CMS sets 2027 ESRD and AKI dialysis rate at $297.52, moves low-volume attestation deadline to Dec. 31

On October 28, 2026, CMS issued the CY 2027 ESRD PPS final rule, CMS-1846-F. It updates payment for outpatient maintenance dialysis furnished by ESRD facilities, the separate payment rate for dialysis furnished to beneficiaries with acute kidney injury (AKI), and the ESRD Quality Incentive Program (QIP). The Federal Register public inspection copy, document 2026-22194, says the rule is scheduled for publication on October 30, 2026, and takes effect January 1, 2027.

For billing teams, the big items are a new base rate, a new obligation for AKI patients, a wider low-volume adjustment with a later attestation date, and a bigger training add-on.

The CY 2027 ESRD PPS base rate is $297.52

The ESRD PPS pays a bundled, case-mix adjusted amount per treatment. For CY 2027, the base rate is $297.52, an increase of $15.81 from the CY 2026 base rate of $281.71. The rule shows the math as (($281.71 + $12.85) × 1.00260 × 0.98864) × 1.019 = $297.52.

CMS projects that total payments to ESRD facilities will rise 2.7 percent, about $240 million, with the same 2.7 percent estimate for hospital-based and freestanding facilities. CMS estimates beneficiary coinsurance will also rise 2.7 percent, about $50 million of that total.

What changes for AKI dialysis claims

The AKI dialysis payment rate for CY 2027 is $297.52, the same as the ESRD PPS base rate, and CMS uses the CY 2027 ESRD PPS wage index to adjust it. The higher home and self-dialysis training add-on also applies to training payments for AKI dialysis.

The bigger change is phosphate binders. While these drugs were paid through the transitional drug add-on payment adjustment (TDAPA), the AKI rate didn't include any amount for them, so facilities weren't yet responsible for furnishing them to beneficiaries with AKI. Now that the $12.85 is built into the base rate, the rule says ESRD facilities must furnish medically necessary phosphate binders to beneficiaries with AKI under their direct care. The rule adds that Medicare Advantage organizations must cover oral-only ESRD drugs, including phosphate binders, for beneficiaries with AKI who get outpatient renal dialysis services.

CMS says facilities report phosphate binders on Medicare ESRD facility claims (the 837 institutional claim, bill type 072X) using their HCPCS codes. The rule's rate-setting tables list eight of them: J0601, J0602, J0603, J0605, J0607, J0608, J0609 and J0615.

Low-volume payment adjustment: six tiers and a December 31 deadline

To qualify for the LVPA, a facility generally must have furnished fewer than 8,000 total treatments in each of the 3 cost reporting years before the payment year. The old ceiling was 4,000. The exception for disasters and other emergencies at 42 CFR 413.232(g)(5) still applies: a facility that crosses the threshold only because of temporary patient-shifting after a disaster or emergency can ask CMS for an exception, and it still has to meet the other LVPA requirements. CMS now pays the adjustment in six tiers, and the CMS fact sheet says the tier is based on a facility's median treatments over those three years.

Treatments here mean total hemodialysis-equivalent treatments, Medicare and non-Medicare, and a facility has to attest to its MAC that it meets the requirements. The usual deadline is November 1, but for payment year 2027 the rule moves it to December 31, 2026. The LVPA changes and the later deadline also apply to treatments for pediatric ESRD patients. CMS says the change is budget neutral and lowers the base rate by about 1.1 percent.

Training add-on, pediatric patients and outlier amounts

The home and self-dialysis training add-on rises from $95.60 to $138.00. CMS will also pay it during the onset period, the first 120 days of ESRD dialysis, when it wasn't paid before. To avoid paying twice for the same costs, the onset adjustment factor drops from 1.327 to 1.311.

The Transitional Pediatric ESRD Add-on Payment Adjustment ends December 31, 2026. In its place, CMS is updating the case-mix adjusters for patients under 18 and letting low-volume facilities get the LVPA for pediatric treatments.

CMS also reset the outlier amounts, mostly because of projected use of new drugs that will count as outlier services in CY 2027:

Drug add-on payments now update every quarter

When a drug's reported average sales price (ASP) is zero or negative, CMS will base the TDAPA and the post-TDAPA add-on on the most recent usable quarter of ASP data. If a manufacturer doesn't report ASP at all, the fact sheet says those payments stop under CMS's existing policy.

The post-TDAPA add-on will now be updated quarterly through change requests. The rule sets only the first-quarter 2027 amounts: $8.3220 per treatment for DefenCath, $0.9970 for Vafseo, and $0.0793 for Korsuva, which counts in the first quarter of 2027 only. CMS says it'll publish the other quarters' amounts in later change requests, as long as it keeps receiving ASP data.

ESRD QIP changes start with payment year 2029

Starting with payment year 2029, the Hyperphosphatemia clinical measure replaces the Hypercalcemia reporting measure. CMS is also removing the Medication Reconciliation and COVID-19 Vaccination Coverage Among Healthcare Personnel reporting measures, which leaves no reporting measures, so the Reporting Measure Domain goes away and the other domain weights are updated. The NHSN Bloodstream Infection measure moves to 2023 national baseline data and an updated risk adjustment.

The final rule doesn't change ICD-10-CM codes. CMS posts ESRD PPS rule documents and payment files on its ESRD PPS page.