New ESRD Payment Adjustments: Key Changes for Dialysis Facilities by 2026

What Changed The Centers for Medicare & Medicaid Services (CMS) has announced updates to the End Stage Renal Disease Prospective Payment System (ESRD PPS), effective July 6, 2026. This transmittal, identified as CMS-T-R13770CP, introduces modifications to the payment rates and methodologies for reimbursing dialysis services and related treatments for patients with end-stage renal disease (ESRD). While specific CPT, HCPCS, or ICD-10 codes affected are not detailed in the transmittal, the adjustments will influence how dialysis facilities are compensated under the ESRD PPS.

Why It Matters for Coding These changes directly impact claims submission and documentation for dialysis services, necessitating careful attention to code selection and reimbursement strategies. As the ESRD PPS payment rates and methodologies are adjusted, coders must be vigilant in selecting the appropriate CPT and HCPCS codes to ensure accurate billing. The lack of specific code details in the transmittal means coders should proactively monitor updates and guidance from CMS. Accurate documentation will be essential to support claims under the new payment system, minimizing the risk of denials or audits. This is particularly important for ICD-10 codes related to ESRD management, as precise coding will be critical in aligning with the updated ESRD PPS framework.