PDGM Payment Suite

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Rate Parameters

Payment Year

Geography

CBSA Lookup

Enter 5-digit code

Wage Index Auto-filled or manual

Quality Reporting

Sequestration

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Payment Rates

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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)

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Geography & Payment Year

Payment Year

Area Type

CBSA Lookup

Enter 5-digit code

Wage Index Auto-filled or manual override

Visits & Quality

Visit Count For LUPA check

—

Quality Reporting

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Estimated Payment

30-Day Period Payment

—

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.

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Reverse Lookup — Payment to HIPPS

Enter a known payment year, CBSA, and a target payment amount. The tool will identify which HIPPS codes could produce that payment and rank them by closeness.

Payment Year & Geography

Payment Year

Geography

CBSA Lookup

Enter 5-digit code

Wage Index Auto-filled or manual override

Target Payment

Payment Amount Enter the 30-day period payment received

Payment Parameters

Quality Reporting

Sequestration

Tolerance Max $ difference to show as match

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Matching HIPPS Codes

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

Area Type

CBSA / Wage Index Optional — adds local line to chart

Enter 5-digit code

Quality Reporting

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

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

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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.

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LUPA Parameters

Payment Year

Geography

CBSA Lookup

Enter 5-digit code

Wage Index Auto-filled or manual

Rural Add-on

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)

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LUPA Payment

Enter visit counts to calculate LUPA payment.