Calculator
See how close a 30-day period is to its group-specific LUPA threshold. PDGM thresholds vary by HHRG group (10th percentile of visits, minimum 2), so you enter your period’s threshold.
Last reviewed June 15, 2026.
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Above threshold by 1 visit(s) — paid the full case-mix 30-day rate.
Under PDGM, each of the 432 payment groups has its own LUPA threshold set at the 10th percentile of visits for that group (minimum 2). A 30-day period with total visits below its group threshold is paid per-visit (a LUPA) instead of the full case-mix-adjusted 30-day amount. Because the threshold varies by group, this tool asks you to enter your period's threshold rather than assuming one. CMS recalibrated CY2026 thresholds using CY2024 data.
Source CMS CY2026 HH PPS Final Rule (CMS-1828-F) — group-specific LUPA thresholds, recalibrated with CY2024 data: cms.gov CMS-1828-F fact sheet
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Open guideCalculatorsNOA penalty, LUPA threshold, CY2026 impact, and EMR switching cost.
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