Palmetto GBA
Home Health
Prospective Payment System
LUPA Calculation for
Periods Ending on or After 1/1/21
CBSA number for site of service
1
99926
Rural Type
ALL
Rural FIFPS Code to Enter on Claim
29007
Skilled Nursing
0
Physical Therapy
1
Occupational Therapy
0
Speech Pathology
0
Medical Social Services
0
Home Health Aid
0
Total
1
Has your agency submitted the Required Quality Data?
Yes
Is this the initial or only adjacent lupa episode?
Yes
Enter fist visit - sn,pt,st
pt
Home Health Value Based Purchasing Adjustment
1.00000
SN
PT
OT
ST
MSS
HHA
1.
CY 2021 Rural Rate Increase Fed Reg 11/4/20
$154.16
$168.50
$169.66
$183.15
$247.09
$69.80
2.
Imputed Labor Costs (# of visits by discipline x line 1)
$154.16
$168.50
$169.66
$183.15
$247.09
$69.80
3.
Labor Portion of Per Visit Amount (line 2 x 76.100%)
$117.31
$128.23
$129.11
$139.38
$188.03
$53.12
4.
Wage Index Factor (from Addendums A & B,
Federal Register
, November 4, 2020)
0.7778
0.7778
0.7778
0.7778
0.7778
0.7778
5.
Wage adjusted labor portion (line 3 x line 4)
$91.25
$99.74
$100.42
$108.41
$146.25
$41.32
6.
Non-labor portion of payment (line 2 x 23.900%)
$36.84
$40.27
$40.55
$43.77
$59.05
$16.68
7.
Per Visit Amount (line 5 + line 6)
$128.09
$140.01
$140.97
$152.18
$205.31
$58.00
8.
LUPA Add-On Multiplier
1.0000
1.6700
0.0000
1.0000
0.0000
0.0000
9.
LUPA Rate and Add-on Amount
$128.09
$233.81
$0.00
$152.18
$0.00
$0.00
10.
LUPA Add-On Visit
0
1
0
0
0
0
11.
Visits During 60-day episode less add-on
0
0
0
0
0
0
12.
LUPA amounts
$0.00
$233.81
$0.00
$0.00
$0.00
$0.00
13.
Total Payment
$233.81
14.
Home Health Value Based Purchasing Adjustment
1.00000
15.
Calculated Payment After HHVBP Adjustment and Before Sequestration
$233.81
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1
Effective January 1, 2006, wage index factors are transitioned from the Metropolitan Statistical Area (MSA) code or Core Based Statistical Area (CBSA) Code. To determine payment for 2006 episodes, home health agencies should use the CBSA code, or, if appropriate, the Transitional code provided to them in our letter of December 22, 2005. The Transitional codes are from addendum A & B of the November 9, 2005 Federal Register and are intended to be used only for the 2006 rate year. MSA codes should no longer be used for any claims with 2006 dates of service.
1
See corresponding Federal Register for CBSA (MSA) codes and weights
2
Home Health Resource Groups (HHRG) and Health Insurance Prospective Payment System (HIPPS) codes and weights can be found in Federal Registers dated, July 3, 2000; August 29, 2007; November 4, 2011; November 22, 2013; November 6, 2014; November 13, 2018; November 8, 2019; November 4, 2020
Calculations are estimates only. This calculator is intended to assist providers in calculating their estimated payments for initial RAPs, Full episodes, PEPs, SCICs, LUPAs, and Outliers for service periods beginning on or after October 1, 2000. The payment amounts computed are subject to change based on updated instructions provided in the
Federal Register
, the actual number of visits, geographical locations, and urban/rural status
.