The Centers for Medicare & Medicaid Services (CMS) issued a final rule on Oct. 28, 2026, updating payment rates for end-stage renal disease dialysis services effective Jan. 1, 2027. CMS expects the changes to increase total payments to approximately 7,600 ESRD facilities—both freestanding and hospital-based—by 2.7% compared to 2026.
The final ESRD Prospective Payment System base rate will increase to $297.52 per treatment, up from $281.71 in 2026. This includes a $12.85 increase to account for the incorporation of phosphate binders, which are medications that help manage kidney disease complications. Medicare expects to pay $7.0 billion total to ESRD facilities for dialysis services in 2027.
The rule also modifies several payment policies. The low-volume payment adjustment, which provides additional funding to smaller facilities, now applies to facilities treating fewer than 8,000 treatments per year, expanded from the previous 4,000-treatment threshold. CMS updated payment adjustments for pediatric patients and increased the payment amount for home and self-dialysis training from $95.60 to $138.00.
The rule updates the ESRD Quality Incentive Program, which assesses facility performance on quality measures. Beginning in 2029, CMS will replace the Hypercalcemia reporting measure with a new Hyperphosphatemia clinical measure and will remove two reporting measures from the program. CMS also updated baseline data for bloodstream infection measures and adjusted the scoring methodology for calculating facility performance scores.
For acute kidney injury dialysis services, CMS set the 2027 payment rate at $297.52, the same as the base ESRD rate, in accordance with federal law.