The Centers for Medicare & Medicaid Services has proposed to update payment for renal dialysis services for Medicare beneficiaries by 1.1% in 2027. This figure represents a significant shift from the 2.2% increase that was finalized for the preceding year, 2026. The agency issued the proposal on Wednesday as part of the Medicare End-Stage Renal Disease (ESRD) Prospective Payment System for renal dialysis services. If the rule is finalized, the base rate for these services would be $299.55 per treatment, which marks an increase from the base rate of $281.71 in 2026 and $274.82 in 2025.
Adjustments to Base Rates and Binders
The increase includes a specific addition of $15.96 to account for the incorporation of phosphate binders. This specific amount is derived from the most recent average sales price data for each of the six types of phosphate binders, plus operational costs equal to 6% of that price. The inclusion of this $15.96 figure completes the bundling of these medications into the per-treatment payment, a process that began on Jan. 1, 2025. The proposed rule also includes the application of a proposed wage index budget neutrality adjustment and a market basket update of 1.6%. These elements combine with the budget neutrality factor to result in a total payment update of 1.1% for free-standing renal dialysis service facilities in 2027.
For hospital-based facilities, CMS projects a 2% increase in total payments. The agency expects to pay $6.2 billion to approximately 7,600 end-stage renal disease facilities for furnishing renal dialysis services. The proposed rule provides a bundled, per-treatment payment to end-stage renal disease facilities that includes all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biological products. Additionally, the bundled payment includes all other renal dialysis items and services that were formerly separately payable under previous payment methodologies.
Related: Trump Admin Invests $125M in Rural Funding
Modifications to Training and Patient Adjustments
The proposal would also make changes to the low-volume payment adjustment and alter payments for pediatric patients. Furthermore, CMS is proposing to increase the payment for home and self-dialysis training from $95.60 to $138.22. This increase represents a substantial adjustment to the add-on amount designed to support patients managing their care outside of a facility setting.
Additional technical modifications are proposed for the Transitional Drug Add-on Payment Adjustment (TDAPA) and a post-TDAPA add-on payment adjustment. These changes aim to refine how facilities are reimbursed for specific medications and services during critical transition periods for patients. Beginning with calendar year 2029, CMS is proposing several changes to reporting measures to improve data collection and oversight.
Beyond these financial adjustments, CMS is looking for input on potential reporting measures. The agency is seeking public comment through a request for information on the potential inclusion of the Dialysis Facility Discussion of Patient Life Goals Patient-Reported Outcome Performance measure. CMS noted it may propose this measure in future rulemaking. The measure would assess patient satisfaction with discussions about their life goals and the extent to which those goals are incorporated into treatment planning.