PDGM Calc | HHVBP Suite

Calculator Inputs

Payment Year

Quality compliant Sequestration (n/a)

Geography (CBSA / Wage Index)

CBSA Code

City / Metro Search

Payment Rates

HIPPS / HHRG Code

Code Positions

Timing

Clinical

Function

Comorbidity

Placeholder

Enter HIPPS Code type or paste — auto-advances between positions

— or build it position by position —

Position 1 — Admission Source & Timing

Position 2 — Clinical Group

Position 3 — Functional Impairment Level

Position 4 — Comorbidity Adjustment

Position 5 is always 1 (placeholder)

Calculator Inputs

Payment Year

Quality compliant Sequestration (n/a)

Geography (CBSA / Wage Index)

CBSA Code

City / Metro Search

Visits & Quality

Visit Count For LUPA check

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Estimated Payment

30-Day Period Payment

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Enter a HIPPS code to calculate

⚠ LUPA — Below Visit Threshold Payment switches to per-visit rates. See rates below.

HIPPS Code—

Payment Year—

Base Rate—

Case-Mix Weight—

Case-Mix Adjusted—

Wage Index—

Rural Add-On—

LUPA Threshold—

Estimated Payment—

Per-Visit LUPA Rates (wage-adjusted)

Skilled Nursing

—

Physical Therapy

—

Occupational Therapy

—

Speech-Language

—

Home Health Aide

—

Medical Social Work

—

⚑ Estimate OnlyCalculations use official CMS case-mix weights, base rates, and LUPA thresholds from CY 2020–2026 Home Health final rules: FR 2019-24026 (CY2020), 2021-23993 (CY2021), 2020-24146 (CY2022), 2022-23722 (CY2023), 2023-24455 (CY2024), 2024-25441 (CY2025), 2025-21767 (CY2026). Actual payment depends on your MAC, final HIPPS grouper assignment, outlier thresholds, and your specific CBSA wage index. Always verify with official CMS tables.

Calculator Inputs

Payment Year

Quality compliant Sequestration

Geography (CBSA / Wage Index)

CBSA Code

City / Metro Search

Target Payment

Payment Amount 30-day period payment

Search Parameters

Tolerance Max $ difference to show as match

Matching HIPPS Codes

Enter a payment amount and geography to find matching HIPPS codes.

Rate Trends Parameters

Geography (CBSA / Wage Index)

CBSA Code

City / Metro Search

Quality Reporting

Rate Type

30-Day Base Payment Rate — CY 2020 to CY 2026

National standardized rate, unadjusted · Select a CBSA above to apply wage index

Year-by-Year Breakdown

Year	National Base Rate	Labor / Non-Labor	Wage Index	Wage Adj Rate	Sequestration	Net Rate	YoY Δ	Mkt Basket

⚑ Rate History NotesCY 2020–2026 national standardized 30-day rates shown. Rates reflect permanent behavior adjustments and annual market basket updates per final rules. Wage Adj Rate applies the year-specific wage index without sequestration. Net Rate deducts the 2% sequestration reduction applicable for CY 2020–2023. Labor share: 76.1%/23.9% for CY 2020–2023; 74.9%/25.1% for CY 2024–2026 per CMS rebasing. Rate reductions in CY 2023–2026 reflect CMS behavioral adjustment corrections.

Calculator Inputs

Payment Year

Quality compliant

Geography (CBSA / Wage Index)

CBSA Code

City / Metro Search

HIPPS Code Optional — auto-fills visit threshold

Enter HIPPS to auto-set threshold

LUPA Visit Threshold Set from HIPPS code above

—

visits required to avoid LUPA

Visit Counts by Discipline

Skilled Nursing (SN) ★

Physical Therapy (PT) ★

Occupational Therapy (OT)

Speech-Language (SLP) ★

Home Health Aide (HHA)

Medical Social Work (MSW)

★ Eligible for initial visit add-on (OT eligible from CY 2022 onward)

Initial Visit Add-on First visit discipline (SN, PT, or SLP only)

LUPA Payment

Enter visit counts to calculate LUPA payment.

Historical comparison of CMS proposed vs. final PDGM payment rates and casemix weights, and a projection tool for estimating where the next year's final rates may land once the proposed rule is published.

Geography (optional)

CBSA Code

City / Metro Search

Manual WI Override

Leave blank for national

⚑ All rates on this page reflect quality-compliant HHAs (those submitting required OASIS/HHCAHPS data). Non-compliant HHAs receive a 2% reduction to the annual payment update.

Proposed vs. Final — Payment Update %

Final minus Proposed, in percentage points

Proposed vs. Final — 30-Day Base Rates

CY 2027 Rate Projector

⚑ Notes CMS proposed rules are typically published in June and finalized in October/November. The delta between proposed and final base rates varies year to year due to wage index standardization, market basket revisions, and behavioral adjustment corrections. CY 2023 was a significant outlier due to CMS correcting prior behavioral adjustment methodology. Proposed casemix weights are from the published proposed rule and may differ from final weights. Projections are statistical estimates only — not a forecast of CMS policy.

Upload a worksheet of HIPPS episodes to calculate the revenue impact of a rate change between any two available payment years. HIPPS codes are held constant — changes to OASIS scoring, grouper logic, or case-mix weight assignment in the target rule are not reflected in this analysis.

⚑ Important: This tool holds HIPPS codes constant. It does not reflect any changes to OASIS scoring, case-mix weight assignment, or grouper methodology proposed or finalized in the target rule. Revenue impact reflects rate and wage index changes only.

Baseline Year

Target Year

Upload Episode File

↑

Drop CSV here or click to browse

Required columns: hipps, cbsa, episodes · Optional: label

No PHI — do not include patient identifiers

⚑ Notes HIPPS codes are held constant across baseline and target years. This analysis does not model any changes to OASIS scoring, case-mix weight assignment methodology, or grouper logic that may be proposed or finalized in the target rule. Wage index values are sourced from CMS published tables for each respective rule year and type. Quality-compliant base rates are used for all calculations. Non-compliant agencies should apply a 2% reduction. Results are estimates only — verify against official CMS tables and your MAC.