CY 2026 ESRD PPS Final Provider Level Impact File										
										
Column	Title	Description								
A	Provider ID	Six character OSCAR Provider Number (CMS Certification Number). 								
B	Number of Dialysis Treatments	Hemo-equivalent treatments								
C	Total Payment for Step 1	"This is the baseline result for comparison purposes, which uses 2024 data with all parameters - including the base rate, predicted outlier threshold, prices (including TDAPA prices), CBSA delineations, post-TDAPA add-on payments, and wage index - based on final FR 2025 values."								
D	Total Payment for Step 1 Non-Outlier	This is the baseline result without outlier payments.								
E	Total Payment for Step 2	"This step updates the baseline result by enforcing the 1% outlier policy. This step uses the CY 2025 base rate.  In this step, the adult FDL is projected from the from the updated FDL methodology for CY 2023."								
F	Total Payment for Step 2 Non-Outlier	This is the baseline result without outlier payments.  This is the same as Step 1 Non-Outlier.								
G	Total Payment for Step 3	This step accounts for the end of TDAPA payments for drugs whose TDAPA period ends in 2025.								
H	Total Payment for Step 3 Non-Outlier	This step accounts for the end of TDAPA payments for drugs whose TDAPA period ends in 2025.  This step does not include outlier payments.								
I	Total Payment for Step 4	This step updates the post-TDAPA payment adjustment for CY2026 by applying the recalculated post-TDAPA add-on amount for each quarter of 2026.								
J	Total Payment for Step 4 Non-Outlier	This step updates the post-TDAPA payment adjustment for CY2026 by applying the recalculated post-TDAPA add-on amount for each quarter of 2026.  This step does not include outlier payments.								
K	Total Payment for Step 5	"This step updates wage indices to CY 2026 wage indices based on the latest available BLS wage data. In this step, an updated phase-out of the rural adjustment is also applied for ESRD facilities that switched from rural to urban status under the CBSA delineations adopted in CY 2025."								
L	Total Payment for Step 5 Non-Outlier	"This step updates wage indices to CY 2026 wage indices based on the latest available BLS wage data. In this step, an updated phase-out of the rural adjustment is also applied for ESRD facilities that switched from rural to urban status under the CBSA delineations adopted in CY 2025.  This step does not include outlier payments."								
M	Total Payment for Step 6	This step applies a budget neutrality factor to account for the change in the wage index and rural adjuster.								
N	Total Payment for Step 6 Non-Outlier	This step applies a budget neutrality factor to account for the change in the wage index and rural adjuster. This step does not include outlier payments.								
O	Total Payment for Step 7	"This step applies the Non-contiguous Area Payment Adjustment (NAPA) multiplier for ESRD facilities located in AK, HI, GU, MP, and AS."								
P	Total Payment for Step 7 Non-Outlier	"This step applies the Non-contiguous Area Payment Adjustment (NAPA) multiplier for ESRD facilities located in AK, HI, GU, MP, and AS.  This step does not include outlier payments."								
Q	Total Payment for Step 8	This step applies a budget neutrality factor to account for the NAPA.								
R	Total Payment for Step 8 Non-Outlier	This step applies a budget neutrality factor to account for the NAPA. This step does not include outlier payments.								
S	Total Payment for Step 9	This step updates the base rate by the final market basket update and productivity adjustment.  This step also uses projected 2026 drug prices based on the ESRD drug price index to calculate the FDLs and outlier payments.								
T	Total Payment for Step 9 Non-Outlier	This step updates the base rate by the final market basket update and productivity adjustment.  This step does not include outlier payments.								
U	Rural	Identifies urban or rural status based on geographic location								
		Yes=Rural								
		No=Urban								
V	Hospital Based	Yes=Hospital-based								
		No=Freestanding								
W	"Low Volume (Less than 3,000 treatments)"	Identifies facilities that qualify for tier 1 of the low-volume adjustment								
		"Yes = Low Volume, Tier 1"								
		No = Not low volume tier 1								
X	"Low Volume (3,000 to 3,999 treatments)"	Identifies facilities that qualify for tier 2 of the low-volume adjustment								
		"Yes = Low Volume, Tier 2"								
		No = Not low volume tier 2								
Y	Census Region	Identifies location of facility by Census Region								
Z	State	Identifies the facility's state								
AA	Pediatric	Identifies percentage of pediatric patients								
		1=Less than 2%								
		2=From 2% to 19%								
		3=From 20% to 49%								
		4=50% or more								
AB	Size	Identifies size of facility based on total number of hemo-equivalent treatments (including treatments for non-Medicare patients)								
		"1=Less than 4,000 treatments"								
		"2=4,000 to 9,999 treatments"								
		"3=More than 10,000 treatments"								
		4=Unkown								
AC	Ownership	Identifies type of ownership by:								
		1=Large dialysis organization								
		2=Regional chain								
		3=Independent								
		4=Hospital-based								
		5=Unknown								
AD	For Profit	Identifies facilities profit status								
		1) Yes								
		2) No								
AE	NAPA Multiplier	NAPA multiplier								
AF	2025 Wage Index	Final Wage Index for 2025								
AG	"2026 Wage Index, Capped"	Final Wage Index for 2026								
