Medicare Tweaks Dialysis Payments and Quality Rules for 2027
Published Date: 10/30/2026
Rule
Summary
Starting January 1, 2027, Medicare is updating how it pays for kidney dialysis treatments for people with End-Stage Renal Disease (ESRD) and those with Acute Kidney Injury (AKI). These changes include new payment rates and updated quality rules to make sure patients get the best care. If you’re a dialysis provider or patient, expect some shifts in payments and quality standards that aim to improve treatment and support innovation.
Analyzed Economic Effects
9 provisions identified: 6 benefits, 2 costs, 1 mixed.
Post-TDAPA add-on payments finalized (Q1 amounts)
CMS finalized Q1 CY 2027 post-TDAPA add-on payment amounts per treatment: Korsuva $0.0793, DefenCath $8.3220 (included each quarter of CY 2027), and Vafseo $0.9970 (included each quarter of CY 2027). CMS will update post-TDAPA amounts quarterly and estimates total payments associated with the post-TDAPA add-on payment adjustment will be approximately $290 million in CY 2027.
ESRD base rate raised to $297.52
Starting January 1, 2027 the ESRD Prospective Payment System (PPS) base rate is $297.52, up from $281.71 for CY 2026. CMS projects an overall 2.7 percent increase in Medicare payments to dialysis facilities (about $190 million) and estimates beneficiary coinsurance payments will also rise by 2.7 percent (about $50 million).
Phosphate binders added to bundled payment
Effective January 1, 2027 CMS is incorporating phosphate binders into the ESRD PPS bundled base rate and is adding $12.85 to the base rate to account for those drugs. The $12.85 addition is part of the final CY 2027 base rate calculation of $297.52.
Low-Volume Payment Adjustment expanded
Beginning in CY 2027 the Low-Volume Payment Adjustment (LVPA) is expanded to ESRD facilities that furnish up to 8,000 treatments per year, with payments based on six volume tiers. CMS finalized this change as budget neutral with a factor of 0.98901.
Outlier policy and payment thresholds updated
CMS updated the outlier fixed dollar loss (FDL) and Medicare allowable payment (MAP) amounts for CY 2027. Pediatric FDL rises from $162.43 to $229.49 and pediatric MAP from $50.19 to $63.27; adult FDL rises from $14.80 to $90.60 and adult MAP from $23.68 to $41.83. CMS projects these outlier changes will reduce ESRD PPS payments by about 1.6 percent (approximately $140 million).
ESRD QIP measure set changed for PY 2029
Beginning with Payment Year (PY) 2029 CMS will replace the Hypercalcemia reporting measure with a Facility-Level Percentage of Chronic Hyperphosphatemia clinical measure, update the NHSN bloodstream infection clinical measure, and remove the Medication Reconciliation and COVID-19 Vaccination Coverage Among Health Care Personnel reporting measures. CMS estimates the PY 2029 ESRD QIP will have an overall economic impact of about $133.2 million, including approximately $18.7 million in payment reductions across facilities.
Pediatric payment adjusters changed; TPEAPA ends
CMS finalized modifications to the ESRD PPS case-mix adjusters for pediatric patients and will allow facilities to receive the LVPA for pediatric ESRD patients. These permanent changes coincide with the end of the Transitional Pediatric ESRD Add-on Payment Adjustment (TPEAPA) as of December 31, 2026.
Higher home/self-dialysis training add-on
Starting CY 2027 the home and self-dialysis training add-on increases to $138.00 per training from $95.60, and training sessions during the onset period (the first 120 days of ESRD dialysis) are allowed. CMS reduced the onset adjustment factor from 1.327 to 1.311 to reduce duplicative payments.
AKI dialysis payment set to ESRD base rate
For CY 2027 the payment rate for renal dialysis services furnished to individuals with Acute Kidney Injury (AKI) is set at $297.52, the same as the CY 2027 ESRD PPS base rate. CMS projects a 5.4 percent increase in Medicare payments for AKI services and an aggregate increase of about $5 million in CY 2027 compared to CY 2026.
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