Revenue Cycle

LUPA Threshold

The LUPA Threshold is the minimum number of qualified skilled home health visits required during a 30-day payment period to receive the full PDGM payment rather than reduced per-visit rates.

Definition

The LUPA Threshold is the minimum number of qualified skilled home health visits required during a 30-day payment period to receive the full PDGM payment rather than reduced per-visit rates.

Why it matters

LUPA Threshold is part of the Revenue Cycle vocabulary used across home health operations, documentation, and revenue cycle. Understanding it helps clinicians, QA leads, and administrators stay aligned on care quality and compliance.

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Related Blogs

Billing

LUPA Explained: How Low Utilization Payment Adjustment Affects Home Health Agencies

LUPA — Low Utilization Payment Adjustment — kicks in when a 30-day home health period falls below its PDGM visit threshold, shifting payment from the case-mix-adjusted 30-day rate to per-visit. This guide explains how thresholds work, what causes avoidable LUPAs, and how to manage LUPA risk without chasing visits.

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