Low Utilization Payment Adjustment (LUPA)

10.6 - Low Utilization Payment Adjustment (LUPA) (Rev. 265, Issued: 01-10-20, Effective: 01-01-20, Implementation: 02-11-20) The LUPA threshold varies for a 30-day period of care depending on the payment group to which it is assigned. For each payment group, the 10th percentile value of visits is used to create a payment group-specific LUPA threshold with a minimum threshold of at least 2 visits for each group. A 30-day period with visits less than the LUPA threshold for the payment group is paid the national per visit amount by discipline adjusted by the appropriate wage index based on the site of service of the beneficiary. Such periods that do not meet the LUPA threshold for the payment group are paid the wage-adjusted per visit amount for each of the visits rendered instead of the full 30-day period payment amount. The national per visit amounts by discipline (skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, and medical social services) are updated and published annually by the applicable market basket for each visit type. To offset the full cost of longer, initial visits in some LUPA periods, the LUPA payment is increased by an add-on amount for LUPAs that occur as the only 30- day period or the initial 30-day period during a sequence of adjacent periods.