CMS Pub. 100-02, ch. 7, § 10.6

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.