The Facts About Upcoming Changes in Home Health Payment

Major changes are coming to the case-mix methodology and payment system for home health agencies (HHAs) under Medicare. What are the key details? How will physical therapists (PTs) and physical therapist assistants (PTAs) be affected?

Let's look at what PTs and PTAs need to know about the Home Health Patient-Driven Groupings Model (PDGM) to ensure that patients in home health get optimal access to the physical therapy services they need.

Background

Current Medicare payment for home health services under the Prospective Payment System (PPS) is based on a 60-day episode of care. (If fewer than 5 visits are delivered within a 60-day period, payment is based on a standardized per-visit payment by discipline rather than by payment for a 60-day episode. This is called low-utilization payment adjustment, or LUPA.)

Join APTA to get unlimited access to content.

Create a free account Log in

Bell A. Understanding the CPT process. PT in Motion. 2018;10(10):8-11.
AMA CPT® 2018 Professional Edition. Chicago, IL: American Medical Association; 2017.

You Might Also Like...

Article

Final 2027 Physician Fee Schedule Has Mixed Payment Impact for Physical Therapy

The 2027 Medicare Physician Fee Schedule final rule includes meaningful progress toward modernizing payment for physical therapist services, featuring

Column

Defining Moment | The Ten Yards to Hope

A short walk with a patient in a skilled nursing facility taught this PT that recovery is about more than simple movement.

Article

Modest Payment Increases Finalized by CMS for SNFs and IRFs

Note: This article was updated on Oct. 27, 2026, to add additional information about interdisciplinary team meetings and case-mix upcoding. The Centers