Medicare sets 2027 dialysis base rate at $297.52 and folds in phosphate binders
CMS finalised the End-Stage Renal Disease payment system for 2027 on 30 October, lifting the per-treatment base rate from $281.71 and raising total dialysis payments by about $245 million.
| Group | Value ($) |
|---|---|
| CY 2026 base rate | 281.71 |
| CY 2027 base rate | 297.52 |
The Centers for Medicare & Medicaid Services has finalised how it will pay for dialysis in 2027. The final rule, published in the Federal Register on 30 October 2026 under docket number CMS-1846-F, updates the End-Stage Renal Disease Prospective Payment System, the payment rate for dialysis given to people with acute kidney injury, and the ESRD Quality Incentive Program [s1]. The regulations take effect on 1 January 2027 [s1].
The new base rate
The ESRD Prospective Payment System is a bundled, case-mix-adjusted payment that ESRD facilities receive for each dialysis treatment. For calendar year 2027, CMS set the base rate at $297.52, up from the CY 2026 base rate of $281.71 [s1]. The agency lays out the arithmetic explicitly: starting from $281.71, it adds $12.85 to incorporate phosphate binders, applies a wage-index budget-neutrality factor of 1.00260 and a budget-neutrality factor of 0.98864, and then applies the market basket update of 1.9 percent, which produces $297.52 [s1].
That 1.9 percent update is itself the product of two numbers. CMS finalised an ESRDB market basket percentage increase of 2.9 percent for 2027, based on the forecaster IGI's third-quarter 2026 projection, and reduced it by a productivity adjustment of 1.0 percentage point, as required by the Social Security Act [s1]. The market basket was also rebased to a 2024 base year to reflect more recent Medicare cost-report data [s1].
Phosphate binders enter the bundle
A notable part of the 2027 rate is the inclusion of phosphate binders, oral drugs that control phosphorus levels in people on dialysis. CMS added $12.85 to the base rate to pay for them within the bundle [s1]. The agency notes that the acute-kidney-injury dialysis payment rate had previously included no amount for phosphate binders, leaving facilities without a payment mechanism to furnish them to those patients; folding the drugs into the base rate changes that [s1].
Acute kidney injury and the dollar impact
Because the payment rate for dialysis furnished to individuals with acute kidney injury is tied to the ESRD base rate, it moves with it. CMS set the AKI dialysis payment rate for 2027 at $297.52, equal to the ESRD base rate, before each facility's wage-index adjustment [s1].
CMS estimates that the updates to the ESRD PPS and AKI dialysis payment rates together will produce a total increase of approximately $245 million in Medicare payments to ESRD facilities in 2027, an amount that includes the inclusion of phosphate binders [s1]. The agency puts the overall payment increase at about 2.7 percent [s1].
What it means for patients' share
Higher Medicare payments feed through to what beneficiaries pay. CMS estimates the rule will raise beneficiary coinsurance payments by 2.7 percent, which it describes as roughly $50 million in transfers from beneficiaries to ESRD facilities, or about 20 percent of the overall estimated payment increase it puts at $240 million [s1]. Medicare's dialysis benefit requires beneficiaries to pay coinsurance on covered services, so a rise in the payment rate is matched by a rise in that share.
The quality programme
The rule also updates the ESRD Quality Incentive Program, the pay-for-performance scheme that can reduce a facility's Medicare payments if it does not meet performance standards [s1]. The quality programme and the payment system are finalised together each year in this single rule, so facilities learn their payment rate and their quality requirements at the same time.
What is settled
What is fixed by this rule is concrete: a dated final rule now exists, the 2027 base rate is $297.52, the AKI rate matches it, phosphate binders are inside the bundle, and the changes take effect on 1 January 2027 [s1]. These are not proposals; a final rule carries the force of regulation once effective.
What the rule does not do is change the underlying structure of how dialysis is paid for. The bundled, case-mix-adjusted design dates to the system's implementation on 1 January 2011, and the 2027 rule operates within it, adjusting rates and adding a drug category rather than rebuilding the payment model [s1]. The figures are set prospectively, and CMS acknowledges in the rule that its market basket forecasts have historically been revised against actual inflation — a reminder that the numbers reflect the agency's best current estimate rather than realised cost [s1].
Sources
- 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 — Centers for Medicare & Medicaid Services / Federal Register , October 30, 2026
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