Visit Threshold
Minimum number of billable skilled visits required during a PDGM 30-day payment period.
Definition
A Visit Threshold is the minimum number of billable skilled visits required during a PDGM 30-day payment period to avoid a LUPA adjustment. CMS assigns a threshold ranging from 2 to 6 visits, depending on the patient's payment group.
Why it matters
Knowing the threshold helps agencies schedule visits appropriately while meeting patient needs and avoiding unnecessary payment reductions.
What Should I Document? 100 OASIS Situations Home Health Nurses Face Every Day
100 real OASIS scenarios, worked end to end — clinical situation, common mistake, better approach, and key takeaway. Built around OASIS-E2 (effective April 1, 2026) to turn what you assess into accurate, defensible documentation.
Listen While You Read
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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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