Medicare dialysis payments rise sharply under new CMS rules
The Centers for Medicare & Medicaid Services (CMS) has finalized a 2.7% increase in dialysis payments for 2027, lifting the Medicare base rate to $297.52 per treatment—up from $281.71 this year. The rule, published Wednesday, continues the same 2.7% adjustment seen in 2025 and surpasses the 1.1% proposal CMS had suggested in June. Under the new rates, the agency projects spending about $7 billion across 7,600 end-stage renal disease (ESRD) facilities next year, covering both hospital-based and independent providers. Phosphate binder costs are now fully incorporated into bundled payments, adding $12.85 per treatment.
CMS has also expanded its low-volume payment adjustment to facilities delivering fewer than 8,000 treatments annually, up from the prior limit of 4,000. Six new reimbursement tiers will further differentiate payments based on facility size and service volume. Training costs for home and self-dialysis programs have risen significantly, with the add-on payment increasing from $95.60 to $138; now covering the first four months of treatment. While this adjustment better reflects patient and caregiver education expenses, the final per-treatment rate of $297.52 remains slightly below the initially proposed $299.55.
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The rule also phases out outdated reporting requirements, replacing a hypercalcemia metric with a clinical measure for hyperphosphatemia beginning in 2029 and removing two other reporting obligations. Pediatric dialysis payments will be recalibrated, and drug reimbursement policies will align with current market costs. These changes reflect CMS’s broader strategy to align payments with provider costs, particularly for smaller facilities. In 2025, the agency introduced a new wage index for dialysis reimbursements, shifting from hospital-based data to labor statistics and facility-specific cost reports. This index, still in development, will eventually replace older hospital-derived adjustments to better account for regional wage variations.
The 2.7% increase follows years of discussion over ESRD reimbursement rates. While it addresses inflation and operational challenges, some providers had sought higher adjustments. Smaller facilities may see greater benefit from the expanded low-volume payment thresholds, though long-term effects on access and affordability remain unclear. CMS has not yet detailed plans beyond 2027, but the trend indicates ongoing efforts to improve cost transparency and support underfunded providers. The shift toward clinical measures over administrative reporting could simplify future rulemaking, though timelines for pediatric and drug policy updates have not been specified.
