Medicare Tweaks Kidney Dialysis Payment Rates for 2027
Published Date: 6/26/2026
Proposed Rule
Summary
Starting in 2027, Medicare is updating how it pays for kidney dialysis treatments for people with serious kidney problems, including those with sudden kidney injuries. These changes affect dialysis centers and aim to improve care quality while adjusting payment rates. If you’re involved in kidney care or Medicare billing, watch for new rules and get ready to comment by August 24, 2026!
Analyzed Economic Effects
9 provisions identified: 3 benefits, 4 costs, 2 mixed.
ESRD Base Rate Raised to $299.55
Medicare proposes to set the ESRD Prospective Payment System (PPS) base rate for CY 2027 at $299.55, up from $281.71 in CY 2026. CMS estimates this set of CY 2027 payment changes would raise aggregate Medicare ESRD payments by about $70 million and increase beneficiary coinsurance by about 1.1% (roughly $20 million).
Outlier Payment Amounts Increased
CMS proposes higher outlier fixed dollar loss (FDL) and Medicare allowable payment (MAP) amounts for CY 2027. For pediatric beneficiaries the FDL would increase from $162.43 to $206.43 and the MAP from $50.19 to $60.86; for adult beneficiaries the FDL would increase from $14.80 to $114.98 and the MAP from $23.68 to $41.28.
Phosphate Binders Added to Base Rate (+$15.96)
CMS proposes to incorporate phosphate binders into the ESRD PPS base rate beginning in CY 2027, increasing the base rate by $15.96 to account for these drugs and related operational costs. That $15.96 increase is explicitly included in the proposed CY 2027 base rate calculation.
Low-Volume Payment Adjustment Expanded
CMS proposes to expand the low-volume payment adjustment (LVPA) to ESRD facilities that furnish up to 8,000 treatments per year and to make payments based on six volume tiers. CMS proposes this expansion to be budget neutral with a factor of 0.98898.
Higher Home Dialysis Training Payment
CMS proposes to increase the home and self-dialysis training add-on payment to $138.22 (from $95.60) and to allow training sessions during the onset period (the first 120 days of ESRD dialysis). CMS proposes this change to be budget neutral with a factor of 0.99884.
ESRD QIP Measure Set Changes for PY 2029
CMS proposes ESRD Quality Incentive Program (QIP) changes beginning with PY 2029: replace the Hypercalcemia reporting measure with a Hyperphosphatemia clinical measure, update the NHSN BSI clinical measure baseline and risk adjustment, remove the Medication Reconciliation and COVID-19 Vaccination Coverage Among HCP reporting measures, and request comment on adding the D-PaLS patient-reported outcome measure. CMS estimates PY 2029 QIP impacts of about $125.4 million (including $23.3 million in payment reductions and $102.1 million in information collection costs).
AKI Dialysis Payment Set Equal to ESRD Rate
CMS proposes the payment rate for dialysis services furnished to individuals with acute kidney injury (AKI) for CY 2027 to be $299.55, equal to the proposed ESRD PPS base rate. CMS projects a 6.0 percent increase in Medicare payments for AKI dialysis services in CY 2027 compared with CY 2026, an aggregate increase of about $5 million.
Quarterly Post-TDAPA Add-On Drug Amounts
CMS proposes modifications to post-TDAPA add-on payment adjustments and estimates specific per-treatment amounts for certain drugs in CY 2027: Korsuva estimated at $0.1068 per treatment (first quarter only), DefenCath at $5.5951 per treatment (each quarter), and Vafseo at $0.9437 per treatment (each quarter). CMS would include these amounts in ESRD PPS payments and adjust by patient-level factors.
ASP Fallback for TDAPA/Post-TDAPA
CMS proposes that when Average Sales Price (ASP) data are unusable because ASP is zero or negative, the TDAPA and post-TDAPA add-on payment adjustments would use the most recent prior quarter of usable ASP data, if available, as the payment basis.
Personalized for You
How does this regulation affect your finances?
Personalize government policy and PRIA will tell you what this federal register document means for your household, plus every other regulation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-15686, Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
This final rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027. This final rule also includes an analysis of Medicare non-hospice spending, including details regarding a hospice service and spending variation index, and finalizes the requirement that hospices provide the hospice election statement addendum to all Medicare beneficiaries at the time of hospice election. Additionally, this rule finalizes conforming changes to discharge from hospice care regulations and changes to the face-to-face encounter regulations. This final rule also includes a summary of comments received on our requests for information regarding community- based palliative care; the construction of a hospice specific wage index; and the overlap between hospice and medical aid in dying laws. Finally, this rule finalizes changes to the Hospice Quality Reporting Program.
2026-15652, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program
This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2027. As required by statute, this final rule includes the classification and weighting factors for the IRF prospective payment system's (PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2027. It also finalizes the third and final of the 3-year phaseout of the rural adjustment, which began in FY 2025. This final rule includes a solicitation for public comments on alternative data sources for the IRF PPS wage index; requires all therapy treatments and/or therapy evaluations to begin no later than 36 hours from midnight on the day of admission; finalizes requirements for the initial Interdisciplinary Team meeting to occur on or before 4 days from the date the patient is admitted; and summarizes a request for information on potential future IRF PPS payment reform. Additionally, this final rule includes updates to the IRF Quality Reporting Program and changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
2026-15562, Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027
Starting October 1, 2026, skilled nursing facilities (SNFs) will see updated payment rates and new rules for how Medicare pays them. The Quality Reporting and Value-Based Purchasing programs are also getting tweaks to help improve care. These changes affect SNFs nationwide and could impact how much money they get and how they report quality data.
2026-14897, Medicaid Program; Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes
Starting October 1, 2026, new rules will change how states handle health care-related taxes under Medicaid. These changes set clear limits on tax amounts based on 2025 levels and will gradually lower those limits in some states by 2027. States and taxpayers should get ready for tighter rules and better oversight that could affect tax collections and Medicaid funding.
2026-14709, Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This correction fixes some typos and technical mistakes in the 2027 health insurance rules under the Affordable Care Act. It mainly affects people and organizations involved in health coverage plans by clarifying when the rules take effect and restoring some important regulation details. These fixes take effect on July 20, 2026, ensuring smoother and clearer health plan operations next year.
2026-14327, Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
Starting in 2027, Medicare and Medicaid are updating how doctors and clinics get paid to better match today’s medical care and laws. This includes new rules for drug price rebates, shared savings programs, and payments for rural and specialty care. These changes affect doctors, patients, and drug makers, aiming to save money and improve care quality.
Previous / Next Documents
Previous: 2026-12924, Nondiscrimination in Federally-Assisted Programs of the Department of Veterans Affairs
The VA is updating its rules to focus only on intentional discrimination in programs it supports, dropping rules about accidental unfair effects. This change affects anyone using VA programs and aims to clear up confusion, cut costs, and follow new government orders. You’ve got until July 27, 2026, to share your thoughts before the new rules take shape!
Next: 2026-12935, Air Quality Plan; California; Mojave Desert Air Quality Management District; Rescissions of Outdated Requirements Within Riverside County
The EPA is proposing to remove some old air pollution rules in Riverside County’s Mojave Desert area because they’re no longer needed to keep the air clean. This change affects local businesses and residents by simplifying regulations without extra costs or delays. You have until July 27, 2026, to share your thoughts before the EPA makes it official.