Free home health tool
LUPA Revenue Calculator
To use our FREE LUPA Revenue Calculator, select the calendar year, HIPPS code and CBSA or Rural service area, then enter planned or actual visits by payment discipline. See the applicable LUPA threshold and compare estimated Full Revenue with estimated LUPA Revenue.
Free home health tool
LUPA Revenue Calculator
Estimate Full Revenue, LUPA Revenue and the revenue difference for a HIPPS code, CBSA/Rural service area and your planned or actual visit mix.
Result
- HIPPS
- Year
- Total visits
- Wage index area
- Wage index
- Case-mix weight
- Clinical group / function
- Timing / source
- Comorbidity adjustment
Estimate basis: Full Revenue is the wage-adjusted 30-day payment rate for the selected HIPPS Code. The LUPA Revenue is the wage-adjusted visit revenue based on the discipline visits identified for the payment period.
Payments (Full and LUPA) are estimated using post-sequestration Medicare rates.
NOTE: This model does not include a potential LUPA add-on payment, nor the agency-specific HHVBP revenue adjustment. Results are informational estimates, not a guarantee of payment.
Need agency-specific detail? Explore the Case-Mix Planner™Understanding the result
See the potential impact with IFS4hh's free LUPA revenue calculator.
The calculator combines the selected year's payment data, HIPPS code, CBSA or Rural service area and visit mix by discipline to provide a focused revenue comparison for one 30-day payment period.
Define the payment period
Select the calendar year and enter the complete five-character HIPPS code to identify the case-mix weight and LUPA threshold.
Apply the Wage-Index
Select the applicable CBSA or Rural service area so the labor portion of both payment estimates reflects the chosen service area. (CMS Home Health PPS Wage Index).
Enter the visit mix
Enter planned or actual visits across SN, PT, OT, ST, MSS and HHA. Related practitioner types are combined within their Medicare payment discipline.
Visits < threshold
The period meets the visit-count condition for a LUPA. The calculator estimates LUPA Revenue from the entered discipline visits and compares it with estimated Full Revenue.
Visits ≥ threshold
The visit threshold has been met, so a LUPA payment is not applicable based on the entered visits. Other claim rules and adjustments may still apply.
Common questions
What to know before using the LUPA Calculator.
What is a LUPA?
A Low-Utilization Payment Adjustment applies when a home health 30-day period contains fewer visits than the threshold assigned to its HIPPS payment group. The qualifying period is paid using the applicable wage-adjusted per-visit rates rather than the full case-mix and wage-adjusted payment.
Does every HIPPS code have the same threshold?
No. LUPA thresholds vary by payment group and may change between calendar years. Currently, LUPA Thresholds range between 2 and 5.
How are Full Revenue and LUPA Revenue estimated?
Full Revenue uses the annual standardized 30-day payment rate, the HIPPS Code case-mix weight and the selected area's wage index. LUPA Revenue uses the applicable per-visit rate for each entered payment discipline and the same wage-index adjustment. Difference / Lost Revenue shows the difference between those two estimates when the visit total is below the LUPA threshold.
How should visits be entered by discipline?
Combine visits as follows: SN includes RN, LPN and LVN; PT includes PT and PTA; OT includes OT and COTA. Enter ST, MSS and HHA visits in their corresponding fields. Use zero when no visits are planned or provided for a discipline.
What is included—and what is not?
The displayed estimates use post-sequestration Medicare rates and the selected wage index. They exclude the agency-specific HHVBP revenue adjustment, the initial or only-period LUPA add-on, and any other claim-specific adjustments. The figures are informational estimates, not a guarantee of payment.
Can I get this information for Full (non-LUPA) encounters as well?
Yes. IFS4hh offers licensing of the Case-Mix Planner™ (CMP), which identifies the projected revenue, costs, and profit/loss for any patient encounter (LUPA or Full). The CMP is built to work with any payor that follows the "Per Visit" or "PPS/PDGM" reimbursement methodology, including those Medicare Advantage Plans that follow PPS but pay at discounted rates. The CMP can also adjust the agency's expected Medicare payments applicable to the HH VBPM impacts and other revenue adjustments as required. This tool can be used prospectively to help develop Plans of Care, retrospectively to review clinical and operational efficiencies and outcomes, and in a classroom setting for training staff.
Should I enter patient information?
No. The calculator does not require and should not receive a patient name, medical-record number, diagnosis, agency name, notes, or other identifiable information.
Where does the calculator information come from?
The calculator uses annual CMS-derived HIPPS, case-mix, wage-index and discipline-rate reference records maintained for the IFS4hh Case-Mix Planner™. Selecting the calendar year determines which annual dataset is applied. (Sources: Official final source for CY 2026 payment updates, case-mix weights, LUPA thresholds and wage-index downloads.)
Need more detail?
Move from a single estimate to complete case-mix planning.
The Case-Mix Planner™ adds the agency-specific detail needed to evaluate care plans, resource utilization, reimbursement, projected cost and financial outcomes together.