When do home health claims qualify for the LUPA add-on payment?

Low-Utilization Payment Adjustment (LUPA) claim payments qualify for an add-on payment in the case that the established episode is the first or only episode in a sequence of related episodes. The current LUPA add-on amount for CY 2010 is $97.72. By way of reference, a LUPA is made for beneficiaries who require four or fewer visits during the 60-day episode. These episodes are paid the labor adjusted, national standardized, service-specific per-visit amount multiplied by the number of discipline-specific visits actually furnished during the episode.


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