Medicare's 2027 Dialysis Rule Sets the Base Rate at $297.52 and Folds In Phosphate Binders
CMS's Oct. 28 final rule raises dialysis payments 2.7 percent, adds $12.85 for phosphate binders and extends low-volume payments to 1,489 facilities.
The Centers for Medicare and Medicaid Services (CMS) has finalized a 2027 dialysis base rate of $297.52 per treatment, up from $281.71, in an end-stage renal disease payment rule released Oct. 28. CMS projects that total payments to dialysis facilities will rise 2.7 percent.
The CMS fact sheet on the final rule (CMS-1846-F) says Medicare expects to pay about $7.0 billion to roughly 7,600 facilities in 2027. The rule itself is scheduled for Federal Register publication Oct. 30 and takes effect Jan. 1, 2027. CMS received 228 public comments, 171 of them unique.
Where does the increase come from?
Most of it is phosphate binders. The rule ends the transitional drug add-on payment for binders and adds $12.85 to the base rate to cover them, including operational costs. The market basket update is 1.9 percent. CMS estimates the rule adds about $240 million in Medicare payments, and that beneficiary coinsurance rises about $50 million.
By The Script Pad's comparison with the July proposal, the final base rate is $2.03 lower than the proposed $299.55. Most of that gap comes from the binder amount, which CMS proposed at $15.96 and finalized at $12.85. Commenters had already complained that only $1.88 of the proposed increase was unrelated to binders.
For nephrologists the binder change is not just a payment line. It moves who supplies the drug, including for patients with acute kidney injury.
What changes for patients with acute kidney injury?
Facilities will now supply their binders too. Because the dialysis payment for acute kidney injury equals the base rate, it now includes the binder amount. CMS writes that facilities "will be expected to furnish medically necessary phosphate binders to beneficiaries with AKI" beginning Jan. 1, 2027, after commenters asked who is responsible. CMS says it will issue subregulatory guidance to Medicare contractors, facilities, treating clinicians, Part D plans and Medicare Advantage plans before then.
Who gets the low-volume adjustment now?
Far more facilities. The low-volume payment adjustment, until now limited to facilities furnishing fewer than 4,000 treatments a year, extends to those furnishing up to 8,000, across six tiers. The final adjustment factors run from 1.368 for facilities below 3,000 treatments to 1.050 for those at 7,000 to 7,999. CMS expects 1,489 facilities to receive the adjustment across the six tiers, 412 of them in the two lowest, so by The Script Pad's arithmetic about 1,077 would qualify through the new 4,000-to-7,999 tiers. The expansion is budget neutral, which the fact sheet says lowers the base rate by about 1.1 percent, or about $3. Facilities may attest for 2027 through Dec. 31, 2026.
What else changes?
The home and self-dialysis training add-on rises from $95.60 to $138.00, and training sessions will be paid during the first 120 days of dialysis, with the onset adjustment trimmed from 1.327 to 1.311 to reduce the potential for duplicate payments. In the Quality Incentive Program, beginning with payment year 2029, a hyperphosphatemia clinical measure replaces the hypercalcemia reporting measure. CMS is also removing the medication reconciliation and health care personnel COVID-19 vaccination reporting measures.
What it means in clinic
Nephrologists who prescribe binders for patients with acute kidney injury in outpatient dialysis should expect the supply route to change in January and should watch for the CMS guidance. Medical directors at mid-sized units should confirm that their facility files its low-volume attestation by Dec. 31. With the hyperphosphatemia measure ahead, phosphorus control becomes something facilities will be scored on. The rule follows the HHS national kidney care plan this site covered Oct. 26, and trial evidence on dialysis modality in acute kidney injury that this site covered on Oct. 19.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
