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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.


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.)

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

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