Implementation of Lesser of Logic for MA Home Health Claims
March 26, 2026
This notice is to inform Medicare Advantage (MA) Home Health providers that Lesser of Logic will be applied to Home Health claims reimbursed under both the PPS Methodology and Per Diem beginning April 1, 2026.
Although configuration is effective April 1, 2026, the logic will be applied to claims with dates of service (DOS) on or after January 1, 2024, as allowed by contract terms.
Provider action required
Providers should carefully review their billed charges to ensure accuracy and alignment with contractual expectations.
Providers may contact their contract representative with any questions.