Per-Visit Rate
A per-visit rate is a payment amount tied to each individual home health visit, usually set separately by discipline such as skilled nursing, physical therapy, or aide services. Medicare uses national per-visit rates to pay LUPA periods, and per-visit payment is the most common structure in Medicare Advantage and Medicaid managed care contracts. Under per-visit payment, revenue scales directly with the number of visits delivered.
Where per-visit rates appear
Per-visit rates show up in four places in home health finance. First, Medicare pays 30-day periods that fall below the LUPA (Low Utilization Payment Adjustment) threshold at national per-visit rates by discipline, wage adjusted for the patient's location. Second, outlier payment calculations use wage-adjusted per-visit amounts to estimate the cost of unusually visit-heavy periods. Third, most Medicare Advantage, Medicaid managed care, and commercial contracts pay negotiated per-visit rates. Fourth, private-pay and some institutional contracts price by the visit. Because the same visit can be worth very different amounts depending on the payer, agencies need visit-level revenue visibility rather than blended averages.
Per-visit vs. episodic economics
Episodic payment, like Medicare's PDGM, pays a fixed amount for a period regardless of visit count, so the agency profits by delivering the right care efficiently. Per-visit payment inverts the incentive: every additional authorized visit adds revenue, but every visit also adds cost. The margin math is simple and unforgiving. Margin per visit equals the contracted rate minus the fully loaded cost of delivering that visit. If a plan pays a skilled nursing rate below your true cost, every visit under that contract loses money, and volume makes it worse. This is why the same census growth can strengthen one agency and weaken another.
Know your fully loaded cost per visit
A per-visit rate can only be evaluated against a fully loaded cost per visit, which includes more than the clinician's visit pay:
- Drive time and mileage reimbursement
- Documentation time, whether paid directly or embedded in visit rates
- Supervision, case conferencing, and quality review time
- Benefits, payroll taxes, and paid time off
- An allocation of branch and back-office overhead
Calculate it by discipline, since a therapy visit and an aide visit have very different cost structures. Agencies that skip this analysis routinely sign contracts that pay less than delivery costs.
Common pitfalls
The most common per-visit mistakes are accepting rates below fully loaded cost to win volume, treating all disciplines as interchangeable when negotiating a single blended rate, and letting old contracts ride while wages rise. Operationally, agencies lose money when visit length and travel patterns drift without anyone re-checking the cost side, or when unauthorized visits are delivered under managed care contracts and written off. A quarterly review that puts each payer's rates next to current cost per visit by discipline catches most of these problems while they are still small.
Frequently asked questions
How do Medicare per-visit rates work for LUPA periods?
Each HIPPS group has a LUPA threshold between 2 and 6 visits per 30-day period. If visits fall below the threshold, Medicare pays each visit at the national per-visit rate for its discipline, wage adjusted, instead of paying the full period amount. Thresholds and rates are recalibrated annually.
Are per-visit rates negotiable with Medicare Advantage plans?
Yes. MA rates are contract terms, not regulated amounts. Agencies with strong outcomes data, broad coverage capacity, and a clear cost-per-visit floor negotiate meaningfully better rates and escalators than agencies that accept the first rate sheet offered.
What should a per-visit rate cover to be profitable?
The rate must exceed the fully loaded cost of the visit: clinician compensation, drive time and mileage, documentation time, supervision, benefits, and an overhead allocation. A rate that only covers the clinician's visit pay loses money on every visit.