Medicare raises dialysis payments 2.7% for 2027, and patient coinsurance rises with it
A final rule sets next year's per-treatment rate for kidney dialysis, finishes folding phosphate binder drugs into the payment and expands extra pay for low-volume clinics.
The Centers for Medicare & Medicaid Services (CMS) has finalized 2027 payment rates that it estimates will raise Medicare payments to dialysis facilities by 2.7%. The base payment for each dialysis treatment rises to $297.52 from $281.71, according to the final rule1 and a CMS fact sheet2 issued Oct. 28. The new rates apply to services furnished on or after Jan. 1, 2027.
The rule covers the end-stage renal disease (ESRD) prospective payment system, under which Medicare expects to pay about $7.0 billion to roughly 7,600 facilities in 2027, according to the fact sheet. CMS estimates the update will raise total payments by about $240 million in 2027. Of that, Medicare itself pays about $190 million more. Patients cover the rest: because beneficiaries generally owe 20% coinsurance, CMS estimates their coinsurance payments will rise 2.7%, or about $50 million.
The final increase is larger than the one CMS proposed in June 2026. The proposed rule estimated a 1.1% overall increase, which commenters told the agency was too low compared with inflation, according to the final rule. The final market basket update, which measures price changes for the goods and services facilities buy, is 1.9%, up from 1.6% in the proposal. That update accounts for about $170 million of the increase. Changes to outlier thresholds for unusually costly patients reduce payments by about 1.6%, or $140 million, the rule says.
Part of the jump in the base rate reflects a change in how Medicare pays for phosphate binders, oral drugs used to manage phosphorus levels in people on dialysis. Since Jan. 1, 2025, those drugs have been paid under the dialysis bundle rather than through Part D drug plans, with a temporary add-on payment. With the add-on ending, CMS is adding $12.85 to the base rate to cover the drugs, including an amount for operating costs.
CMS cautioned in the rule that the base rate is not a stand-in for total payment, because changes to adjustments can lower the base rate while total spending stays the same. The low-volume adjustment is an example. The extra payment for small facilities will now reach clinics that furnish up to 8,000 treatments a year, up from a 4,000-treatment limit, and will be paid in six tiers instead of two. Because the change is budget neutral, it lowers the base rate by about 1.1%, or about $3, according to the fact sheet.
Other changes affect home dialysis and patients with acute kidney injury (AKI). The add-on payment for home and self-dialysis training sessions rises to $138.00 from $95.60, the amount set in 2017, and training during the first 120 days of dialysis will now qualify. The rate for AKI dialysis also rises to $297.52, and starting in 2027 facilities must provide phosphate binders to those patients when medically necessary. Those patients also owe 20% coinsurance, the rule notes.
The rule updates the ESRD Quality Incentive Program as well. CMS estimates the program will lead to about $18.7 million in payment reductions across facilities in payment year 2029.
What comes next: the rule was published in the Federal Register on Oct. 30 and takes effect Jan. 1, 2027. Facilities can attest that they qualify for the low-volume adjustment for 2027 through Dec. 31, 2026, according to the fact sheet.
