ESRD & Dialysis Payment (Medicare)

Current understanding

Medicare pays for outpatient dialysis for beneficiaries with End-Stage Renal Disease under the ESRD Prospective Payment System (PPS), a bundled per-treatment rate, and also pays for dialysis furnished to patients with acute kidney injury (AKI) at ESRD facilities. CMS updates the base rate, wage index, case-mix adjustments, outlier thresholds, and ESRD Quality Incentive Program (QIP) measures annually through rulemaking, which directly affects dialysis facility reimbursement and quality reporting obligations.

Evidence log

• 2026-10-30 — Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury (AKI) Dialysis Payment, and ESRD Quality Incentive Program: 2026 — CY 2027 ESRD PPS, AKI Dialysis Payment, and ESRD QIP Final Rule: CMS finalizes the annual update to dialysis bundled payment rates, AKI dialysis payment, and ESRD QIP scoring that can raise or reduce facility payments. (novelty: 2)
• 2025-11-20 — Kidney Care Access Protection Act: cross-connection with kidney-care-access-protection-act: Both address Medicare coverage and payment policy for kidney disease patients. (novelty: 2)
• 2025-02-24 — New Era of Preventing End-Stage Kidney Disease Act: cross-connection with rare-kidney-disease-prevention: HR1518 aims to reduce progression to dialysis, connecting upstream prevention capacity-building with downstream Medicare ESRD/dialysis payment policy. (novelty: 3)
• 2026-05-21 — Improving Home Dialysis Act of 2026: cross-connection with improving-home-dialysis-act: The bill would modify Medicare policy governing home dialysis, which is paid under the ESRD Prospective Payment System. (novelty: 3)
• 2026-04-16 — KIDNEY Remote Monitoring Act: cross-connection with kidney-remote-monitoring-act: Remote monitoring policy for kidney patients would intersect with Medicare’s ESRD/dialysis payment framework, which governs how kidney care services are reimbursed. (novelty: 3)

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