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.
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