# 2025-20681: Medicare Tweaks Kidney Dialysis Payments: Bureaucracy Flows On 2025-20681, Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices Model, is a Federal Register rule from Health and Human Services Department, Centers for Medicare & Medicaid Services published 2025-11-24, effective 2026-01-01; deemed significant under Executive Order 12866 (as of 2026-06-11). - Canonical: https://policyrisk.com/federal-register/2025-20681 - As of: 2026-06-11 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Document number: 2025-20681 - Title: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices Model - Type: Rule - Agencies: Health and Human Services Department; Centers for Medicare & Medicaid Services - Citation: 90 FR 53068 - Published: 2025-11-24 - Effective: 2026-01-01 - Comments close: not stated - Significant: yes (OIRA_API) - Touches household money: no - Regulation identifier numbers: 0938-AV52 - Last updated: 2026-06-11 ## In one line Medicare Tweaks Kidney Dialysis Payments: Bureaucracy Flows On ## Summary Starting January 1, 2026, Medicare is updating how it pays for kidney dialysis services for people with end-stage kidney disease and those with acute kidney injury. The rule changes payment rates, improves quality programs, and ends some parts of the kidney treatment choices model. These updates aim to make care better and smarter while adjusting how money flows to dialysis providers. ## Abstract This final rule updates and revises the End-Stage Renal Disease (ESRD) Prospective Payment System for calendar year 2026. This rule also includes updates to the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. In addition, this rule updates the requirements for the ESRD Quality Incentive Program and terminates and modifies requirements for the ESRD Treatment Choices Model. ## Effects PRIA read - ESRD Dialysis Base Rate Raised to $281.71: cost, medium. Starting January 1, 2026, the Medicare ESRD per-treatment base rate is $281.71 (up from $273.82). CMS estimates aggregate Medicare payments to dialysis providers will increase by about $180 million in CY 2026 and estimates beneficiary coinsurance payments will rise by about 2.2 percent (about $40 m… - AKI Dialysis Paid at ESRD Base Rate: mixed, low. For calendar year 2026, Medicare payment for dialysis furnished to individuals with acute kidney injury (AKI) is set at $281.71 per treatment (the same as the ESRD PPS base rate). CMS estimates aggregate Medicare payments for AKI dialysis will increase by $1 million in CY 2026. - TDAPA Eligibility Window Tightened: cost, medium. Beginning for TDAPA applications submitted on or after January 1, 2028, a new renal dialysis drug or biological product must have been approved by the FDA within the past 3 years at the time of TDAPA application submission. - New Non-Contiguous Area Payment Adjustment (NAPA): benefit, low. CMS is finalizing a Non-Contiguous Areas Payment Adjustment (NAPA) for ESRD facilities in Alaska, Hawaii, and the U.S. Pacific Territories (Guam, American Samoa, and the Northern Mariana Islands). To keep the change budget neutral, CMS applied a corresponding budget neutrality factor of 0.99860 to… - Outlier Payment Amounts Reduced for CY2026: cost, medium. For CY 2026 CMS reduced outlier thresholds: pediatric fixed dollar loss (FDL) falls from $234.26 to $162.43 and pediatric MAP from $59.60 to $50.19; adult FDL falls from $45.41 to $14.80 and adult MAP from $31.02 to $23.68. CMS also reports outlier payments represented about 0.8 percent of total Me… - TDAPA Payments Continue; $500M in Drug Payments: cost, high. TDAPA payment periods for DefenCath, Vafseo, and certain oral phosphate binders continue into CY 2026. CMS estimates combined TDAPA payments for these drugs in CY 2026 will be about $500 million, of which roughly $100 million will be beneficiary coinsurance. CMS also finalizes post-TDAPA add-on amo… - ESRD QIP Measure Set and Survey Changes: mixed, medium. Beginning with Payment Year (PY) 2027, CMS removes three ESRD Quality Incentive Program reporting measures (Facility Commitment to Health Equity; Screening for Social Drivers of Health; Screen Positive Rate for Social Drivers of Health). Beginning with PY 2028, CMS shortens the ICH CAHPS survey by… - Termination of the ETC Model Dec. 31, 2025: mixed, low. CMS finalizes termination of the End-Stage Renal Disease Treatment Choices (ETC) Model effective December 31, 2025. CMS will apply the payment adjustments described in 42 CFR part 512, subpart C only to claims with service dates beginning January 1, 2021 through December 31, 2025. CMS estimates the… ## Related documents - [2026-22812](https://policyrisk.com/federal-register/2026-22812): Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care, 2026-11-10 - [2026-22750](https://policyrisk.com/federal-register/2026-22750): Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the E…, 2026-11-09 - [2026-22792](https://policyrisk.com/federal-register/2026-22792): Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program, 2026-11-09 - [2026-22743](https://policyrisk.com/federal-register/2026-22743): Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage…, 2026-11-09 - [2026-22739](https://policyrisk.com/federal-register/2026-22739): Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; i…, 2026-11-06 - [2026-22381](https://policyrisk.com/federal-register/2026-22381): Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Conditions for Coverage, 2026-11-03 ## Sources - [2025-20681 on federalregister.gov](https://www.federalregister.gov/documents/2025/11/24/2025-20681/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis) - [2025-20681 as published (PDF)](https://www.govinfo.gov/content/pkg/FR-2025-11-24/pdf/2025-20681.pdf) ## Related - [Previous: 2025-20612, Fisheries of the Exclusive Economic Zone Off Alaska; Big Skates in the Central…](https://policyrisk.com/federal-register/2025-20612) - [Next: 2025-20721, Excise Tax on Repurchase of Corporate Stock](https://policyrisk.com/federal-register/2025-20721) - [All Federal Register documents](https://policyrisk.com/federal-register) Source: PRIA, https://policyrisk.com/federal-register/2025-20681 (as of 2026-06-11).