Palmetto GBA
Home Health
Prospective Payment System
LUPA Calculation for
Episodes Ending on or After 1/1/13
CBSA number for site of service
1
10420
Skilled Nursing
2
Physical Therapy
1
Occupational Therapy
1
Speech Pathology
0
Medical Social Services
0
Home Health Aid
0
Total
4
Has your agency submitted the Required Quality Data?
Yes
Is this the initial or only adjacent lupa episode?
Yes
SN
PT
OT
SP
MSS
HHA
1.
Standardized Per Visit Rates for CY 2013
$114.35
$125.03
$125.88
$135.86
$183.31
$51.79
2.
Visits during 60-day episode
2
1
1
0
0
0
3.
Imputed Labor Costs (# of visits by discipline x line 1)
$228.70
$125.03
$125.88
$0.00
$0.00
$0.00
4.
Labor Portion of Per Visit Amount (line 3 x 78.535%)
$179.61
$98.19
$98.86
$0.00
$0.00
$0.00
5.
Wage Index Factor
0.8729
0.8729
0.8729
0.8729
0.8729
0.8729
6.
Wage adjusted labor portion (line 4 x line 5)
$156.78
$85.71
$86.29
$0.00
$0.00
$0.00
7.
Non-labor portion of payment (line 3 x 21.465%)
$49.09
$26.84
$27.02
$0.00
$0.00
$0.00
8.
LUPA Payment (line 6 + line 7)
$205.87
$112.55
$113.31
$0.00
$0.00
$0.00
9.
Total LUPA payment
$431.74
10.
Calculation of the total wage adjusted amount for only or initial
episodes
:
$95.85
No Reduction
$95.85
11.
Labor portion
(LUPA Add On Amount x 78.535%)
$75.28
12.
Wage index factor
0.8729
13.
Wage adjusted labor portion
$65.71
14.
Non-labor portion
(LUPA Add On Amount x 21.465%)
$20.57
15.
Total wage adjusted add-on amount for initial or Only LUPA episodes
$86.28
16.
Total payment with LUPA add-on, if
applicable
$518.02
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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.
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
.