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.