Updated on 11/02/2021

Home Health LUPA Threshold: Bill Correctly

 

In a recent report, the Office of Inspector General found that Medicare improperly paid some claims for home health services with 5–7 visits in a payment episode. Review the Medicare Home Health Benefit (PDF) and Home Health Prospective Payment System (PPS) (PDF) booklets to properly bill for services slightly above the Low Utilization Payment Adjustment (LUPA) threshold.

Visit the Home Health Prospective Payment System webpage for additional resources to stay informed about the latest policy and payment updates:

Article  published by CMS on October 28, 2021
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