CY 2027 ESRD PPS NPRM 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 2025 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 2026 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 2026 base rate.  In this step, the adult FDL is projected from the from the updated FDL methodology established beginning in 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 2026.								
H	Total Payment for Step 3 Non-Outlier	This step accounts for the end of TDAPA payments for drugs whose TDAPA period ends in 2026.  This step does not include outlier payments.								
I	Total Payment for Step 4	This step updates the post-TDAPA payment adjustment for CY2027 by applying the recalculated post-TDAPA add-on amount for each quarter of 2027.								
J	Total Payment for Step 4 Non-Outlier	This step updates the post-TDAPA payment adjustment for CY2027 by applying the recalculated post-TDAPA add-on amount for each quarter of 2027.  This step does not include outlier payments.								
K	Total Payment for Step 5	"This step incorporates the proposed phosphate binders amount to be added to the base rate, and recalculates FDLs to enforce the 1% outlier policy. Phosphate binders are not post-TDAPA eligible, but are outlier-eligible for the full year."								
L	Total Payment for Step 5 Non-Outlier	This step incorporates the proposed phosphate binders amount to be added to the base rate.  This step does not include outlier payments.								
M	Total Payment for Step 6	This step updates the pediatric case-mix multipliers as proposed for CY 2027.								
N	Total Payment for Step 6 Non-Outlier	This step updates the pediatric case-mix multipliers as proposed for CY 2027. This step does not include outlier payments.								
O	Total Payment for Step 7	This step applies a budget neutrality factor to account for the proposed changes in pediatric case-mix multipliers.								
P	Total Payment for Step 7 Non-Outlier	This step applies a budget neutrality factor to account for the proposed changes in pediatric case-mix multipliers. This step does not include outlier payments.								
Q	Total Payment for Step 8	This step updates the two-tier LVPA adjusters to the proposed six-tier LVPA adjusters.								
R	Total Payment for Step 8 Non-Outlier	This step updates the two-tier LVPA adjusters to the proposed six-tier LVPA adjusters. This step does not include outlier payments.								
S	Total Payment for Step 9	This step applies a budget neutrality factor to account for the proposed update from the two-tier LVPA adjusters to six-tier LVPA adjusters.								
T	Total Payment for Step 9 Non-Outlier	This step applies a budget neutrality factor to account for the proposed update from the two-tier LVPA adjusters to six-tier LVPA adjusters.  This step does not include outlier payments.								
U	Total Payment for Step 10	This step extends the LVPA adjustment to dialysis treatments for pediatric patients as proposed for CY 2027.								
V	Total Payment for Step 10 Non-Outlier	This step extends the LVPA adjustment to dialysis treatments for pediatric patients as proposed for CY 2027. This step does not include outlier payments.								
W	Total Payment for Step 11	This step applies a budget neutrality factor to account for the proposed LVPA adjustment for pediatric treatments.								
X	Total Payment for Step 11 Non-Outlier	This step applies a budget neutrality factor to account for the proposed LVPA adjustment for pediatric treatments. This step does not include outlier payments.								
Y	Total Payment for Step 12	"This step increases the training add-on amount from its 2026 value ($95.60) to its proposed 2027 value ($138.22), and expanding it to cover training sessions during the onset period."								
Z	Total Payment for Step 12 Non-Outlier	"This step increases the training add-on amount from its 2026 value ($95.60) to its proposed 2027 value ($138.22), and expanding it to cover training sessions during the onset period. This step does not include outlier payments."								
AA	Total Payment for Step 13	This step applies a budget neutrality factor to account for proposed changes to the training add-on amount.								
AB	Total Payment for Step 13 Non-Outlier	This step applies a budget neutrality factor to account for proposed changes to the training add-on amount. This step does not include outlier payments.								
AC	Total Payment for Step 14	"This step updates labor share from its 2026 value (0.552) to its proposed 2027 value (0.635), and updates the 2026 wage index to the proposed 2027 wage index based on the latest available BLS wage data. In this step, the phase-out of the rural adjustment is no longer applied for ESRD facilities that switched from rural to urban status under the CBSA delineations adopted in CY 2025."								
AD	Total Payment for Step 14 Non-Outlier	"This step updates labor share from its 2026 value (0.552) to its proposed 2027 value (0.635), and updates the 2026 wage index to the proposed 2027 wage index based on the latest available BLS wage data. In this step, the phase-out of the rural adjustment is no longer 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."								
AE	Total Payment for Step 15	"This step applies a budget neutrality factor to account for the change in the wage index, labor share, and rural adjuster."								
AF	Total Payment for Step 15 Non-Outlier	"This step applies a budget neutrality factor to account for the change in the wage index, labor share, and rural adjuster. This step does not include outlier payments."								
AG	Total Payment for Step 16	This step updates the base rate by the proposed market basket update and productivity adjustment.  This step uses projected 2027 drug prices based on the ESRD drug price index to calculate the FDLs and outlier payments.								
AH	Total Payment for Step 16 Non-Outlier	This step updates the base rate by the proposed market basket update and productivity adjustment.  This step does not include outlier payments.								
AI	Rural	Identifies urban or rural status based on geographic location								
		Yes=Rural								
		No=Urban								
AJ	Hospital Based	Yes=Hospital-based								
		No=Freestanding								
AK	Low Volume (CY 2026 Tiers)	Identifies the facility's low-volume tier								
		1) < 3000 								
		2) 3000-3999 								
		3)  Non-LVPA 								
AL	Low Volume (CY 2027 Proposed Tiers)	Identifies the facility's low-volume tier								
		1) < 3000 								
		2) 3000-3999 								
		3) 4000-4999								
		4) 5000-5999								
		5) 6000-6999								
		6) 7000-7999								
		7) Non-LVPA								
AM	Census Region	Identifies location of facility by Census Region								
AN	State	Identifies the facility's state								
AO	Pediatric	Identifies percentage of pediatric patients								
		1=Less than 2%								
		2=From 2% to 49%								
		3=50% or more								
AP	Size	Identifies size of facility based on total number of hemo-equivalent treatments (including treatments for non-Medicare patients)								
		"1=Less than 3,000 treatments"								
		"2=3,000 to 3,999 treatments"								
		"3=4,000 to 4,999 treatments"								
		"4=5,000 to 5,999 treatments"								
		"5=6,000 to 6,999 treatments"								
		"6=7,000 to 7,999 treatments"								
		"7=8,000 treatments or more"								
AQ	Ownership	Identifies type of ownership by:								
		1=Large dialysis organization								
		2=Regional chain								
		3=Independent								
		4=Hospital-based								
		5=Unknown								
AR	For Profit	Identifies facilities profit status								
		1) Yes								
		2) No								
AS	CBSA	Core-Based Statistical Area								
AT	2026 Wage Index	Final Wage Index for 2026								
AU	"2027 Wage Index, Capped"	Proposed Wage Index for 2027								
AV	NAPA Multiplier	NAPA multiplier								
