low Utilization Payment Adjustment (LUPA) in operational context.

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