This webpage provides educational resources for the End Stage Renal Disease (ESRD) provider community.
Analysis of the ESRD PPS Payment Model
CMS contracted with a data contractor to conduct research and analysis to refine the case-mix adjustment model. Below, we will post information about this project as it progresses.Data Collection
A Technical Expert Panel (TEP) was held on December 6, 2018 to discuss options for improving data collection for refining the ESRD PPS case-mix adjustment model. This TEP represented the first step in acquiring stakeholder and expert input to inform these refinements. The slides used during this TEP, as well as a report that summarizes the discussion and recommendations of the Technical Expert Panel, may be found below:
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2021 (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report April 2022 for December 2021 TEP (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2020 (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report April 2021 for December 2020 TEP (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2019 (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report May 2020 for December 2019 TEP (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Presentation December 2018 (PDF)
- End Stage Renal Disease Prospective Payment System Technical Expert Panel Summary Report June 2019 for December 2018 TEP (PDF)
CY 2022 ESRD PPS RFI Summary of Comments
CY 2023 ESRD PPS RFI Summary of Comments
- CY 2023 ESRD PPS Equity RFI Summary of Comments (PDF)
- CY 2023 ESRD PPS Payment After TDAPA RFI Summary of Comments (PDF)
CMS Decision Memos
CMS Manual References
- Medicare Claims Processing Manual, Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims (PDF)
- Medicare Claims Processing Manual, Chapter 16 - Laboratory Services (PDF), Section 40.6 and Exhibit 1.
- Medicare Benefit Policy Manual, Chapter 11 - End Stage Renal Disease (ESRD) (PDF)
- Medicare Secondary Payer (MSP) Manual, Chapter 2 - MSP Provisions (PDF), Section 20
Medicare Coverage Database
- Medicare Coverage Database - search National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions
- Medicare Coverage of Kidney Dialysis and Kidney Transplant Services
Medicare Learning Network® (MLN) Resources
- MLN Matters® Articles – search database for national CMS articles related to ESRD
- MLN National Provider Calls & Events – search list for educational presentations related to ESRD
Legislative Citations
- Section 153(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
- Section 3401(h) of the Patient Protection and Affordable Care Act (the Affordable Care Act or ACA)
- Section 632 of the American Taxpayer Relief Act of 2012 (ATRA)
- Section 217 of Protecting Access to Medicare Act of 2014 (PAMA)
- Section 204 of Stephen Beck, Jr., Achieving a Better Life Experience Act of 2014 (ABLE)
- Section 808 of the Trade Preferences Extension Act of 2015
Reports
- Analysis to Support the 2016 Refinements to the ESRD PPS (PDF) 6/2016
- Analysis to Inform the Design and Implementation of the End-Stage Renal Disease Prospective Payment System (PDF) 12/2015
- End Stage Renal Disease Payment System: Results of Research on Case-mix Adjustment for an Expanded Bundle (PDF) 2/2008
- A Design for a Bundled End Stage Renal Disease Prospective Payment System (PDF) 2008 Report to Congress
Other ESRD Related Websites
- Dialysis Facility Compare
- End Stage Renal Disease and Clinical Laboratories Open Door Forums
- End Stage Renal Disease (ESRD) Center
- Erythropoietin Stimulating Agents Policies
- ESRD Network Organizations
- ESRD PC Pricer
- ESRD Quality Incentive Program
- Medicare Part B Drug Average Sales Price
- National Kidney Disease Education Program (NKDEP)
- Preventive Services
- Survey & Certification - Certification & Compliance - Transplant
- Survey & Certification - Guidance to Laws & Regulations - Dialysis
- Telehealth