How does Medicare pay for a 30-day home health period in 2027?

For periods starting in 2027, the national, standardized 30-day payment is $2,092.69, up from $2,038.22 in 2026. It carries a new 3% temporary cut, the same size as the one CMS first applied in 2026; without it the rate would be $2,157.41.

If your agency doesn't submit the required quality data, the 2027 update is 0.1% instead of 2.1%, and the starting amount is $2,051.70 (final rule, tables 13 and 14, 91 FR 72070). That's $40.99 less on every period before any weight is applied.

PDGM, the Patient-Driven Groupings Model, sorts every 30-day period into one of 432 payment groups, each with its own case-mix weight. Multiply $2,092.69 by the weight and you have the national payment for that period, before the wage adjustment, which raises or lowers part of the payment for local labor costs where the patient gets care. The group shows on the claim as a five-character HIPPS code.

CMS recalibrated every group's weight and visit threshold for 2027 using 2025 claims.

Take one patient type, a neuro rehab patient with medium functional impairment, and change one fact at a time. The weights are CMS's 2027 weights (final rule, table 11, 91 FR 72052 to 72061). The period payments, differences, per-day and LUPA amounts on this page are by our arithmetic from CMS's published rates and weights, national and before the wage adjustment.

On this patient, a qualifying stay in the 14 days before admission puts the first period $444.28 above the community version. One secondary diagnosis that qualifies for the low adjustment adds $119.49. And the patient's later periods pay $676.57 less than the first.

The clinical group and functional level come straight from the diagnosis and OASIS answers in the table above.

Early and late

Only the first 30-day period in a sequence counts as early. Every period after it is late. A new sequence starts only if more than 60 days pass between the end of one period and the start of the next.

Admission source

A period is institutional when the patient had an inpatient acute hospital, psychiatric hospital, skilled nursing facility, inpatient rehab or long-term care hospital stay in the 14 days before home health admission. For later periods, only an acute hospital stay counts, and only if you didn't discharge and readmit.

Medicare's claims system checks for a Medicare inpatient claim in that window and adjusts your claim if it finds one. A stay Medicare didn't pay for won't turn up that way, so your claim reports it with occurrence code 61 for a hospital or 62 for other institutions.

Comorbidity

A period gets the low comorbidity adjustment when one secondary diagnosis is on CMS's home health comorbidity list. It gets the high adjustment when two secondary diagnoses appear together on CMS's interaction list. No qualifying secondary diagnosis, no adjustment. CMS rebuilds the lists each year: 2027 has 22 low subgroups and 103 high interaction subgroups (final rule, tables 8 and 9, 91 FR 72043 to 72047), so a code that counted in 2026 may not count now.

Every payment group has a visit threshold, set at the 10th percentile of visits for that group, never fewer than two. Make fewer visits than the threshold in a 30-day period and Medicare pays per visit instead of the period amount. This is the low-utilization payment adjustment (LUPA).

The 2027 national per-visit amount for skilled nursing is $180.66 (table 15 of the final rule lists every discipline), and the 3% temporary cut doesn't apply to it. If the LUPA period is the patient's only period or the first in a sequence, the first visit gets an add-on: nursing's is multiplied by 1.72, and therapy disciplines have their own factors in the final rule (91 FR 72072).

In table 11, the 1BB11 patient above has a 2027 threshold of four visits. Make four and the period pays $2,347.37. Make three nursing visits and it pays about $672.06 ($180.66 x 1.72 for the first, plus two at $180.66). The fourth visit is worth $1,675.31 before the wage adjustment. In the late version, 3BB11, the threshold is two.

The principal diagnosis decides the clinical group. If the code you put first doesn't map to any of the twelve groups, Medicare's grouper, the software that assigns each period's group, can't assign a payment group and the claim goes back to you for correction. Nothing is paid until it's fixed, and the plan of care has to be corrected too.

When CMS built PDGM, in its 2019 rule, it named codes it considers too vague to explain why home health is needed, such as M62.81, generalized muscle weakness, and T14.90, injury, unspecified. It also said a clinician shouldn't report an "unspecified" code when the side or site can be identified. Which codes map to a group changes each year, so check the 2027 grouper.

You file a Notice of Admission (NOA) once, and Medicare has to receive and accept it within five calendar days after the start of care. File it late and Medicare doesn't pay for the days from the start of care until the NOA is filed, cutting the period payment by 1/30th for each of those days. No LUPA visits in that window are paid either, and you can't bill the patient for the lost days. CMS may waive the cut in exceptional circumstances, such as a Medicare systems problem.

Each day on the $2,347.37 period is about $78.25. An NOA accepted on day 10 costs about $704 or $782, depending on whether the filing day counts; neither the rule nor CMS's manual says.

The counts and timing in this plan are our suggestions; CMS sets the rates, weights and deadlines.

1. Pull last quarter's LUPA periods. For each, look up the group's 2027 threshold and count how many fell one visit short.
2. Check every admission for a stay in the prior 14 days. Ask intake to record it, and confirm non-Medicare stays went on the claim with occurrence code 61 or 62.
3. Audit secondary diagnoses on a sample of charts. Compare what the clinician documented with what reached the claim and with CMS's 2027 comorbidity lists.
4. Track NOA acceptance days. For each NOA accepted after day 5, write down which step held it up: referral paperwork, the start-of-care visit or the submission itself.

Enzo is a home health EHR. Enzo Scribe generates complete, OASIS-ready visit notes in real time, with gaps flagged against OASIS requirements before anything is submitted for review; clinicians review, edit and sign off. Enzo QA reviews every chart before submission, checking OASIS responses and Plan of Care alignment, and explains what needs attention and why. Your team makes the call.

Can Medicare change the payment group after we bill?

Yes. Any payment can be adjusted after medical review, including the case-mix group. When a reviewer asks for your records through an ADR, it records the OASIS answers it thinks the chart supports, and the grouper reprices the claim.

Does value-based purchasing change this payment?

Yes, through a separate adjustment: your 2027 quality results raise or lower your Medicare payments in 2029. You can work out yours with what HHVBP will do to your Medicare payment.