Other Adjustments to the AKI Dialysis Payment Rate

100.4 Other Adjustments to the AKI Dialysis Payment Rate (Rev. 13599, Issued: 01-30-26, Effective: 05-01-26, Implementation: 05-01-26) Beginning for 2025 ESRD facilities are allowed to bill for the ESRD PPS home and self- dialysis training add-on payment adjustments on claims for renal dialysis services provided to AKI beneficiaries. For these beneficiaries, the add-on payment adjustment is applied in the same way as under the ESRD PPS, a payment of $95.60 multiplied by the ESRD facility’s wage index value, as described in §60.C of this chapter. As this adjustment is required to be extended in a budget neutral basis under section 1834(r) of the Act, we finalized a reduction that rounds to $0.00 per treatment to the AKI dialysis payment rate in the CY 2025 ESRD PPS final rule based on a calculation of estimated training payments. For more information, please see Pub 100-04 Chapter 8 § 40. 100.5 Renal Dialysis Services Included in the AKI Dialysis Payment Rate (Rev. 13599, Issued: 01-30-26, Effective: 05-01-26, Implementation: 05-01-26) Drugs, biological products, laboratory services, and supplies that are considered to be renal dialysis services under the ESRD PPS as defined in 42 CFR § 413.171, are considered to be renal dialysis services for patients with AKI. As such, no separate payment would be made for renal dialysis drugs, biological products, laboratory services, and supplies that are included in the ESRD PPS base rate when they are furnished by an ESRD facility to an individual with AKI. Other items and services furnished to beneficiaries with AKI that are not considered to be renal dialysis services as defined in 42 CFR § 413.171, but that are related to their dialysis treatment as a result of their AKI and that an ESRD facility might furnish to a beneficiary with AKI, would be separately payable. In particular, an ESRD facility could seek separate payment for drugs, biological products, laboratory services, and supplies that ESRD facilities are certified to furnish and that would otherwise be furnished to a beneficiary with AKI in a hospital outpatient setting. Items and services included on the consolidated billing list are not separately payable for patients with AKI, except for items and services that are not considered included in the ESRD PPS base rate. All dialysis treatments, that is, hemodialysis and peritoneal dialysis, furnished to individuals with AKI in an ESRD facility will be paid the AKI dialysis payment rate. This includes any treatments that exceed the three times-weekly limitation applied to treatments furnished to ESRD beneficiaries. CMS expects that individuals with AKI will need renal dialysis services for a finite number of days since the intent of the dialysis for these patients is curative.