Dialysis Providers Get Pay Bump Under CMS Rule

Effective Jan. 1, 2027, the changes come as more Americans face chronic kidney disease, a condition that can progress to end-stage renal disease (ESRD) requiring dialysis or a kidney transplant. More than 26 million Americans have chronic kidney disease, and many are unaware they have it until significant damage has occurred, according to the National Kidney Foundation of Arizona.

Under the final rule, CMS will increase the End-Stage Renal Disease Prospective Payment System base rate from $281.71 to $297.52 per treatment, a $15.81 increase. The agency projects the changes will raise total Medicare payments to dialysis facilities by approximately 2.7% in 2027, bringing overall spending to roughly $7 billion across about 7,600 facilities nationwide.

A key component of the increase is the permanent incorporation of phosphate binders into the Medicare dialysis payment bundle. CMS added $12.85 to the base payment rate to reflect the ongoing cost of those medications, which help dialysis patients manage phosphorus levels and reduce complications associated with kidney disease. The rule also includes one of the most significant recent expansions of support for home dialysis.

Combating kidney disease starts with prevention, early detection, and timely treatment to help protect kidney health and slow disease progression. For Americans who depend on dialysis, high-quality care is vital to their health and daily lives

CMS increased the home and self-dialysis training payment adjustment from $95.60 to $138 per treatment and will now allow providers to receive the add-on payment during the first four months of dialysis, known as the onset period. Previously, facilities could not receive the training adjustment during that period. CMS said the change better reflects the actual cost of teaching patients and caregivers how to safely perform dialysis at home.

The agency is also expanding assistance for smaller dialysis providers. CMS raised the eligibility threshold for its low-volume payment adjustment from 4,000 to 8,000 annual treatments and expanded the program from two payment tiers to six. The change is intended to better recognize the higher operating costs often faced by smaller dialysis facilities, particularly those in rural and underserved areas. Additional payment changes include updated reimbursement policies for pediatric dialysis patients, modifications to drug payment adjustments and updated payment rates for dialysis services furnished to patients with acute kidney injury. CMS also finalized new policies allowing more frequent updates to certain drug payment adjustments to better reflect current pricing and utilization.

Beyond payment policy, CMS finalized several quality program changes beginning with payment year 2029. The agency will replace a hypercalcemia reporting measure with a new clinical measure focused on chronic hyperphosphatemia, a condition associated with cardiovascular complications and increased mortality among dialysis patients. CMS is also removing medication reconciliation and COVID-19 vaccination reporting measures, citing reporting burden and changing clinical priorities as explained in Telehealth.

Healthcare providers are expected to watch closely as the payment increases and expanded home dialysis incentives take effect, particularly as policymakers continue to encourage more care outside traditional dialysis centers.