PDGM – LUPA Look Up Tool

Currently in the PPS model, for a claim to be a LUPA you needed to have four visits or less but in PDGM (Patient-Driven Grouping Model, effective 2020) there’s a threshold that varies for every patient group. LUPA thresholds in CMS’ proposed payment model vary from two to six visits for every 30-day payment period. So, in PDGM, in order for an agency to know if the claim is going to be a LUPA, they need to know the HIPPS code from the OASIS and then use this look-up tool below to see how many visits would be considered a LUPA for that particular claim.

Results will be shown here.

Patient Driven Groupings Model

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